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Objective:To evaluate collared and bipolar hemiarthroplasty combined with medial femoral calcar reconstruction in the treatment of senile patients with osteoporotic unstable intertrochanteric fracture.Methods:The data of 28 senile patients with unstable femoral intertrochanteric fracture were retrospectively analyzed who had been admitted to Department of Orthopedics, The First Affiliated Hospital to Zhejiang University of Chinese Medicine from March 2014 to February 2020. They were 8 males and 20 females, aged from 75 to 99 years (average, 81.5 years). All the fractures were low violence injuries due to falls. By the Evans-Jensen classification, there were 2 cases of type Ⅲ, 5 cases of type Ⅳ and 21 cases of type Ⅴ. All patients were osteoporotic, with a BMD T-score ranging from -4.5 to -2.0. Surgery was performed 2 to 6 days after injury (3.8 days on average). Corail collared femoral stems and bipolar ball heads produced by DePuy company were selected for implantation during surgery. Their fractures were reduced and fixated by titanium wire bundling system or bifilar winding wire bundles. The femoral calcar reconstruction was accomplished by inserting the beak-shaped distal part of the head-neck fracture fragment into the femoral medullary cavity together with the medial side of the stem just under the collar and impacting it to a tight position.Results:The average operation time for this group of patients was 62 min (from 50 to 85 min) and the average intraoperative blood loss 170 mL (from 110 to 320 mL). All the 28 patients were followed up for 10 to 71 months (average, 46 months). Their Harris hip scores averaged 92 points (from 89 to 96 points) at 6 months after operation. Two patients developed intermuscular venous thrombosis in the calf after operation. During follow-up, none of the patients had such complications as deep iliac femoral vein thrombosis, pulmonary embolism, incision infection, or deep prosthesis infection. At the last follow-up, their Harris hip scores averaged 88 points (from 82 to 96 points).Conclusion:For some senile patients with osteoporotic unstable intertrochanteric fracture, collared and bipolar hemiarthroplasty combined with medial femoral calcar reconstruction can achieve fine therapeutic efficacy.
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Objective To investigate the distribution characteristics of the fracture lines on the posteromedial wall by mapping the femoral intertrochanteric fractures involving the posteromedial wall on 3D CT.Methods A retrospective study was conducted of the 136 patients with femoral intertrochanteric fracture who had been treated at Department of Orthopaedics,Affiliated Hospital to Chengdu University from January 2009 to October 2018.They were 57 men and 79 women with an average age of 64 years (from 48 to 81 years).By the AO classification,101 cases were type 31-A2 and 35 type 31-A3.Their CT data were collected for 3D reconstruction.By comparing the specific markers on the femoral shaft and lesser trochanter,the 3D CT reconstruction images were superimposed and orientated to the standard models of intertrochanteric posteromedial wall to create a map of the fracture.The width,height,area,and fracture deviation angle of the fracture of posteromedial wall were measured to characterize the distribution of the fracture lines.Results In the 136 femoral intertrochanteric fractures involving the posteromedial wall,the height of the posteromedial wall fracture was 48.76 ± 4.11 mm,the width 29.78 ± 3.29 mm,the area 1,468.47 ± 75.26 mm2,and the fracture deviation angle 49.93° ± 13.05°.The fracture area ratio (fracture area/posteromedial wall area) was 38.34％ ± 16.58％.On the map of the posteromedial wall fracture,the fracture lines were densely distributed in the lesser trochanter and in front of it.In the fractures of type 31-A2,the lines of the posteromedial wall fracture were mostly distributed in the lesser trochanter and below it,going obliquely from anterosuperior to posteroinferior to affect the lower calcar femorale.In the fractures of type 31-A3,the lines of the posteromedial wall fracture were mostly distributed in the lesser trochanter and above it,going obliquely from anteroinferior to posterosuperior to affect the upper calcar femorale.Conclusion The fracture map can help visual understanding of the inteetrochanteric fracture involving the posteromedial wall,and provide further characterization ofthe posteromedial wall fracture in the fractures of AO types 31-A2 and 31-A3.
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Objective@#To investigate the distribution characteristics of the fracture lines on the posteromedial wall by mapping the femoral intertrochanteric fractures involving the posteromedial wall on 3D CT.@*Methods@#A retrospective study was conducted of the 136 patients with femoral intertrochanteric fracture who had been treated at Department of Orthopaedics, Affiliated Hospital to Chengdu University from January 2009 to October 2018. They were 57 men and 79 women with an average age of 64 years (from 48 to 81 years). By the AO classification, 101 cases were type 31-A2 and 35 type 31-A3. Their CT data were collected for 3D reconstruction. By comparing the specific markers on the femoral shaft and lesser trochanter, the 3D CT reconstruction images were superimposed and orientated to the standard models of intertrochanteric posteromedial wall to create a map of the fracture. The width, height, area, and fracture deviation angle of the fracture of posteromedial wall were measured to characterize the distribution of the fracture lines.@*Results@#In the 136 femoral intertrochanteric fractures involving the posteromedial wall, the height of the posteromedial wall fracture was 48.76±4.11 mm, the width 29.78±3.29 mm, the area 1,468.47±75.26 mm2, and the fracture deviation angle 49.93°±13.05°. The fracture area ratio (fracture area/posteromedial wall area) was 38.34%±16.58%. On the map of the posteromedial wall fracture, the fracture lines were densely distributed in the lesser trochanter and in front of it. In the fractures of type 31-A2, the lines of the posteromedial wall fracture were mostly distributed in the lesser trochanter and below it, going obliquely from anterosuperior to posteroinferior to affect the lower calcar femorale. In the fractures of type 31-A3, the lines of the posteromedial wall fracture were mostly distributed in the lesser trochanter and above it, going obliquely from anteroinferior to posterosuperior to affect the upper calcar femorale.@*Conclusion@#The fracture map can help visual understanding of the intertrochanteric fracture involving the posteromedial wall, and provide further characterization of the posteromedial wall fracture in the fractures of AO types 31-A2 and 31-A3.