Cut Out Complications and Anisomelia of the Lower Limbs In Surgery With Valgus Reduction for Intertrochanteric Fractures
Keywords:Fractures of the femur, Orthopedic Surgery, Orthopedic fixation devices, Fracture fixation, Post-operative complications, Elderly
Background: The proximal fractures of the femur are counted among the group of orthopedic and traumatic pathologies which consume most of the financial resources set aside for health worldwide. Surgical treatment continues to be the treatment of choice for intertrochanteric fractures of the femur. However, although the surgical treatment of the proximal fracture of the femur is widely known and accepted in the orthopedic field, it is not without risk with the cut out being the most feared complication. Objective: This paper describes the complications of cut out or the anisomelia of the lower limbs of patients with intertrochanteric fractures who underwent valgus reduction surgery. Method: Sixty-one patients with 3rd and 4th degree, according to Tronzo classification, intertrochanteric fractures underwent surgery with the use of Dynamic hip screw type sliding screw and valgus reduction. The data were analyzed one year after surgery, when a functional assessment was made by scanometry, Tip-Apex Distance index diaphyseal cervical angle and the modified Merle d'AubignÃ© & Postel questionnaire. Kruskal-Wallis and Mann-Whitney tests were used for the statistical analysis, Spearmanâ€™s correlation test for the quantitative variables and the chi-squared test for the qualitative variables. Results: The correlation between the Tip-Apex Distance index and the diaphyseal cervical angle was statistically significant (rho=0.391, p=0.002), while the correlations between the Tip-Apex Distance index and the scanometry and the diaphyseal cervical angle and the scanometry were not significantly correlated. In accordance with the modified Merle dâ€™AubignÃ© & Postel questionnaire, 23 patients (37.7%) achieved a very good result, 29 patients (47.5%) had a good result, five patients (8.2%) obtained a moderately good result, one patient (1.6%) presented a reasonable result and three patients (4.9%) obtained a poor result. Conclusion: No cut out complications occurred in the 3rd and 4th degree intertrochanteric fractures with a Baumgaertner index â‰¥ 25 mm, when the reduction and valgus fixation of the intertrochanteric fracture was performed with the Dynamic hip screw type sliding pin, as there was also, in the majority of patients, no anisomelia of the lower limbs.
Balasegaram S, Majeed A, Fitz-Clarence H: Trends in hospital admissions for fractures of the hip and femur in England, 1989â€“1990 to 1997â€“1998. J Public Health Med 2001, 23(1):11-17.
Saudan M, Lubbeke A, Sadowski C, Riand N, Stern R, Hoffmeyer P: Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma 2002,16(6):386-393.
McCarthy, J. C. "SUBCAPITAL FRACTURES: A CHANGING PARADIGM." Bone & Joint Journal Orthopaedic Proceedings Supplement. 2013. 95(22): 16.
Koberle G: Fraturas intertrocantÃ©ricas. Rev Bras Ortop 2001, 36(9):325-329.
Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA 2009; 302:1573
Fujiki EN, Honda EK, Ohara GH: Estudo prospectivo e comparativo das fraturas intertrocantÃ©ricas, tratadas com o pino-parafuso de Pinto de Souza e parafuso deslizante DHS. Acta Ortop Bras 1994, 2:143-148.
Behrendt C, Faleiro TB, Schulz RDS, Silva BOD, Paula EQD. Repruducibility of tronzo and ao/asif classifications for transtrochanteric fractures. Acta Ortopedica Brasileira 2014;22(5):275-277. doi:10.1590/1413-78522014220500884
Tronzo RG (Ed): Surgery of the hip joint. Philadelphia Lea and Febiger; 1973.
Baumgaertner M, Curtin S, Lindskog D, Keggi J: The value of the tip-apex-distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 1995, 77(7):1058-1064.
Werlang HZ, Oliveira GA, Tamelini AM, Madalosso BH, Maciel Jr FS: Escanometria dos membros inferiores: revisitando Dr. Juan Farril. Radiol Bras 2007, 40(2):137-141.
Ugino FK, Righetti CM, Alves DPL, GuimarÃ£es RP, Honda EK, Ono NK: AvaliaÃ§Ã£o da confiabilidade do mÃ©todo Merle Dâ€™AubignÃ© e Postel Modificado. Acta Ortop Bras 2012, 20(4):213-217.
Charnley J. The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surg Br. 1972;54B(1):61-76.
Nieves JW, Bilezikian JP, Lane JM, Einhorn TA, Wang Y, Steinbuch M, Cosman F: Fragility fractures of the hip and femur: incidence and patient characteristics. Osteoporos Int 2010, 21(3):399-408.
Johnell O, Kanis JA: An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int 2006, 17(12):1726-1733.
Canto RST, Sakaki M, Susuki I, Tucci P, Belangero W, Kfuryi Jr M, Skaf AY: Sociedade Brasileira de Ortopedia e Traumatologia. Fratura IntertrocantÃ©rica. Rev Assoc Med Bras 2009, 55(6):631-641.
Mohan R, Karthikeyan R, Sonanis SV: Dynamic hip screw: Does side make a difference? Effects of clockwise torque on right and left DHS. Injury 2000, 31(9):697-699.
Chirodian N, Arch B, Parker MJ: Sliding Hip Screw Fixation of Trochanteric Hip Fractures: Outcome of 1024 Procedures. Injury 2005, 36(6):793-800.
Baumgartner MR, Solberg BD: Awareness of tip-apex-distance reduces failure of fixation of trochanteric fractures of the hip. J Bone Joint Surg Br 1997, 79(6):969-971.
Rao JP, Banzon MT, Weiss AB, Rayhack J: Treatment of unstable intertrochanteric fractures with anatomic reduction and compression hip screw fixation. Clin Orthop Relat Res 1983, 175:65-71.
Malkani AL, Karandikar N: Revision fixation for failed intertrochanteric fractures. Techniques in Orthopaedics 2002, 17(4):443-447.
Jones HW, Johnston P, Parker M: Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures. Int Orthop 2006, 30(2):69-78.
Olsson O, Ceder L, Hauggaard A: Femoral shortening in intertrochanteric fractures. A comparison between the Medoff sliding plate and the compression hip screw. J Bone Joint Surg Br 2001, 83(4):572-578.
Papasimos S, Koutsojannis CM, Panagopoulos A, Megas P, Lambiris E. A randomised comparison of AMBI, TGN and PFN for treatment of unstable trochanteric fractures. Arch Orthop Trauma Surg 2005;125:462-8.
Endo Y, Aharonoff GB, Zucherman JD, Egol KA, Koval KJ: Gender differences in patients with hip fracture: a greater risk of morbidity and mortality in men. J Orthop Trauma 2005, 19(1):29-35.
Cornwall R, Gilbert MS, Koval KJ, Strauss E, Siu AL: Functional outcomes and mortality vary among different types of hip fractures. Clin Orthop Relat Res 2004, 425:64-71.
Campbell AC, Goyal S, Miller NJK, Sinha S: New technique for revising dynamic hip screw fixations with lag screw in situ. J Orthop Trauma 2010, 24(10):653-655.
Lucke M, Burghardt RD, Siebenlist S, Ganslmeier A, Stockle U: Medial migration of lag screw with intrapelvic dislocation in gamma nailing - a unique problem? A report of 2 cases. J Orthop Trauma 2010, 24(2):e6-e11.
Gotfried Y: The lateral trochanteric wall. Clin Orthop Relat Res 2004, 425:82-86.
Yoo MC, Cho YJ, Kim Kl, Khairuddin M, Chul YS: Treatment of unstable peritrochanteric femoral fractures using a 95-degree angled blade plate. J Orthop Trauma 2005, 19(10):687-692.
.Branlet DG: Use of the talon hip compression screw in intertrochanteric fractures of the hip. Clin Orthop Relat Res 2004, 425:93-100.
Bramlet DG, Wheeler D: Biomechanical evaluation of a new type of hip compression screw with retractable talons. J Orthop Trauma 2003, 17(9):618-624.
BartonÃÄek J, SkÃ¡la-Rosenbaum J, Dousa P: Valgus intertrochanteric osteotomy for malunion and nonunion of trochanteric fractures. J Orthop Trauma 2003, 17(9):606-612.
Thorngren K-G: National registration of hip fractures in Sweden. In European Instructional Lectures. Edited by Bentley G. 2009, 9:11-18.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under aÂ Creative Commons Attribution LicenseÂ that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeÂ The Effect of Open AccessÂ and Benefits of Publishing Open Access).