Department of Orthopaedic Surgery, Hiroshima-Nishi Medical Center, Japan; Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan.
Department of Orthopaedic Surgery, Hiroshima-Nishi Medical Center, Japan.
Injury. 2019 Nov;50(11):2014-2021. doi: 10.1016/j.injury.2019.06.035. Epub 2019 Jul 10.
The aim of this study was to clarify the relationship between the preoperative radiographic classification of trochanteric fractures and the success/failure of closed reduction. Identification of irreducible fractures would be important to proceed promptly to direct reduction.
Our retrospective analysis included 141 trochanteric fractures, in 122 women and 17 men, with a mean age of 85.7 years (range, 45-101 years). Evans' classification of trochanteric fractures, as modified by Jensen, and the lateral view classification were used, based on preoperative plain radiographs and computed tomography images. Features predictive of irreducible fractures were identified.
Among the 141 fractures, 16 (11.3%) were irreducible by closed reduction. The position of the proximal fragment, relative to the shaft on lateral view, and the fracture pattern of the lesser and greater trochanters were predictive of the feasibility of obtaining a successful closed reduction. These criteria identified success/failure of closed reduction in 99.3% of cases.
Our findings should be useful for identifying patients in whom closed reduction would be suitable and for avoiding ineffectual manipulation in unsuitable patients.
本研究旨在阐明术前转子间骨折放射学分类与闭合复位成功/失败之间的关系。识别无法复位的骨折对于及时进行直接复位非常重要。
我们的回顾性分析包括 141 例转子间骨折，其中 122 例为女性，17 例为男性，平均年龄为 85.7 岁（45-101 岁）。根据术前的普通 X 线和平扫 CT 图像，使用 Evans 改良后的分类法和侧位分类法进行转子间骨折分类。确定了预测无法复位的骨折的特征。
在 141 例骨折中，16 例（11.3%）无法通过闭合复位来复位。侧位片上近端骨折块相对于骨干的位置以及小转子和大转子骨折的形态，可预测闭合复位是否成功。这些标准可在 99.3%的病例中识别出闭合复位的成功/失败。
我们的研究结果有助于识别适合闭合复位的患者，并避免对不适合的患者进行无效的操作。
