Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea.
Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea.
Clin Orthop Surg. 2023 Aug;15(4):560-566. doi: 10.4055/cios22325. Epub 2023 Apr 12.
The purpose of this study was to investigate the demographic factors and radiological characteristics of lesser trochanter splitting (LTS) irreducible intertrochanteric fractures and to report the clinical results of patients who underwent open reduction and internal fixation using dynamic hip screws (DHS).
Inclusion criteria were as follows: AO/Orthopedic Trauma Association type 31A1.2, a fracture line originating from the outside of the greater trochanter that passes through the lesser trochanter, and patients who were followed up for more than 1 year with a confirmed presence or absence of bone union. A total of 13 cases were identified, accounting for 3.1% (13/416 intertrochanteric fractures). Patients were classified according to posterior sagging of the distal shaft fragment relative to the head-neck fragment (posterior sagging group, 6; non-sagging group, 7). Demographic data, comorbidities, injury mechanism, type of anesthesia, operation time, blood loss, tip-apex distance, reduction quality, leg length discrepancy (> 5 mm), long lesser trochanter sign, postoperative complications, and presence of bony union were obtained by reviewing medical records and radiological findings.
The mean age of the patients was 50.4 ± 10.4 years, and 12 were men. Except for 1 case (slip down), all were induced by high-energy trauma. According to the grade of reduction quality, 5 cases (38.5%) had good reduction quality and 8 cases (61.5%) had acceptable reduction quality. There were no postoperative complications, and bony union was observed in all cases. The long lesser trochanter sign was observed in 5 cases (38.5%) and leg length discrepancy greater than 5 mm was not observed. Compared with the non-sagging group, the posterior sagging group had more head-neck fragments containing more than 1/2 of the lesser trochanter length, longer operation time, and more blood loss ( < 0.05). Compared to the non-sagging group, the posterior sagging group had worse reduction quality and more long lesser trochanter signs ( < 0.05).
Open reduction and internal fixation using DHS for the LTS irreducible intertrochanteric fractures can achieve good clinical and radiological outcomes. However, in the posterior sagging type, reduction can be more difficult with a longer operation time and higher likelihood of blood loss.
本研究旨在探讨小转子劈裂（LTS）型难复位股骨转子间骨折的人口统计学因素和影像学特征，并报告采用动力髋螺钉（DHS）行切开复位内固定治疗的患者的临床结果。
纳入标准如下：AO/骨科创伤协会 31A1.2 型，骨折线始于大转子外侧，穿过小转子，且随访时间超过 1 年，证实有或无骨愈合。共确定了 13 例，占股骨转子间骨折的 3.1%（13/416）。根据远端骨干相对于股骨头颈片段的后下移位情况将患者进行分类（后下移位组 6 例，非后下移位组 7 例）。通过回顾病历和影像学结果，获取人口统计学数据、合并症、损伤机制、麻醉类型、手术时间、失血量、尖顶距、复位质量、下肢长度差异（>5mm）、小转子过长征、术后并发症和骨愈合情况。
患者的平均年龄为 50.4±10.4 岁，男性 12 例。除 1 例（滑下）外，均由高能创伤引起。根据复位质量分级，5 例（38.5%）复位质量良好，8 例（61.5%）复位质量可接受。无术后并发症，所有病例均观察到骨愈合。5 例（38.5%）出现小转子过长征，下肢长度差异>5mm 未观察到。与非后下移位组相比，后下移位组股骨头颈片段包含小转子长度 1/2 以上的比例更高，手术时间更长，失血量更多（<0.05）。与非后下移位组相比，后下移位组的复位质量更差，小转子过长征更多（<0.05）。
采用 DHS 切开复位内固定治疗 LTS 型难复位股骨转子间骨折可获得良好的临床和影像学结果。然而，在后下移位型中，复位可能更困难，手术时间更长，失血量更多。
