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HERO ID
4354983
Reference Type
Journal Article
Title
Anteromedial cortical support reduction in unstable pertrochanteric fractures: a comparison of intra-operative fluoroscopy and post-operative three dimensional computerised tomography reconstruction
Author(s)
Chang, SM; Zhang, YQ; Du, SC; Ma, Z; Hu, SJ; Yao, XZ; Xiong, WF
Year
2018
Is Peer Reviewed?
Yes
Journal
International Orthopaedics
ISSN:
0341-2695
EISSN:
1432-5195
Volume
42
Issue
1
Page Numbers
183-189
Language
English
PMID
28891021
DOI
10.1007/s00264-017-3623-y
Web of Science Id
WOS:000419130000026
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.
Tags
PFAS
•
Additional PFAS (formerly XAgency)
•
PFAS 150
Literature Search August 2019
Web of Science
Not prioritized for screening
Perfluorononanoic acid
•
PFNA
Literature Search
WOS
PFNA May 2019 Update
Web of Science
Title and Abstract Screening
Excluded
Not relevant to PECO
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