Brammar Timothy J, Kendrew John, Khan Riaz J K, Parker Martyn J
East Anglian Orthopaedic Rotation, 65 Caernarvon Road, Norwich NR2 3HY, UK.
Injury. 2005 Jul;36(7):851-7. doi: 10.1016/j.injury.2005.02.004. Epub 2005 Apr 2.
Reverse obliquity and transverse fractures of the proximal femur represent a distinct fracture pattern in which the mechanical forces displace the femur medially thus increasing the risk of fixation failure. There is a paucity of published literature in this area of trauma. This study constitutes the largest series of such fractures.
Using a retrospective analysis of prospectively collected data from a single institution, 101 reverse obliquity and transverse fracture patterns were identified from 3336 consecutive hip fractures. All surviving patients were followed up for 1 year.
Of 100 patients treated operatively, 59 were treated with 135 degrees sliding hip screws (SHS), 19 with a Medoff plates modification of the SHS, three with a sliding hip screw and trochanteric stabilising plate and 19 with intramedullary sliding hip screw devices. Nine fracture fixation-healing complications occurred, with cut-out being the commonest complication (seven cases). Cut-out of the implant was associated with femoral medialisation and a larger tip to apex distance.
This fracture pattern is a challenge for the orthopaedic surgeon with a high risk of fracture healing complications. The 135 degrees SHS and the intramedullary devices had similar failure rates.
股骨近端的反向斜形骨折和横行骨折代表一种独特的骨折类型，其中机械力使股骨向内侧移位，从而增加固定失败的风险。在这一创伤领域，已发表的文献较少。本研究构成了此类骨折的最大系列研究。
通过对来自单一机构的前瞻性收集数据进行回顾性分析，从3336例连续的髋部骨折中识别出101例反向斜形骨折和横行骨折类型。所有存活患者均随访1年。
在100例接受手术治疗的患者中，59例采用135度动力髋螺钉（SHS）治疗，19例采用SHS的Medoff钢板改良术治疗，3例采用动力髋螺钉和转子稳定钢板治疗，19例采用髓内动力髋螺钉装置治疗。发生了9例骨折固定愈合并发症，其中穿出是最常见的并发症（7例）。植入物穿出与股骨向内侧移位和较大的尖顶距有关。
这种骨折类型对骨科医生来说是一个挑战，骨折愈合并发症风险高。135度SHS和髓内装置的失败率相似。
