Sharma Gaurav, kumar G N Kiran, Yadav Sanjay, Lakhotia Devendra, Singh Ravijot, Gamanagatti Shivanand, Sharma Vijay
Injury. 2014 Dec;45(12):1950-7. doi: 10.1016/j.injury.2014.10.007.
To define the unique radiographic features, operative treatment, and complications of pertrochanteric fractures (AO/OTA 31-A1 and A2) which are not amenable to the usual closed reduction manoeuvres.
During a 2-year period (from August 2011 until December 2013), 212 patients with pertrochanteric fractures were treated at our level I trauma centre. A retrospective review was undertaken to determine which of these fractures were not reducible via the routine closed reduction manoeuvres and required some form of open reduction. These fractures were assessed for radiographic markers of irreducibility, surgical findings, reduction techniques, and perioperative complications.
Twenty-four patients had fractures, which were not amenable to closed reduction and underwent open reduction. These fractures could be grouped into four patterns. A preoperative CT scan was available for at least two cases of each pattern, which provided further insights into the cause of irreducibility by closed means. These included a variant where the proximal fragment is locked underneath the shaft fragment (3 cases), bisected lesser trochanter with a locked proximal fragment (3 cases), irreducibility due to entrapped posteromedial fragment at the fracture site (6 cases) and a variant where the proximal fragment is flexed passively by the underlying lesser trochanter (12 cases).
Pertrochanteric fractures, which are not amenable to closed reduction, are uncommon, but are heralded by unique radiographic features. These patients warrant special consideration in terms of recognition and management. The specific radiographic markers should alert the surgeon to this injury pattern and its related difficulty encountered during closed reduction. Once reduction is achieved, however, these fractures follow an uneventful course.
明确对于常规闭合复位手法不适用的转子间骨折（AO/OTA 31 - A1和A2型）的独特影像学特征、手术治疗方法及并发症。
在2年期间（从2011年8月至2013年12月），我们的一级创伤中心治疗了212例转子间骨折患者。进行回顾性研究以确定哪些骨折无法通过常规闭合复位手法复位而需要某种形式的切开复位。对这些骨折的不可复位影像学标志、手术发现、复位技术及围手术期并发症进行评估。
24例患者的骨折无法闭合复位而接受了切开复位。这些骨折可分为四种类型。每种类型至少有两例患者术前进行了CT扫描，这为闭合复位失败的原因提供了进一步的见解。这些类型包括：近端骨折块锁定于骨干骨折块下方的变异型（3例）、小转子二分且近端骨折块锁定的情况（3例）、骨折部位后内侧骨折块嵌顿导致的不可复位（6例）以及近端骨折块被下方小转子被动屈曲的变异型（12例）。
无法闭合复位的转子间骨折并不常见，但具有独特的影像学特征。在识别和处理方面，这些患者需要特别考虑。特定的影像学标志应提醒外科医生注意这种损伤类型及其在闭合复位过程中遇到的相关困难。然而，一旦实现复位，这些骨折的病程通常较为顺利。
