Gupta Anupam, Rai Dinakar
Orthopaedics, PSG Institute of Medical Sciences and Research, Coimbatore, IND.
Trauma and Orthopaedics, PSG Institute of Medical Sciences and Research, Coimbatore, IND.
Cureus. 2024 Dec 3;16(12):e75014. doi: 10.7759/cureus.75014. eCollection 2024 Dec.
Background Numerous classifications exist for intertrochanteric (IT) fractures, commonly focused on stability. However, the currently utilized Arbeitsgemeinschaft Osteosynthesefragen and Orthopaedic Trauma Association (AO/OTA) classification has limitations in identifying irreducible fractures. This study aims to answer the following questions: does fracture stability imply irreducibility; which fracture fragments complicate reduction; and which reduction techniques should be employed? Materials and methods Eligibility criteria included fractures in adult long bones without pathological fractures being treated by native conservative means. Preoperative pelvic X-rays were obtained from 49 patients who had intertrochanteric fractures and classified according to the 2018 AO Classification. Anterior-posterior pelvic X-rays were reviewed by six experienced surgeons, who reached a consensus on type, group, and subgroup classifications in this prospective observational study. The methods for intraoperative fracture reduction used by five different unit chiefs were recorded and tabulated. All fractures were reduced on a fracture table with traction and rotation and subsequently checked under C-arm imaging. Persistent non-anatomical alignment with displacement was classified as an irreducible IT fracture. Various reduction techniques, using either semi-open or open methods, were analyzed. Results Fractures classified as AO types A1.1, A1.3, and A2.1 were generally more reducible, while types A2.2, A2.3, A3.1, A3.2, and A3.3 were more frequently irreducible. Patients under 65 years of age were more likely to present with irreducible fracture patterns (P = 0.026), a statistically significant association. A semi-open method using spikes or Hohman's retractors was most commonly employed, with no preliminary cortical fixation using K-wires after reduction. Conclusion Irreducible fractures exhibit unique features on C-arm imaging, potentially leading to increased anxiety and longer operation times. Awareness of these fracture characteristics can assist surgeons in achieving effective reduction and reducing operation time. The 2018 AO classification alone does not reliably predict irreducible IT fractures.
转子间（IT）骨折存在多种分类方法，通常侧重于稳定性。然而，目前使用的 Arbeitsgemeinschaft Osteosynthesefragen 和骨科创伤协会（AO/OTA）分类在识别不可复位骨折方面存在局限性。本研究旨在回答以下问题：骨折稳定性是否意味着不可复位性；哪些骨折碎片会使复位复杂化；以及应采用哪些复位技术？
纳入标准包括未合并病理性骨折的成人长骨骨折且采用保守治疗。从49例转子间骨折患者中获取术前骨盆X线片，并根据2018年AO分类进行分类。六位经验丰富的外科医生对骨盆前后位X线片进行了评估，在这项前瞻性观察研究中，他们就类型、组和亚组分类达成了共识。记录并列表了五位不同科室主任术中使用的骨折复位方法。所有骨折均在骨折牵引床上进行牵引和旋转复位，随后在C形臂成像下进行检查。持续存在移位的非解剖对位被分类为不可复位的IT骨折。分析了使用半开放或开放方法的各种复位技术。
分类为AO类型A1.1、A1.3和A2.1的骨折通常更易于复位，而A2.2、A2.3、A3.1、A3.2和A3.3类型的骨折更常出现不可复位情况。65岁以下的患者更有可能出现不可复位的骨折类型（P = 0.026），这是一种具有统计学意义的关联。最常采用的是使用尖钉或霍曼牵开器的半开放方法，复位后未使用克氏针进行初步皮质固定。
不可复位骨折在C形臂成像上表现出独特特征，可能导致焦虑增加和手术时间延长。了解这些骨折特征有助于外科医生实现有效复位并缩短手术时间。仅2018年AO分类不能可靠地预测不可复位的IT骨折。
