Functional and Radiographic Outcomes of Intertrochanteric Hip Fractures Treated With Calcar Reduction, Compression, and Trochanteric Entry Nailing

医学 伸缩系列 外科 股骨 还原(数学) 髋部骨折 动力髋螺钉 队列 固定(群体遗传学) 口腔正畸科 骨质疏松症 人口 内分泌学 工程类 内科学 环境卫生 结构工程 数学 几何学
作者
Omesh Paul,Joseph U. Barker,Joseph M. Lane,David L. Helfet,Dean G. Lorich
出处
期刊:Journal of Orthopaedic Trauma [Ovid Technologies (Wolters Kluwer)]
卷期号:26 (3): 148-154 被引量:48
标识
DOI:10.1097/bot.0b013e31821e3f8c
摘要

Objectives: Shortening after intertrochanteric hip fractures with sliding constructs is an increasingly recognized problem by the orthopaedic community. It often results in a limb length discrepancy causing maladaptation of the abductor lever arm. Functional limitations can also result from altered hip biomechanics and negatively influence patient outcomes. We hypothesized that with trochanteric entry nailing, calcar reduction, and intraoperative compression, a near-normal restoration of gait parameters and satisfactory outcomes can be achieved. Design: Level 4, prospective descriptive study. Settings: Level 1 trauma care center. Patients/Participants: Fifty-eight patients with intertrochanteric hip fractures were managed operatively from 2007 to 2008. A strict exclusion criterion was used to analyze the data of interest for a final cohort of 30 patients. Intervention: Stable fixation was achieved with trochanteric entry nail after calcar reduction and intraoperative compression of the fracture site. Patients were grouped into stable (n = 17) and unstable (n = 13) fracture types based on the OTA classification. Outcome/Measurements: Postoperative collapse was measured as telescoping of the lag screw from lateral cortex and blade tip migration within the femoral head. Alteration in femoral head offset and abductor lever arm was measured at the last follow-up visit. Gait parameters were recorded and compared with contralateral side at 6-week, 3-, 6-, and 12-month follow-up visits. Functional outcomes were assessed through 36-item short form health survey (version 2) and Harris Hip Scores at 1 year. Results: Fracture type (stable or unstable) significantly predicted telescoping (P = 0.007). Mean telescoping was 3.3 mm (SD = 2.41 mm) in the unstable group versus 1.2 mm (SD = 0.81 mm) in the stable group (P = 0.004). The stable group recovered 95% of the single limb stance versus 91% in the unstable group, at 1 year. (P = 0.02). Return of single limb stance improved from 76% to 95% between 6 weeks and 6 months. No improvement in gait was seen after 6 months (P > 0.05). The average scores on the physical and mental components of 36-item short form health survey and Harris Hip Scores were 44, 53, and 89, respectively. The radiographic union rate was 100%. There was 1 (3%) screw cutout that did not require a revision surgery in our series. There were no cases with implant failure, femur fracture, or any wound complications. Conclusions: Satisfactory functional outcomes with near-normal gait restoration can be achieved in cases of intertrochanteric hip fractures with an emphasis on calcar reduction and compression after fixation with trochanteric entry nail. Level of Evidence: Therapeutic Level IV. See page 128 for a complete description of levels of evidence.
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