Platzer Patrick, Thalhammer Gerhild, Wozasek Gerald E, Vécsei Vilmos
Department of Traumatology, University of Vienna Medical School, Vienna, Austria.
J Trauma. 2008 Apr;64(4):982-9. doi: 10.1097/TA.0b013e3180467745.
Femoral shortening is a well-known clinical finding after surgical treatment of per- and intertrochanteric fractures. Particularly, in geriatric patients with poor bone quality and unstable fracture types, secondary compression of these fractures often leads to length inequality of the lower limbs. In younger patients with good bone quality and mobilization with delayed weight bearing, limb length shortening is expected to be a rare complication. The purpose of this study was to analyze incidence and degree of femoral shortening in patients younger than 60 years of age after fixation of different types of per- and intertrochanteric fractures. In addition, we compared the results of two different implants, which were used for operative treatment.
Ninety-five patients, younger than 60 years of age, were evaluated for femoral shortening after surgical treatment of per- and intertrochanteric fractures between 1997 and 2002. Follow-up examinations took place at an average of 3.2 years (2-5 years) after trauma. Fractures were classified by the AO/OTA system and divided into sub-types 31 A1, 31 A2, and 31 A3. Two different implants (dynamic hip screw and cephalomedullary nail) were used for operative treatment, mainly depending on type and stability of the fracture. Femoral shortening was analyzed by standardized lower extremity radiographs measuring the distance from the top of the femoral head to the center of a line drawn between the most distal part of the medial and lateral femoral condyles.
Fifty-seven patients were treated by a cephalomedullary nail, 38 by dynamic hip screw. Femoral shortening was seen in 46 patients (48%) with a mean value of 11 mm. Twenty-two patients had a femoral inequality of less than 10 mm, 17 patients an inequality between 10 mm and 20 mm, and 7 patients a shortening of more than 20 mm. Statistical analysis revealed that fracture type and implant had a significant influence on the shortening: In patients with fracture types 31 A2 and A3 femoral shortening was found to be more severe than in patients with fracture type 31 A1. Additionally, in unstable fracture types (31 A2 and A3) femoral shortening was significantly larger, if patients were treated by dynamic hip screw than by a cephalomedullary nail.
Femoral shortening after operative treatment of per- and intertrochanteric fractures was found to be a common clinical finding in nongeriatric patients. Nearly half of them showed a lower limb length inequality after fracture fixation. The degree of the shortening was rather low and depended mainly on the fracture type. Comparing the two different implants used for operative treatment, a cephalomedullary nail was more successful in preventing limb length discrepancy in unstable fracture types than dynamic hip screw.
股骨缩短是转子周围骨折和转子间骨折手术治疗后一种常见的临床现象。特别是在骨质较差且骨折类型不稳定的老年患者中，这些骨折的二次压缩常导致下肢长度不等。在骨质良好且可延迟负重活动的年轻患者中，肢体长度缩短预计是一种罕见的并发症。本研究的目的是分析60岁以下不同类型转子周围骨折和转子间骨折固定术后患者股骨缩短的发生率和程度。此外，我们比较了两种不同用于手术治疗的植入物的效果。
对1997年至2002年间接受转子周围骨折和转子间骨折手术治疗的95例60岁以下患者进行股骨缩短情况评估。创伤后平均3.2年（2 - 5年）进行随访检查。骨折按AO/OTA系统分类，分为31 A1、31 A2和31 A3亚型。主要根据骨折类型和稳定性，使用两种不同的植入物（动力髋螺钉和髓内钉）进行手术治疗。通过标准化下肢X线片分析股骨缩短情况，测量股骨头顶部到股骨内外侧髁最远端连线中点的距离。
57例患者采用髓内钉治疗，38例采用动力髋螺钉治疗。46例患者（48%）出现股骨缩短，平均值为11毫米。22例患者股骨长度不等小于10毫米，17例患者长度不等在10毫米至20毫米之间，7例患者缩短超过20毫米。统计分析显示，骨折类型和植入物对缩短有显著影响：31 A2型和A3型骨折患者的股骨缩短比31 A1型骨折患者更严重。此外，在不稳定骨折类型（31 A2和A3）中，如果患者采用动力髋螺钉治疗，股骨缩短明显大于采用髓内钉治疗。
转子周围骨折和转子间骨折手术治疗后股骨缩短在非老年患者中是一种常见的临床现象。近一半患者骨折固定后出现下肢长度不等。缩短程度较低，主要取决于骨折类型。比较两种用于手术治疗的不同植入物，在不稳定骨折类型中，髓内钉在预防肢体长度差异方面比动力髋螺钉更成功。
