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Anteromedial cortical support reduction in unstable pertrochanteric fractures: a comparison of intra-operative fluoroscopy and post-operative three dimensional computerised tomography reconstruction

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Abstract

Purpose

Anteromedial cortical support reduction is favourable for secondary stability after limited sliding in unstable pertrochanteric fractures. The aim of this study was to compare the accuracy and agreement between intra-operative fluoroscopy and post-operative 3D reconstruction.

Materials and methods

A retrospective analysis of 28 patients (mean 81.6 years) treated with short cephalomedullary nails was performed. All patients had full sets of intra-operative fluoroscopy and post-operative 3D CT images. Observation was focused on the position of the anteromedial cortices of the inferior corner between the head-neck fragment and femoral shaft, and their relationship was categorised into three types: positive, neutral and negative. The percentage of subsequent changes in cortical reduction quality between fluoroscopy and 3D CT was calculated and compared.

Results

There were 24 positive (85.7%), four neutral and no negative positions in the anteroposterior (AP) view and one positive, 20 neutral (71.4%) and seven negative positions in the lateral view from fluoroscopy. On post-operative 3D CT images with a full range of rotation, definitive anteromedial cortical contact (positive and neutral support) was observed in 18 cases (64.3%). Ten cases lost the anteromedial cortical buttress. With the posteromedial region of the lesser trochanter detached, a positive AP cortical position combined with a positive/neutral lateral position on fluoroscopy (17 cases) was highly predictive of reliable, definitive cortical support (15 cases, 88.2%) on 3D CT. A negative lateral position on fluoroscopy (seven cases), regardless of the combination in the AP view, was likely to predict the final loss of cortical support (six cases, 85.7%) on 3D CT; a positive/neutral lateral position (21 cases) was only associated with loss of support in four cases (19.1%) (p < 0.05).

Conclusions

A lateral negative position of the anterior cortex on fluoroscopy for unstable pertrochanteric fractures may be highly predictive of post-operative final loss of the anteromedial cortical buttress, which should be avoided during operation.

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Funding

The study was supported by funding from Shanghai Municipal Science Committee (No. 14411971900) and national Nature Science Foundation of China (NSFC No.81772323).

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Authors and Affiliations

  1. The Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, People’s Republic of China

    Shi-Min Chang, Shou-Chao Du, Zhuo Ma, Sun-Jun Hu, Xi-Zhou Yao & Wen-Feng Xiong

  2. Department of Orthopaedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, People’s Republic of China

    Ying-Qi Zhang

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  1. Shi-Min Chang
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Correspondence to Shi-Min Chang.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by Institutional Review Board of Yangpu Hospital, Tongji University, No. 2016012.

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Chang, SM., Zhang, YQ., Du, SC. et al. Anteromedial cortical support reduction in unstable pertrochanteric fractures: a comparison of intra-operative fluoroscopy and post-operative three dimensional computerised tomography reconstruction. International Orthopaedics (SICOT) 42, 183–189 (2018). https://doi.org/10.1007/s00264-017-3623-y

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  • DOI: https://doi.org/10.1007/s00264-017-3623-y

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