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Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_16 | Pages 69 - 69
1 Apr 2013
Shoda E Ouchi K Maruyama S Okada Y Kitada S Haneda M Sasaki Y
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Fracture classification of femoral trochanteric fracture is usually based on plain X-ray. However, complications such as delayed union, non-union, and cut out are seen in stable fracture on X-ray. In this study, fracture was classified by 3D-CT and relationship to X-ray classification was investigated.

48 femoral trochanteric fractures (15 males, 33 female, average age: 82.6) treated with PFNA-II were investigated.

Fracture was classified to 2part, 3part(5 subgroups), and 4part with combination of 4 fragments in CT; Head (H), Greater trochanter (G), Lesser trochanter (L), and Shaft (S). 5 subgroups of 3 part fracture were (1) H+G (S: small fragment) + L-S, (2) H + G (B:big fragment) + L-S, (3) H + G-L + S, (4) H + G (W:whole) + S, and (5) H + L + G-S. Numbers of each group were as follows; 2 part: 11, 3 part (1) : 7, 3 part (2) : 12, 3 part (3) : 10, 3 part (4) : 2, 3 part (5) : 3, 4 part : 3. 3 part (3), (4), (5) and 4 part are considered as unstable, however, 6 cases in these groups were classified in A1–1 or A1–2 stable fracture in AO classification. 10 fractures in Evans and 5 fractures in Jensen classification classified as stable were unstable in CT evaluation.

It is sometimes very difficult to classify the femoral trochanteric fracture by plain X-ray. Classification with 3D-CT is very useful to distinguish which fracture is stable or unstable.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 242 - 242
1 Sep 2012
Shoda E Ouchi K Maruyama S Suzuki A Kitada S
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INTRODUCTION

Short femoral nail is the most popular instrumentation for femoral trochanteric fractures. PFNA is in widely use and good results are reported. In these papers, fracture classification and evaluation of surgical results were based on plain X-ray. However, some cases of delayed union, non-union, and blade cut out showed no critical problems in immediate postoperative X-ray. Cause of these complications was not able to solve in X-ray analysis. CT scan provides more information about fracture pattern and position of nail and blade. CT analysis is likely to solve the cause of these complications.

MATERIALS & METHODS

20 cases of 36 femoral trochanteric fractures treated with PFNA-II were evaluated by CT scan (pre and post surgery). Four males and 16 females, and average age at surgery was 80.5 (65–100). Eleven cases were A1 fracture and 9 cases were A2 fracture in AO classification.

Nail insertion hole was made by custom made Hollow Reamer.

Fracture classification with 3D-CT (Nakano's classification), position of nail insertion hole (relationship between neck or head), and postoperative evaluation with 3D-CT insertion part of nail and blade were investigated.