Subscribe to RSS
Pantrochanteric Fracture: Incidence of the Complication in Patients with Trochanteric Fracture Treated with Dynamic Hip Screw in a Hospital of Southern Brazil[*]Article in several languages: português | English
04 September 2017
19 October 2017
01 March 2019 (online)
The aim of the present study was to investigate the incidence of pantrochanteric fractures in cases of trochanteric fractures treated with dynamic hip screw in our service.
A sample of 54 patients with trochanteric fractures treated with dynamic hip screws was included in this retrospective study. Preoperative radiographs were evaluated for fracture classification using the Arbeitsgemeinschaft für Osteosynthesefragen (Association for the Study of Internal Fixation, in German)/Orthopedic Trauma Association (AO/OTA) system for the identification of radiographic osteoporosis and for the measurement of the lateral femoral wall thickness. In the immediate postoperative images, the presence of pantrochanteric fracture was evaluated.
The final sample presented an incidence of 16.7% of pantrochanteric fractures. The thickness of the lateral wall was significantly lower in the group with the complication (p < 0.001). Although fractures classified as 31-A2 were more numerous in the group with pantrochanteric fracture, the difference was not statistically significant (p = 0.456).
The percentage of pantrochanteric fractures in this service is in accordance with previous studies. There was an association between lateral femoral wall thickness and the occurrence of iatrogenic fracture of the lateral cortex. There was no significant difference between fracture classification and pantrochanteric fracture, possibly due to sample size.
Keywordsproximal femur fracture - trochanteric fracture - DHS - pantrochanteric fracture - lateral wall thickness
* Work developed at Hospital Universitário de Canoas, RS, Brazil.
- 1 Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA 2009; 302 (14) 1573-9
- 2 Yechiel G. The pantrochanteric hip fracture: an iatrogenic entity. J Orthop Trauma 2012; 26 (04) 197-9
- 3 Palm H, Jacobsen S, Sonne-Holm S, Gebuhr P. ; Hip Fracture Study Group. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg Am 2007; 89 (03) 470-5
- 4 Müller ME. [Classification and international AO-documentation of femur fractures]. Unfallheilkunde 1980; 83 (05) 251-9
- 5 Langford J, Pillai G, Ugliailoro AD, Yang E. Perioperative lateral trochanteric wall fractures: sliding hip screw versus percutaneous compression plate for intertrochanteric hip fractures. J Orthop Trauma 2011; 25 (04) 191-5
- 6 Bendo JA, Weiner LS, Strauss E, Yang E. Collapse of intertrochanteric hip fractures fixed with sliding screws. Orthop Rev 1994; ;(Suppl): 30-7
- 7 Haidukewych GJ. Intertrochanteric fractures: ten tips to improve results. J Bone Joint Surg Am 2009; 91 (03) 712-9
- 8 Hsu CE, Shih CM, Wang CC, Huang KC. Lateral femoral wall thickness. A reliable predictor of post-operative lateral wall fracture in intertrochanteric fractures. Bone Joint J 2013; 95-B (08) 1134-8
- 9 Gupta RK, Sangwan K, Kamboj P, Punia SS, Walecha P. Unstable trochanteric fractures: the role of lateral wall reconstruction. Int Orthop 2010; 34 (01) 125-9
- 10 Boopalan PR, Oh JK, Kim TY, Oh CW, Cho JW, Shon WY. Incidence and radiologic outcome of intraoperative lateral wall fractures in OTA 31A1 and A2 fractures treated with cephalomedullary nailing. J Orthop Trauma 2012; 26 (11) 638-42
- 11 Sharma G, Singh R, Gn KK, Jain V, Gupta A, Gamanagatti S. , et al. Which AO/OTA 31-A2 pertrochanteric fractures can be treated with a dynamic hip screw without developing a lateral wall fracture? A CT-based study. Int Orthop 2016; 40 (05) 1009-17
- 12 Yli-Kyyny TT, Sund R, Juntunen M, Salo JJ, Kröger HP. Extra- and intramedullary implants for the treatment of pertrochanteric fractures -- results from a Finnish National Database Study of 14,915 patients. Injury 2012; 43 (12) 2156-60
- 13 Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies. Instr Course Lect 2004; 53: 441-54
- 14 Joshi D, Dhamangaonkar AC, Ramawat S, Goregaonkar AB. Predictors of iatrogenic lateral wall fractures while treating intertrochanteric fracture femur with the dynamic hip screw system in Indian patients. Eur J Orthop Surg Traumatol 2015; 25 (04) 677-82
- 15 Chehade MJ, Carbone T, Awwad D, Taylor A, Wildenauer C, Ramasamy B. , et al. Influence of Fracture Stability on Early Patient Mortality and Reoperation After Pertrochanteric and Intertrochanteric Hip Fractures. J Orthop Trauma 2015; 29 (12) 538-43