Tawari Akhil A, Kempegowda Harish, Suk Michael, Horwitz Daniel S
Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA.
J Orthop Trauma. 2015 Apr;29 Suppl 4:S4-9. doi: 10.1097/BOT.0000000000000284.
Intertrochanteric (IT) fractures pose a tremendous burden to the healthcare system. Although consistently good results are obtained while treating stable IT fractures, treatment failure rates with unstable fractures are much higher, and hence, it is imperative to identify unstable patterns. Presently, the conventionally classified unstable configurations (fracture with posteromedial comminution, reverse oblique, IT with subtrochanteric extension) and the recently added fracture patterns (IT fractures with avulsed greater trochanter and lateral wall breach) qualify as unstable IT fractures; however, the list is certainly not exhaustive. Disruption of lateral wall converts an IT fracture into a reverse oblique fracture equivalent and should be given a strong consideration in the decision matrix.
转子间（IT）骨折给医疗系统带来了巨大负担。尽管在治疗稳定型IT骨折时始终能取得良好效果，但不稳定骨折的治疗失败率要高得多，因此，识别不稳定模式至关重要。目前，传统分类的不稳定构型（伴有后内侧粉碎的骨折、反斜形骨折、伴有转子下延伸的IT骨折）以及最近新增的骨折模式（伴有大转子撕脱和侧壁破裂的IT骨折）都属于不稳定型IT骨折；然而，这份清单肯定并不详尽。侧壁破坏会将IT骨折转变为等效的反斜形骨折，在决策矩阵中应予以充分考虑。
