Image study of anteromedial cortical morphology of intertrochanteric fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Xin ¹ , ZHANG Yingqi ¹ ,  ZHANG Shimin ² , DU Shouchao ² , CHEN Kai ¹ , WANG Zhiyuan ¹

1. Department of Orthopedics, Tongji Hospital of Tongji University, Shanghai, 200065, P.R.China;
2. Department of Orthopedics, Yangpu Hospital, Tongji University, Shanghai, 200090, P.R.China;

Corresponding author：

ZHANG Shimin, Email: shiminchang11@aliyun.com

Keywords：

Intertrochanteric fracture; anteromedial corner cortex; morphology of fracture; cortex buttress reduction; internal fixation

DOI：

10.7507/1002-1892.201905100

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To study the anteromedial cortical morphology of intertrochanteric fracture with CT three-dimensional reconstruction technique, and to provide a reference for further study of cortical buttress reduction theory. Methods CT data of 75 patients with unstable intertrochanteric fracture with complete imaging data treated between January 2016 and January 2019 were retrospectively analyzed, including 32 males and 43 females, aged 65-98 years (mean, 79.8 years). According to AO/Orthopaedic Trauma Association typing of 2018 edition, there were 46 cases of 31-A2.2 type and 29 cases of 31-A2.3 type. The image processing techniques such as segmentation modeling and virtual reset were performed. The thickness of the cortex at the anteromedial corner, the angle between the anterior wall fracture line and the coronal horizontal line, the angle between the medial wall fracture line and the sagittal horizontal line, the width of the cortex supported by the medial wall were measured, and the morphology of the cortical bone at the anteromedial corner were observed. Results The angle between the anterior wall fracture line and the coronal horizontal line was 51.8-72.6°, with an average of 62.4°; the angle between the medial wall fracture line and the sagittal horizontal line ranged from 17.6° to –47.3°, with an average of −15.8°; the thickness of the cortex at the anteromedial angle was 3.6-6.1 mm, with an average of 4.4 mm; and the width of the cortex supported by the medial wall was 14.3-21.2 mm, with an average of 16.8 mm. The morphology of the cortical bone at the anteromedial corner had 3 forms: angle with femoral neck axis >90°, 57 cases (76.0%); perpendicular to femoral neck axis, 7 cases (9.3%); angle with femoral neck axis <90° (including reverse angle), 11 cases (14.7%). Conclusion CT three-dimensional reconstruction can clearly show the cortical morphology and the direction of the fracture line of intertrochanteric fracture, which can indicate the stability of the intertrochanteric fracture after reduction, and has a good guiding on the form of cortical buttress reduction.

Citation： WANG Xin, ZHANG Yingqi, ZHANG Shimin, DU Shouchao, CHEN Kai, WANG Zhiyuan. Image study of anteromedial cortical morphology of intertrochanteric fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(10): 1260-1264. doi: 10.7507/1002-1892.201905100 Copy

1.	张世民, 张英琪, 李清, 等. 内侧皮质正性支撑复位对老年股骨粗隆间骨折内固定效果的影响. 中国矫形外科杂志, 2014, 22(14): 1256-1261.
2.	Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg, 2015, 135(6): 811-818.
3.	Murena L, Moretti A, Meo F, et al. Predictors of cut-out after cephalomedullary nail fixation of pertrochanteric fractures: a retrospective study of 813 patients. Arch Orthop Trauma Surg, 2018, 138(3): 351-359.
4.	Li J, Zhang L, Zhang H, et al. Effect of reduction quality on post-operative outcomes in 31-A2 intertrochanteric fractures following intramedullary fixation: a retrospective study based on computerised tomography findings. Int Orthop, 2019, 43(8): 1951-1959.
5.	Nie B, Chen X, Li J, et al. The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study. J Orthop Surg Res, 2017, 12(1): 197.
6.	Park YC, Yoon SP, Yang KH. The effects of extramedullary reduction in unstable intertrochanteric fracture: a biomechanical study using cadaver bone. J Kor Fract Soc, 2018, 31(3): 79-86.
7.	Chang SM, Zhang YQ, Du SC, et al. Anteromedial cortical support reduction in unstable pertrochanteric fractures: a comparison of intra-operative fluoroscopy and post-operative three dimensional computerised tomography reconstruction. Int Orthop, 2018, 42(1): 183-189.
8.	张世民, 余斌. AO/OTA-2018版股骨转子间骨折分类的解读与讨论. 中华创伤骨科杂志, 2018, 20(7): 583-587.
9.	Fogagnolo F, Kfuri M Jr, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg, 2004, 124(1): 31-37.
10.	Baumgaertner MR, Curtin SL, Lindskog DM, et al. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg (Am), 1995, 77(7): 1058-1064.
11.	Tsukada S, Wakui M, Yoshizawa H, et al. Three-dimensional computed tomographic analysis for comminution of pertrochanteric femoral fracture: comminuted anterior cortex as a predictor of cutting out. Open Orthop J, 2016, 10: 62-70.
12.	Sharma G, Gn KK, Khatri K, et al. Morphology of the posteromedial fragment in pertrochanteric fractures: A three-dimensional computed tomography analysis. Injury, 2017, 48(2): 419-431.
13.	李双, 张世民, 张立智, 等. 不同组合前内侧皮质支撑复位对股骨转子间骨折髓内钉术后稳定性影响的生物力学研究. 中华创伤骨科杂志, 2019, 21(1): 57-64.
14.	李建涛, 张里程, 唐佩福. 股骨粗隆间骨折治疗理念与内固定器械的发展概述. 中国修复重建外科杂志, 2019, 33(1): 1-7.
15.	杜守超, 张世民, 张英琪, 等. 不稳定股骨转子间骨折前内侧皮质支撑复位的影像学研究. 中国矫形外科杂志, 2018, 26(18): 1633-1638.

1. 张世民, 张英琪, 李清, 等. 内侧皮质正性支撑复位对老年股骨粗隆间骨折内固定效果的影响. 中国矫形外科杂志, 2014, 22(14): 1256-1261.
2. Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg, 2015, 135(6): 811-818.
3. Murena L, Moretti A, Meo F, et al. Predictors of cut-out after cephalomedullary nail fixation of pertrochanteric fractures: a retrospective study of 813 patients. Arch Orthop Trauma Surg, 2018, 138(3): 351-359.
4. Li J, Zhang L, Zhang H, et al. Effect of reduction quality on post-operative outcomes in 31-A2 intertrochanteric fractures following intramedullary fixation: a retrospective study based on computerised tomography findings. Int Orthop, 2019, 43(8): 1951-1959.
5. Nie B, Chen X, Li J, et al. The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study. J Orthop Surg Res, 2017, 12(1): 197.
6. Park YC, Yoon SP, Yang KH. The effects of extramedullary reduction in unstable intertrochanteric fracture: a biomechanical study using cadaver bone. J Kor Fract Soc, 2018, 31(3): 79-86.
7. Chang SM, Zhang YQ, Du SC, et al. Anteromedial cortical support reduction in unstable pertrochanteric fractures: a comparison of intra-operative fluoroscopy and post-operative three dimensional computerised tomography reconstruction. Int Orthop, 2018, 42(1): 183-189.
8. 张世民, 余斌. AO/OTA-2018版股骨转子间骨折分类的解读与讨论. 中华创伤骨科杂志, 2018, 20(7): 583-587.
9. Fogagnolo F, Kfuri M Jr, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg, 2004, 124(1): 31-37.
10. Baumgaertner MR, Curtin SL, Lindskog DM, et al. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg (Am), 1995, 77(7): 1058-1064.
11. Tsukada S, Wakui M, Yoshizawa H, et al. Three-dimensional computed tomographic analysis for comminution of pertrochanteric femoral fracture: comminuted anterior cortex as a predictor of cutting out. Open Orthop J, 2016, 10: 62-70.
12. Sharma G, Gn KK, Khatri K, et al. Morphology of the posteromedial fragment in pertrochanteric fractures: A three-dimensional computed tomography analysis. Injury, 2017, 48(2): 419-431.
13. 李双, 张世民, 张立智, 等. 不同组合前内侧皮质支撑复位对股骨转子间骨折髓内钉术后稳定性影响的生物力学研究. 中华创伤骨科杂志, 2019, 21(1): 57-64.
14. 李建涛, 张里程, 唐佩福. 股骨粗隆间骨折治疗理念与内固定器械的发展概述. 中国修复重建外科杂志, 2019, 33(1): 1-7.
15. 杜守超, 张世民, 张英琪, 等. 不稳定股骨转子间骨折前内侧皮质支撑复位的影像学研究. 中国矫形外科杂志, 2018, 26(18): 1633-1638.

Chinese Journal of Reparative and Reconstructive Surgery

Image study of anteromedial cortical morphology of intertrochanteric fractures

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content