Skip to main content

Advertisement

SpringerLink
Log in

Risk factors for over-telescoping in reverse oblique intertrochanteric fractures

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Postoperative over-telescoping (OT) with lag screws is often observed in reverse oblique intertrochanteric fractures. This study aimed to clarify the risk factors of OT in patients with reverse oblique intertrochanteric fractures.

Methods

Electronic medical records of patients diagnosed with reverse oblique intertrochanteric fractures using plain radiography who underwent operative fixation with an intramedullary nail between August 2013 and December 2019 were reviewed. Patients were classified into two groups according to the Futamura classification: lateral wall pattern (LW) and reverse oblique pattern (RO). The incidence of OT in the LW and RO groups was compared. Also, we compared the incidence of OT for each reduction type in the LW group.

Results

Twenty patients had LW, and nine had RO. OT was observed in eight fractures (42.1%) in the LW group but not in the RO group. The incidence of OT was significantly higher in the LW group than in the RO group (P = 0.0261). Among the 19 fractures with LW, OT was observed in 7 of 10 and 1 of 9 fractures with postoperative reduction in the intramedullary and extramedullary or anatomical types, respectively. In the LW group, the incidence of OT was significantly higher in fractures with postoperative reduction in the intramedullary type than in those of the extramedullary or anatomical type (P = 0.0198).

Conclusion

Our study showed that the incidence of OT was significantly higher in LW than in RO and that postoperative reduction in the intramedullary type in LW was a risk factor for OT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Wright LT (1947) Oblique subcervical (reverse intertrochanteric) fractures of the femur. J Bone Jt Surg Am 29:707–710

    CAS  Google Scholar 

  2. Brammar TJ, Kendrew J, Khan RJ, Parker MJ (2005) Reverse obliquity and transverse fractures of the trochanteric region of the femur: A review of 101 cases. Injury 36:851–857. https://doi.org/10.1016/j.injury.2005.02.004

    Article  PubMed  Google Scholar 

  3. Jagow DM, Yacoubian SV, McCrink EJ 3rd, Yacoubian SV (2018) A novel technique for the fixation of inter-trochanteric hip fractures: a telescoping lag screw. J Orthop 15:690–694. https://doi.org/10.1016/j.jor.2018.05.034

    Article  PubMed  PubMed Central  Google Scholar 

  4. Buciuto R, Hammer R (2001) RAB-plate versus sliding hip screw for unstable trochanteric hip fractures: stability of the fixation and modes of failure—radiographic analysis of 218 fractures. J Trauma 50:545–550. https://doi.org/10.1097/00005373-200103000-00022

    Article  CAS  PubMed  Google Scholar 

  5. Parker MJ (1996) Trochanteric hip fractures fixation failure commoner with femoral medialization, a comparison of 101 cases. Acta Orthop Scand 67:329–332. https://doi.org/10.3109/17453679609002325

    Article  CAS  PubMed  Google Scholar 

  6. Ito J, Takakubo Y, Sasaki K, Sasaki J, Owashi K, Takagi M (2015) Prevention of excessive postoperative sliding of the short femoral nail in femoral trochanteric fractures. Arch Orthop Traum Surg 135:651–657. https://doi.org/10.1007/s00402-015-2200-3

    Article  Google Scholar 

  7. Chang SM, Zhang YQ, Ma Z, Li Q, Dargel J, Eysel P (2015) Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg 135:811–818. https://doi.org/10.1007/s00402-015-2206-x

    Article  PubMed  PubMed Central  Google Scholar 

  8. Li J, Zhang L, Zhang H, Yin P, Lei M, Wang G, Wang S, Tang P (2019) Effect of reduction quality on post-operative outcomes in 31–A2 intertrochanteric fractures following intramedullary fixation: a retrospective study based on computerised tomography findings. Int Orthop 43:1951–1959. https://doi.org/10.1007/s00264-018-4098-1

    Article  PubMed  Google Scholar 

  9. Futamura K, Baba T, Homma Y, Mogami A, Kanda A, Obayashi O, Sato K, Ueda Y, Kurata Y, Tsuji H, Kaneko K (2016) New classification focusing on the relationship between the attachment of the iliofemoral ligament and the course of the fracture line for intertrochanteric fractures. Injury 47:1685–1691. https://doi.org/10.1016/j.injury.2016.05.015

    Article  PubMed  Google Scholar 

  10. Choo SK, Oh HK, Ko HT, Min DU, Kim Y (2017) Effectiveness of controlled telescoping system for lateral hip pain caused by sliding of blade following intramedullary nailing of trochanteric fracture. Injury 48:2201–2206. https://doi.org/10.1016/j.injury.2017.07.023

    Article  PubMed  Google Scholar 

  11. Liu W, Wang J, Weaver MJ, Vrahas MS, Zhou D (2014) Lateral migration with telescoping of a trochanteric fixation nail in the treatment of an intertrochanteric hip fracture. Chin Med J (Engl) 127:680–684

    PubMed  Google Scholar 

  12. Kijima H, Yamada S, Konishi N, Kubota H, Tazawa H, Tani T et al (2016) The choice of internal fixator for fractures around the femoral trochanter depends on area classification. Springerplus 5:1512. https://doi.org/10.1186/s40064-016-3206-1

    Article  PubMed  PubMed Central  Google Scholar 

  13. Okano I, Sawada T, Kushima N, Tachibana T, Inagaki K (2017) Treatment with helical blade cephalomedullary nail for two-part basicervical proximal femoral fracture in elderly patients: a retrospective observational study. Geriatr Orthop Surg Rehabil 8:244–251. https://doi.org/10.1177/2151458517743327

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wang Q, Gu XH, Li X, Wu JH, Ju YF, Huang WJ, Wang QG (2019) Management of low-energy basicervical proximal femoral fractures by proximal femoral nail anti-rotation. Orthop Surg 11:1173–1179. https://doi.org/10.1111/os.12579

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48:452–458. https://doi.org/10.1038/bmt.2012.244

    Article  CAS  PubMed  Google Scholar 

  16. Irgit K, Richard RD, Beebe MJ, Bowen TR, Kubiak E, Horwitz DS (2015) Reverse oblique and transverse intertrochanteric femoral fractures treated with the long cephalomedullary nail. J Orthop Trauma 29:e299–e304. https://doi.org/10.1097/BOT.0000000000000340

    Article  PubMed  Google Scholar 

  17. Sadowski C, Lübbeke A, Saudan M, Riand N, Stern R, Hoffmeyer P (2002) Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degrees screw-plate: a prospective, randomized study. J Bone Jt Surg Am 84:372–381. https://doi.org/10.2106/00004623-200203000-00007

    Article  Google Scholar 

  18. Park SY, Yang KH, Yoo JH, Yoon HK, Park HW (2008) The treatment of reverse obliquity intertrochanteric fractures with the intramedullary hip nail. J Trauma 65:852–857. https://doi.org/10.1097/TA.0b013e31802b9559

    Article  PubMed  Google Scholar 

  19. Gao Z, Lv Y, Zhou F, Ji H, Tian Y, Zhang Z, Guo Y (2018) Risk factors for implant failure after fixation of proximal femoral fractures with fracture of the lateral femoral wall. Injury 49:315–322. https://doi.org/10.1016/j.injury.2017.11.011

    Article  PubMed  Google Scholar 

  20. Polat G, Akgül T, Ekinci M, Bayram S (2019) A biomechanical comparison of three fixation techniques in osteoporotic reverse oblique intertrochanteric femur fracture with fragmented lateral cortex. Eur J Trauma Emerg Surg 45:499–505. https://doi.org/10.1007/s00068-018-1061-1

    Article  PubMed  Google Scholar 

  21. Hao Y, Zhang Z, Zhou F, Ji H, Tian Y, Guo Y, Lv Y, Yang Z, Hou G (2019) Risk factors for implant failure in reverse oblique and transverse intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA). J Orthop Surg Res 14:350. https://doi.org/10.1186/s13018-019-1414-4

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hoffmann MF, Khoriaty JD, Sietsema DL, Jones CB (2019) Outcome of intramedullary nailing treatment for intertrochanteric femoral fractures. J Orthop Surg Res 14:360. https://doi.org/10.1186/s13018-019-1431-3

    Article  PubMed  PubMed Central  Google Scholar 

  23. Fan J, Xu X, Zhou F, Zhang Z, Tian Y, Ji H, Guo Y, Lv Y, Yang Z, Hou G (2021) Risk factors for implant failure of intertrochanteric fractures with lateral femoral wall fracture after intramedullary nail fixation. Injury 52:3397–3403. https://doi.org/10.1016/j.injury.2021.07.025

    Article  PubMed  Google Scholar 

  24. Kulkarni SG, Babhulkar SS, Kulkarni SM, Kulkarni GS, Kulkarni MS, Patil R (2017) Augmentation of intramedullary nailing in unstable intertrochanteric fractures using cerclage wire and lag screws: a comparative study. Injury 48(Suppl 2):S18–S22. https://doi.org/10.1016/S0020-1383(17)30489-8

    Article  PubMed  Google Scholar 

  25. Imerci A, Aydogan NH, Tosun K (2019) The effect on outcomes of the application of circumferential cerclage cable following intramedullary nailing in reverse intertrochanteric femoral fractures. Eur J Orthop Surg Traumatol 29:835–842. https://doi.org/10.1007/s00590-018-2356-y

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Hospital Ethics Committee approved the study design.

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. Department of Trauma Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-shi, Kanagawa, Japan

    Yuta Izawa, Kentaro Futamura, Hiroko Murakami, Tetsuya Shirakawa, Masahiro Nishida & Yoshihiko Tsuchida

  2. Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Tokyo, Bunkyo-ku, Japan

    Tomonori Baba

Authors
  1. Yuta Izawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kentaro Futamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroko Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tetsuya Shirakawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masahiro Nishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tomonori Baba
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yoshihiko Tsuchida
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by YI, YT. The first draft of the manuscript was written by YI and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yuta Izawa.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest. The authors have no relevant financial or non-financial interests to disclose.

Consent to participate

All the patients provided written informed consent upon the study enrollment.

Consent for publication

All the patients provided written informed consent for the publication of any associated data and accompanying images.

Ethical approval

This study received ethical approval from The TOKUSHUKAI GROUP COMMMITE under the protocol number TGE01521-024.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Izawa, Y., Futamura, K., Murakami, H. et al. Risk factors for over-telescoping in reverse oblique intertrochanteric fractures. Eur J Orthop Surg Traumatol 33, 1101–1107 (2023). https://doi.org/10.1007/s00590-022-03263-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-022-03263-6

Keywords

Search

Navigation