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Anteromedial cortical support reduction in unstable pertrochanteric fractures: a comparison of intra-operative fluoroscopy and post-operative three dimensional computerised tomography reconstruction.
- Source :
-
International Orthopaedics . Jan2018, Vol. 42 Issue 1, p183-189. 7p. - Publication Year :
- 2018
-
Abstract
- <bold>Purpose: </bold>Anteromedial cortical support reduction is favourable for secondary stability after limited sliding in unstable pertrochanteric fractures. The aim of this study was to compare the accuracy and agreement between intra-operative fluoroscopy and post-operative 3D reconstruction.<bold>Materials and Methods: </bold>A retrospective analysis of 28 patients (mean 81.6 years) treated with short cephalomedullary nails was performed. All patients had full sets of intra-operative fluoroscopy and post-operative 3D CT images. Observation was focused on the position of the anteromedial cortices of the inferior corner between the head-neck fragment and femoral shaft, and their relationship was categorised into three types: positive, neutral and negative. The percentage of subsequent changes in cortical reduction quality between fluoroscopy and 3D CT was calculated and compared.<bold>Results: </bold>There were 24 positive (85.7%), four neutral and no negative positions in the anteroposterior (AP) view and one positive, 20 neutral (71.4%) and seven negative positions in the lateral view from fluoroscopy. On post-operative 3D CT images with a full range of rotation, definitive anteromedial cortical contact (positive and neutral support) was observed in 18 cases (64.3%). Ten cases lost the anteromedial cortical buttress. With the posteromedial region of the lesser trochanter detached, a positive AP cortical position combined with a positive/neutral lateral position on fluoroscopy (17 cases) was highly predictive of reliable, definitive cortical support (15 cases, 88.2%) on 3D CT. A negative lateral position on fluoroscopy (seven cases), regardless of the combination in the AP view, was likely to predict the final loss of cortical support (six cases, 85.7%) on 3D CT; a positive/neutral lateral position (21 cases) was only associated with loss of support in four cases (19.1%) (p < 0.05).<bold>Conclusions: </bold>A lateral negative position of the anterior cortex on fluoroscopy for unstable pertrochanteric fractures may be highly predictive of post-operative final loss of the anteromedial cortical buttress, which should be avoided during operation. [ABSTRACT FROM AUTHOR]
- Subjects :
- *BONE fractures
*FLUOROSCOPY
*POSTOPERATIVE care
*BONE surgery
*COMPUTED tomography
Subjects
Details
- Language :
- English
- ISSN :
- 03412695
- Volume :
- 42
- Issue :
- 1
- Database :
- Academic Search Index
- Journal :
- International Orthopaedics
- Publication Type :
- Academic Journal
- Accession number :
- 127064619
- Full Text :
- https://doi.org/10.1007/s00264-017-3623-y