Palm, J Bone Joint Surg Am 2007 - Integrity of the Lateral Femoral Wall in Intertrochanteric Hip Fractures: An Important Predictor of a Reoperation

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Integrity of the Lateral Femoral Wall in Intertrochanteric Hip Fractures: An Important Predictor of a Reoperation

Palm, Hip Fracture Study Group, et al.·J Bone Joint Surg Am·2007·279 citations·Retrospective cohort

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Background

Reoperations after intertrochanteric fractures are often necessitated by fracture displacement following mobilization of the patient. The biomechanical complexity of the fracture, the position of the implant, and the patient's characteristics are known to influence postoperative outcome. We investigated the importance of an intact lateral femoral wall as a factor in postoperative fracture displacement after fixation with a sliding compression hip screw.

Methods

214 consecutive patients with an intertrochanteric fracture were treated with a 135 degrees sliding compression hip screw with a 4-hole side-plate between 2002 and 2004.
The fractures were classified on preoperative radiographs according to the AO/OTA classification system.
The status of the greater and lesser trochanters, the integrity of the lateral femoral wall, and the position of the implant were assessed postoperatively.
Reoperations due to technical failure were recorded for 6 months postoperatively.

Results

Only 3% (5) of 168 patients with an intact lateral femoral wall postoperatively underwent a reoperation within 6 months, whereas 22% (10) of 46 patients with a fractured lateral femoral wall were operated on again (p < 0.001).
Multivariate logistic regression analyses combining demographic and biomechanical parameters showed a compromised lateral femoral wall to be a significant predictor of a reoperation (p = 0.010).
74 percent (34) of the 46 fractures of the lateral femoral wall occurred during the operative procedure itself.
A fracture of the lateral femoral wall occurred in only 3% (3) of the 103 patients with an AO/OTA type-31-A1.1, A1.2, A1.3, or A2.1 intertrochanteric fracture compared with 31% (31) of the 99 with an AO/OTA type 31-A2.2 or A2.3 fracture (p < 0.001).

Conclusions

A postoperative fracture of the lateral femoral wall was found to be the main predictor for a reoperation after an intertrochanteric fracture. Consequently, we concluded that patients with preoperative or intraoperative fracture of the lateral femoral wall are not treated adequately with a sliding compression hip-screw device, and intertrochanteric fractures should therefore be classified according to the integrity of the lateral femoral wall, especially in randomized trials comparing fracture implants.

Copyright remains with the authors and publisher.

Integrity of the Lateral Femoral Wall in Intertrochanteric Hip Fractures: An Important Predictor of a Reoperation.

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Integrity of the Lateral Femoral Wall in Intertrochanteric Hip Fractures: An Important Predictor of a Reoperation

Palm, Hip Fracture Study Group, et al.·J Bone Joint Surg Am·2007·279 citations·Retrospective cohort

|

Background

Reoperations after intertrochanteric fractures are often necessitated by fracture displacement following mobilization of the patient. The biomechanical complexity of the fracture, the position of the implant, and the patient's characteristics are known to influence postoperative outcome. We investigated the importance of an intact lateral femoral wall as a factor in postoperative fracture displacement after fixation with a sliding compression hip screw.

Methods

214 consecutive patients with an intertrochanteric fracture were treated with a 135 degrees sliding compression hip screw with a 4-hole side-plate between 2002 and 2004.
The fractures were classified on preoperative radiographs according to the AO/OTA classification system.
The status of the greater and lesser trochanters, the integrity of the lateral femoral wall, and the position of the implant were assessed postoperatively.
Reoperations due to technical failure were recorded for 6 months postoperatively.

Results

Only 3% (5) of 168 patients with an intact lateral femoral wall postoperatively underwent a reoperation within 6 months, whereas 22% (10) of 46 patients with a fractured lateral femoral wall were operated on again (p < 0.001).
Multivariate logistic regression analyses combining demographic and biomechanical parameters showed a compromised lateral femoral wall to be a significant predictor of a reoperation (p = 0.010).
74 percent (34) of the 46 fractures of the lateral femoral wall occurred during the operative procedure itself.
A fracture of the lateral femoral wall occurred in only 3% (3) of the 103 patients with an AO/OTA type-31-A1.1, A1.2, A1.3, or A2.1 intertrochanteric fracture compared with 31% (31) of the 99 with an AO/OTA type 31-A2.2 or A2.3 fracture (p < 0.001).

Conclusions

A postoperative fracture of the lateral femoral wall was found to be the main predictor for a reoperation after an intertrochanteric fracture. Consequently, we concluded that patients with preoperative or intraoperative fracture of the lateral femoral wall are not treated adequately with a sliding compression hip-screw device, and intertrochanteric fractures should therefore be classified according to the integrity of the lateral femoral wall, especially in randomized trials comparing fracture implants.

Copyright remains with the authors and publisher.

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