These tools will no longer be maintained as of December 31, 2024. Archived website can be found here. PubMed4Hh GitHub repository can be found here. Contact NLM Customer Service if you have questions.


Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

  • Title: Intramedullary Impaction of the Basicervical Component Is Determinant of Fixation Failure in a Simple Two-Part Pertrochanteric Fracture.
    Author: Hong SH, Yu KH, Han SB.
    Journal: J Orthop Trauma; 2024 Apr 01; 38(4):220-226. PubMed ID: 38241062.
    Abstract:
    OBJECTIVES: To evaluate initial fracture morphology influences on outcomes in simple 2-part pertrochanteric fracture, with a focus on the basicervical component and its initial impaction. DESIGN: A retrospective cohort series. SETTING: Single Level I Trauma Center. PATIENTS SELECTION CRITERIA: Patients older than 60 years with intertrochanteric fractures between 2011 and 2022 were retrospectively reviewed. Inclusion criteria comprised simple 2-part pertrochanteric fractures (Orthopaedic Trauma Association [OTA]/Arbetisgemeinschaftfur Osteosynthesefragen [AO] 31-A1.2) with a basicervical component who underwent cephalomedullary nailing and had a minimum follow-up of 6 months. Patients were divided whether the basicervical component was impacted into the medullary canal (intramedullary impaction [II] group) or displaced beyond the medullary canal (extramedullary [E] group). Exclusion criteria encompassed pathologic fractures, nondisplaced fractures, and basicervical neck fractures (OTA/AO 31-B3). OUTCOME MEASUREMENTS AND COMPARISONS: Reduction status was assessed as unacceptable if the head and neck (proximal) fragment was positioned intramedullary with respect to the distal fragment in either the anterior posterior or cross-lateral x-ray and acceptable otherwise. In addition, the degree of impaction on x-ray and CT scans (coronal, sagittal, axial) at injury was analyzed as a risk factor for failure. Revision rates and lag screw sliding over 15 mm were compared between the II and E groups. RESULTS: Hundred fifteen patients (95 female, average age 80 years) were included. The II group (n = 58) compared with E group (n = 57) showed more acceptable postoperative reductions (57% vs. 81%, P = 0.001), but significantly higher fixation failure (16% vs. 3.5%, P = 0.048) and fracture collapse (28% vs. 7%, P = 0.01). II was identified as a significant independent predictor for failure (odds ratio 5.64, 95% confidence interval, 2.14-16.9, P < 0.001) with more than 19.5-mm impaction in sagittal CT scan as the threshold linked to increased failure risk. CONCLUSIONS: This study highlights the significance of specific intertrochanteric fracture patterns, particularly II of a basicervical component and impaction severity (≥19.5 mm), as drivers of fixation failure. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
    [Abstract] [Full Text] [Related] [New Search]