ABSTRACT
BACKGROUND: The importance of the lateral wall of the femoral trochanter in the intertrochanteric fracture has been paid more and more attention. The research on the classification of the external wall in guiding clinical operation has become a hot issue. OBJECTIVE: To review the treatment strategies of different lateral wall types of intertrochanteric fractures, and the selection of the built-in materials, provide reference and help for future clinical research. METHODS: The first author searched the Chinese database ofWanfang and China National Knowledge Infrastructure with the keywords of “intertrochanteric fracture of femur; lateral wall of femoral trochanter; fracture classification; fracture fixation, internal; implant; intramedullary fixation; extramedullary fixation; complications; elderly; prognosis”. Meanwhile, PubMed English database was retrieved with the keywords “intertrochanteric fracture of femur; lateral wall of femoral trochanter; fracture classification; fracture fixation, internal; implant; intramedullary fixation; extramedullary fixation; complications; elderly; prognosis”. The retrieval time was from May 2009 to May 2019. A total of 166 literatures were retrieved. According to the inclusion and exclusion criteria, 47 literatures were selected as the research object and summarized. RESULTS AND CONCLUSION: (1) During the surgical treatment of intertrochanteric fracture of the femur, intramedullary fixation system and extramedullary fixation system have their own advantages and disadvantages. After full analysis of lateral femoral trochanter wall classification and reasonable preoperative evaluation, it is a combination of theory and practice. Signing, correctly assessing the severity of fractures and judging the prognosis, and fully preoperative evaluation can greatly help the patient’s treatment effect and prognosis. (2) It is a basic quality of doctors and a responsible attitude towards patients to formulate different treatment plans according to their economic conditions and physical qualities. “Individualization” has become the future development trend. (3) There are still many disputes in the treatment of intertrochanteric fractures. More clinical research and data support are needed in the future to solve and improve it.
ABSTRACT
BACKGROUND: The concept of the lateral wall as a hot area has emerged in recent years, and has great guiding significance for the treatment of intertrochanteric fractures. OBJECTIVE: To review the definition, scope, thickness of the lateral wall and its important role in the surgical treatment of intertrochanteric fractures. METHODS: The authors searched Wanfang, CNKI, PubMed, and Web of Science. The search terms were “intertrochanteric fracture, lateral wall, fracture fixation” in Chinese and English. The retrieved documents were sorted, analyzed and summarized. RESULTS AND CONCLUSION: (1) The definition, scope, thickness and measurement method of the lateral wall and its clinical significance were sorted out. (2) Classification criteria based on lateral intertrochanteric fractures of the femur were summarized. (3) In terms of treatment, four kinds of treatment methods: Extramedullary fixation, intramedullary fixation, artificial joint replacement and other treatment methods were listed. Causes and treatment of fracture of lateral wall during and after operation were analyzed. (4) The results showed that the integrity of the lateral wall directly affected the stability of the internal fixation, even the success of the internal fixation. The complete lateral wall can prevent the distal femur from moving inward and the head pin from withdrawing, and prevent the coxa varus deformity. Clinicians should make use of detailed imaging examination, analyze fracture types, comprehensively consider various factors, and select appropriate repair methods.
ABSTRACT
<p><b>OBJECTIVE</b>This study aimed to evaluate the clinical effect of extramedullary fixation combined with intramedullary fixation during the surgical reduction of sagittal mandibular condylar fractures.</p><p><b>METHODS</b>Twenty-four sagittal fractures of the mandibular condyle in18 patients were fixed by two appliances: intramedullary with one long-screw osteosynthesis or Kirschner wire and extramedullary with one micro-plate. The radiologically-recorded post-operative stability-associated com-plications included the screw/micro-plate loosening, micro-plate twisting, micro-plate fractures, and fragment rotation. The occluding relations, the maximalinter-incisal distances upon mouth opening, and the mandibular deflection upon mouth opening were evaluated based on follow-up clinical examination.</p><p><b>RESULTS</b>Postoperative panoramic X-ray and CT scans showed good repositioning of the fragment, with no redislocation or rotation, no screw/plate loosening, and no plate-twisting or fracture. Clinical examination showed that all patients regained normal mandibular movements, ideal occlusion, and normal maximal inter-incisal distances upon mouth opening.</p><p><b>CONCLUSIONS</b>Extramedullary fixation combined with intramedullary fixation is highly recommended for sagittal condylar fractures because of the anti-rotation effect of the fragment and the reasonable place-ment of the fixation appliances.</p>
Subject(s)
Humans , Bone Plates , Bone Screws , Fracture Fixation , Mandible , Mandibular Condyle , Mandibular Fractures , Radiography, Panoramic , RotationABSTRACT
Dynamic hip screw (DHS) fixation is considered standard treatment for most intertrochanteric fractures. However, excessive sliding at the fracture site and medialisation of femoral shaft may lead in fixation failure. In contrast, fixedangled 95 condylar blade plate (CBP) has no effective dynamic capacity and causes little bone loss compared to DHS. We compared the outcome of 57consecutive unstable intertrochanteric fragility fractures treated with these two fixation methods. CBP instrumentation is more difficult requiring longer incision, operating time and higher surgeonreported operative difficulty. The six month post operative mortality rate is 16%. Post operative Harris hip scores were comparable between the two methods. Limb length shortening more than 20 mm was 6 fold more common with DHS. In elderly patients with unstable intertrochanteric fragility fractures, fixed angled condylar blade plate appears to be a better choice than dynamic hip screws for preventing fixation failures.