Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr;48(2):1437-1444.
doi: 10.1007/s00068-021-01718-9. Epub 2021 May 31.

Postoperative computed tomography assessment of anteromedial cortex reduction is a predictor for reoperation after intramedullary nail fixation for pertrochanteric fractures

Norio Yamamoto  1 , Takahiro Imaizumi  2 , Tomoyuki Noda  2 , Tomoo Inoue  2 , Keisuke Kawasaki  2 , Toshifumi Ozaki  2
Affiliations

Postoperative computed tomography assessment of anteromedial cortex reduction is a predictor for reoperation after intramedullary nail fixation for pertrochanteric fractures

Norio Yamamoto et al. Eur J Trauma Emerg Surg. 2022 Apr.

Abstract

Purpose: Postoperative radiographs are routinely used to assess fracture reduction following intramedullary nail fixation for pertrochanteric fractures, even though computed tomography (CT) is a superior modality. We aimed to determine the association between reduction quality assessed by CT and rates of reoperation and to evaluate the association of reoperation and reduction quality according to the assessment modality (plain radiographs vs. CT).

Methods: A retrospective analysis of 299 consecutive patients treated with intramedullary nail fixation for pertrochanteric fractures was conducted. Fracture reduction measured by postoperative radiographs and CT was categorized as anatomical type, extramedullary type, or intramedullary type. Postoperative data for analysis included reduction status, tip-apex distance (TAD), screw position in the femoral head, sliding distance, and conditions associated with reoperation.

Results: Of the 299 patients included with a mean age of 83.1 ± 8.2 years, there were six patients who required reoperation (2.0%). According to the CT assessments, there were 42 intramedullary reductions (14.0%). Patients with a non-intramedullary reduction based on postoperative CT images were significantly more likely to have proper placement of the screw, a reduced TAD, a reduced sliding distance, and a lower reoperation rate than those with an intramedullary reduction (P < 0.05). The reduction quality assessed by postoperative CT was significantly associated with reoperation (95% CI, 1.45-29.31).

Conclusions: Intramedullary reduction assessed by CT was associated with reoperation. The reduction quality based on CT findings was more predictive for reoperation than that from plain radiographs.

Keywords: Intramedullary nail; Pertrochanteric fracture; Postoperative computed tomography; Reduction; Reoperation; Trochanteric fracture.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

References

    1. Tsukada S, Okumura G, Matsueda M. Postoperative stability on lateral radiographs in the surgical treatment of pertrochanteric hip fractures. Arch Orthop Trauma Surg. 2012. https://doi.org/10.1007/s00402-012-1484-9 . - DOI - PubMed
    1. Kozono N, Ikemura S, Yamashita A, Harada T, Watanabe T, Shirasawa K. Direct reduction may need to be considered to avoid postoperative subtype P in patients with an unstable trochanteric fracture: a retrospective study using a multivariate analysis. Arch Orthop Trauma Surg. 2014. https://doi.org/10.1007/s00402-014-2089-2 . - DOI - PubMed
    1. Bojan AJ, Beimel C, Taglang G, Collin D, Ekholm C, Jönsson A. Critical factors in cut-out complication after Gamma nail treatment of proximal femoral fractures. BMC Musculoskelet Disord. 2013. https://doi.org/10.1186/1471-2474-14-1 . - DOI - PubMed - PMC
    1. Ito J, Takakubo Y, Sasaki K, Sasaki J, Owashi K, Takagi M. Prevention of excessive postoperative sliding of the short femoral nail in femoral trochanteric fractures. Arch Orthop Trauma Surg. 2015. https://doi.org/10.1007/s00402-015-2200-3 . - DOI - PubMed
    1. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995. https://doi.org/10.2106/00004623-199507000-00012 . - DOI - PubMed

LinkOut - more resources