Istanbul University Istanbul Faculty Of Medicine Department Of Orthopaedics And Traumatology.
Ulus Travma Acil Cerrahi Derg. 2022 Dec;28(12):1731-1738. doi: 10.14744/tjtes.2022.57400.
We aimed to investigate the effect of bone morphology on fracture type and treatment result in patient with inter-trochanteric fracture (IFF) treated with intramedullary nailing (IMN) aged over 65 years. Primary outcome of study was to investigate the relationship between fracture type (stable or unstable) and bone density.
This was a retrospective cohort study conducted at single trauma center which included patients aged >65 years, minimum 3 months' control postoperatively, patients with simple fall by evaluating the patient data from 2010 to 2021. All fractures were classified based on the AO classification system. Proximal femoral nail anti-rotation was used between 2010 and 2016, while InterTAN was used after 2016 in our clinic practice. For the evaluation of the bone morphology, we measured the canal-to-calcar ratio (CCR) and cortical thickness index (CTI) and classified with Dorr morphology on anteroposterior (AP) hip radiograph of both the fracture side and contralateral sides. Complications were also evaluated on radiological view. Failures were defined as non-union or failure of fixation. Excessive collapse and screw/blade prominence also evaluated by hip radiograph on the 3rd month control visit.
One hundred and fifty females and 59 males were included in this study. The average age was 81.6±8.8 years. One hundred and forty-four patients were treated with InterTAN and 65 patients with helical blade type IMN (PFN-A®). There were 78 patients with stable IFF type A1 fracture and 131 patients with unstable IFF (109 patients with A2 and 22 patients with A3 AO type fracture). The mean CTI was 0.469±0.09 and 0.510±0.09 in the fracture and unaffected side femurs, respectively (p<0.001), the CCR was 0.636±0.15 and 0.568±12 in the fracture and unaffected side femurs, respectively (p<0.001). There were 36 patients with Dorr type A, 115 patients with Dorr type B, and 48 patients with Dorr type C in fracture side and 65 patients with Dorr type A, 123 patients with Dorr type B, and 21 patients with Dorr type C in non-affected side (p<0.001). There were 29 (13.9%) patients with screw (n=14) and blade (n=15) prominence. Excessive collapse was seen 30 patients (14.4%) and 16 patients (7.7) evaluated as a failure.
We found a significant difference in the failure rate between unstable group than stable group which higher in unstable group according to the AO classification. In addition, the mean CTI, CCR, and Dorr index were significant difference in fractured side than unaffected side which indicated lower bone quality at fracture side.
我们旨在研究骨形态对 65 岁以上股骨转子间骨折（IFF）患者接受髓内钉（IMN）治疗的骨折类型和治疗结果的影响。研究的主要结果是研究骨折类型（稳定型或不稳定型）与骨密度之间的关系。
这是一项在单一创伤中心进行的回顾性队列研究，纳入了年龄>65 岁、术后至少 3 个月随访、通过评估患者数据（2010 年至 2021 年）单纯跌倒的患者。所有骨折均根据 AO 分类系统进行分类。2010 年至 2016 年期间使用近端股骨钉抗旋，2016 年后在我们的临床实践中使用 InterTAN。为了评估骨形态，我们测量了管腔至小粗隆比（CCR）和皮质厚度指数（CTI），并在骨折侧和对侧的前后位（AP）髋关节 X 线片上根据 Dorr 形态进行分类。还通过影像学视图评估并发症。失败被定义为非愈合或固定失败。在第 3 个月的随访中，还通过髋关节 X 线片评估过度塌陷和螺钉/刀片突出。
本研究纳入了 150 名女性和 59 名男性。平均年龄为 81.6±8.8 岁。144 名患者接受 InterTAN 治疗，65 名患者接受螺旋刀片型 IMN（PFN-A®）治疗。78 例患者为稳定型 A1 型 IFF，131 例为不稳定型 IFF（109 例为 A2 型，22 例为 A3 AO 型骨折）。骨折侧 CTI 平均值为 0.469±0.09，未受影响侧股骨 CTI 平均值为 0.510±0.09（p<0.001），骨折侧 CCR 平均值为 0.636±0.15，未受影响侧股骨 CCR 平均值为 0.568±0.15（p<0.001）。骨折侧有 36 例 Dorr 型 A，115 例 Dorr 型 B，48 例 Dorr 型 C，未受影响侧有 65 例 Dorr 型 A，123 例 Dorr 型 B，21 例 Dorr 型 C（p<0.001）。有 29 例（13.9%）患者存在螺钉（n=14）和刀片（n=15）突出。30 例（14.4%）出现过度塌陷，16 例（7.7%）评估为失败。
我们发现根据 AO 分类，不稳定型组的失败率明显高于稳定型组，不稳定型组的失败率更高。此外，骨折侧的平均 CTI、CCR 和 Dorr 指数与未受影响侧相比有显著差异，这表明骨折侧的骨质量较低。
