Objectives. Different criteria for assessing the reduction quality of trochanteric fractures have been reported. The Baumgaertner reduction quality criteria (BRQC) are relatively common and the Chang reduction quality criteria (CRQC) are relatively new. The objectives of the current study were to compare the reliability of the BRQC and CRQC in predicting mechanical complications and to investigate the clinical implications of the CRQC. Methods. A total of 168 patients were assessed in a retrospective observational study. Clinical information including age, sex, fracture side, American Society of Anesthesiologists (ASA) classification, tip-apex distance (TAD), fracture classification, reduction quality, blade position, BRQC, CRQC, bone quality, and the occurrence of mechanical complications were used in the statistical analysis. Results. A total of 127 patients were included in the full analysis, and mechanical complications were observed in 26 patients. The
Aims. To develop a core outcome set of measurements from postoperative radiographs that can be used to assess technical skill in performing dynamic hip screw (DHS) and hemiarthroplasty, and to validate these against Van der Vleuten’s criteria for effective assessment. Methods. A Delphi exercise was undertaken at a regional major trauma centre to identify candidate measurement items. The feasibility of taking these measurements was tested by two of the authors (HKJ, GTRP). Validity and reliability were examined using the radiographs of operations performed by orthopaedic resident participants (n = 28) of a multicentre randomized controlled educational trial (ISRCTN20431944). Trainees were divided into novice and intermediate groups, defined as having performed < ten or ≥ ten cases each for DHS and hemiarthroplasty at baseline. The procedure-based assessment (PBA) global rating score was assumed as the gold standard assessment for the purposes of concurrent validity. Intra- and inter-rater reliability testing were performed on a random subset of 25 cases. Results. In total, 327 DHS and 248 hemiarthroplasty procedures were performed by 28 postgraduate year (PGY) 3 to 5 orthopaedic trainees during the 2014 to 2015 surgical training year at nine NHS hospitals in the West Midlands, UK. Overall, 109 PBAs were completed for DHS and 80 for hemiarthroplasty. Expert consensus identified four ‘final product analysis’ (FPA) radiological parameters of technical success for DHS: tip-apex distance (TAD); lag screw position in the femoral head; flushness of the plate against the lateral femoral cortex; and eight-cortex hold of the plate screws. Three parameters were identified for hemiarthroplasty: leg length discrepancy; femoral stem alignment; and femoral offset. Face validity, content validity, and feasibility were excellent. For all measurements, performance was better in the intermediate compared with the novice group, and this was statistically significant for
This study aimed to determine whether lateral femoral wall thickness (LWT) < 20.5 mm was associated with increased revision risk of intertrochanteric fracture (ITF) of the hip following sliding hip screw (SHS) fixation when the medial calcar was intact. Additionally, the study assessed the association between LWT and patient mortality. This retrospective study included ITF patients aged 50 years and over treated with SHS fixation between 2019 and 2021 at a major trauma centre. Demographic information, fracture type, delirium status, American Society of Anesthesiologists grade, and length of stay were collected. LWT and tip apex distance were measured. Revision surgery and mortality were recorded at a mean follow-up of 19.5 months (1.6 to 48). Cox regression was performed to evaluate independent risk factors associated with revision surgery and mortality.Aims
Methods
The objective of this study was to investigate bone healing after
internal fixation of displaced femoral neck fractures (FNFs) with
the Dynamic Locking Blade Plate (DLBP) in a young patient population
treated by various orthopaedic (trauma) surgeons. We present a multicentre prospective case series with a follow-up
of one year. All patients aged ≤ 60 years with a displaced FNF treated
with the DLBP between 1st August 2010 and December 2014 were included.
Patients with pathological fractures, concomitant fractures of the
lower limb, symptomatic arthritis, local infection or inflammation,
inadequate local tissue coverage, or any mental or neuromuscular
disorder were excluded. Primary outcome measure was failure in fracture
healing due to nonunion, avascular necrosis, or implant failure
requiring revision surgery.Aims
Patients and Methods
The purpose of this study was to identify factors
that predict implant cut-out after cephalomedullary nailing of intertrochanteric
and subtrochanteric hip fractures, and to test the significance
of calcar referenced tip-apex distance (CalTAD) as a predictor for
cut-out. We retrospectively reviewed 170 consecutive fractures that had
undergone cephalomedullary nailing. Of these, 77 met the inclusion
criteria of a non-pathological fracture with a minimum of 80 days
radiological follow-up (mean 408 days; 81 days to 4.9 years). The
overall cut-out rate was 13% (10/77). The significant parameters in the univariate analysis were tip-apex
distance (TAD) (p <
0.001), CalTAD (p = 0.001), cervical angle
difference (p = 0.004), and lag screw placement in the anteroposterior
(AP) view (Parker’s ratio index) (p = 0.003). Non-significant parameters
were age (p = 0.325), gender (p = 1.000), fracture side (p = 0.507),
fracture type (AO classification) (p = 0.381), Singh Osteoporosis
Index (p = 0.575), lag screw placement in the lateral view (p =
0.123), and reduction quality (modified Baumgaertner’s method) (p = 0.575).
In the multivariate analysis, CalTAD was the only significant measurement
(p = 0.001). CalTAD had almost perfect inter-observer reliability
(interclass correlation coefficient (ICC) 0.901). Our data provide the first reported clinical evidence that CalTAD
is a predictor of cut-out. The finding of CalTAD as the only significant
parameter in the multivariate analysis, along with the univariate
significance of Parker’s ratio index in the AP view, suggest that
inferior placement of the lag screw is preferable to reduce the
rate of cut-out. Cite this article:
We undertook a multicentre, prospective study of a series of 112 unstable trochanteric fractures in order to evaluate if internal fixation with a sliding screw device combined with augmentation using a calcium phosphate degradable cement (Norian SRS) could improve the clinical, functional and radiological outcome when compared with fractures treated with a sliding screw device alone. Pain, activities of daily living, health status (SF-36), the strength of the hip abductor muscles and radiological outcome were analysed. Six weeks after surgery, the patients in the augmented group had significantly lower global and functional pain scores (p <
0.003), less pain after walking 50 feet (p <
0.01), and a better return to the activities of daily living (p <
0.05). At follow-up at six weeks and six months, those in the augmented group showed a significant improvement compared with the control group in the SF-36 score. No other significant differences were found between the groups. We conclude that augmentation with calcium phosphate cement in unstable trochanteric fractures provides a modest reduction in pain and a slight improvement in the quality of life during the course of healing when compared with conventional fixation with a sliding screw device alone.