Maqungo S, Nicol A, Yimam H, Dey R, Exadaktylos A, Laubscher M
Orthopaedic Trauma Service, Division of Orthopaedic Surgery, University of Cape Town; Trauma Care & Injury Prevention, Division of Global Surgery, University of Cape Town.
Trauma Unit, Division of General Surgery, University of Cape Town.
Injury. 2024 Oct;55(10):111723. doi: 10.1016/j.injury.2024.111723. Epub 2024 Jul 16.
Displaced intracapsular neck of femur (NOF) fractures secondary to civilian gunshots are rare injuries with universally poor outcomes following surgical fixation. No studies have been published on fracture mapping in NOF fractures secondary to civilian gunshots.
We performed CT scan-based fracture mapping to identify the most common fracture patterns in these injuries.
Design: Retrospective search of prospectively collected data.
Single Level 1 Trauma hospital. Patient selection criteria: All patients presenting with gunshot fractures to the femur neck between 01 January 2009 and 31 December 2022 were identified. Once identified from Picture Archiving and Communication System (PACS), computed tomography (CT) scans in Digital Imaging and Communication in Medicine (DICOM) format were imported into Mimics 16 software and fracture fragments were segmented and three-dimensional (3D) reconstruction was generated. The reduced fractures were exported to 3-Matic software to merge the fragments and adjust the orientation in three planes. An uninjured femur model was used as a template for reduction. Fracture lines and heat maps were then generated. Our outcome measures were successful mapping of the identified fracture lines.
A total of 25 intracapsular femur neck fractures were identified and suitable for CT scan mapping. All patients were male with an average age of 22 (range 18-32). Once generated, fracture maps were used to show the location, distribution and frequency of the fracture lines. In all but two cases the fracture line propagation remained within the confines of the hip joint capsule. In three cases there was fracture extension into the superior aspect of the femur head, and in one case extension into the inferior aspect.
This is the first study to perform 3D fracture mapping for intracapsular femur neck fractures secondary to civilian gunshot injuries. The exercise has helped us better understand the commonest fracture patterns and assisted us with surgical planning and execution.
因民用枪支射击导致的股骨颈囊内移位骨折是罕见的损伤，手术固定后的预后普遍较差。目前尚未有关于民用枪支射击导致的股骨颈骨折骨折图谱的研究发表。
我们进行了基于CT扫描的骨折图谱分析，以确定这些损伤中最常见的骨折模式。
设计：对前瞻性收集的数据进行回顾性检索。
单一的一级创伤医院。患者选择标准：确定2009年1月1日至2022年12月31日期间所有股骨颈枪伤骨折患者。一旦从图像存档与通信系统（PACS）中识别出来，将医学数字成像和通信（DICOM）格式的计算机断层扫描（CT）扫描导入Mimics 16软件，对骨折碎片进行分割并生成三维（3D）重建。将复位后的骨折导出到3-Matic软件中，以合并碎片并在三个平面上调整方向。使用未受伤的股骨模型作为复位模板。然后生成骨折线和热图。我们的结果指标是成功绘制识别出的骨折线。
共识别出25例股骨颈囊内骨折，适合进行CT扫描图谱分析。所有患者均为男性，平均年龄22岁（范围18 - 32岁）。骨折图谱生成后，用于显示骨折线的位置、分布和频率。除两例病例外，所有病例的骨折线延伸均局限于髋关节囊内。3例病例骨折延伸至股骨头上方，1例病例延伸至下方。
这是第一项针对民用枪支射击导致的股骨颈囊内骨折进行三维骨折图谱分析的研究。这项工作帮助我们更好地了解了最常见的骨折模式，并辅助我们进行手术规划和实施。
