Primary Arthroplasty for Unstable and Failed Intertrochanteric Fractures: Role of Multi-Planar Trochanteric Wiring Technique.

Javahir A Pachore, Vikram Indrajit Shah, Sachin Upadhyay, Shrikunj Babulal Patel
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Abstract

Purpose: The primary objective of the current study is to demonstrate the trochanteric wiring technique. A secondary objective is to evaluate the clinico-radiological outcomes of use of the wiring technique during primary arthroplasty for treatment of unstable and failed intertrochanteric fractures.

Materials and methods: A prospective study including follow-up of 127 patients with unstable and failed intertrochanteric fractures who underwent primary hip arthroplasty using novel multi-planar trochanteric wiring was conducted. The average follow-up period was 17.8±4.7 months. Clinical assessment was performed using the Harris hip score (HHS). Radiographic evaluation was performed for assessment of union of the trochanter and any mechanical failure. P<0.05 was considered statistically significant.

Results: At the latest follow-up, the mean HHS showed significant improvement from 79.9±1.8 (at three months) to 91.6±5.1 (P<0.05). In addition, no significant difference in the HHS was observed between male and female patients (P=0.29) and between fresh and failed intertrochanteric fractures (P=0.08). Union was achieved in all cases of fractured trochanter, except one. Wire breakage was observed in three patients. There were five cases of limb length discrepancy, three cases of lurch, and three cases of wire-related bursitis. There were no cases of dislocation or infection. Radiographs showed stable prosthesis in situ with no evidence of subsidence.

Conclusion: Use of the proposed wiring technique was helpful in restoring the abductor level arm and multi-planar stability, which enabled better rehabilitation and resulted in excellent clinical and radiological outcomes with minimal risk of mechanical failure.

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不稳定和失败的转子间骨折的初次关节置换术:多平面转子连接技术的作用。
目的:本研究的主要目的是演示转子连接技术。第二个目的是评估在初次关节置换术中使用钢丝技术治疗不稳定和失败的转子间骨折的临床放射学结果。材料和方法:对127例不稳定和失败的转子间骨折患者行新型多平面转子钢丝置换术进行前瞻性随访研究。平均随访时间17.8±4.7个月。临床评估采用Harris髋关节评分(HHS)。影像学检查评估股骨粗隆愈合和任何机械故障。结果:最新随访时,HHS平均值由79.9±1.8(3个月时)提高至91.6±5.1 (PP=0.29),新鲜骨折与失败骨折之间的差异有统计学意义(P=0.08)。除1例外,所有股骨粗隆骨折病例均愈合。3例患者出现钢丝断裂。其中肢体长度不一致5例,跛行3例,钢丝相关性滑囊炎3例。无脱位或感染病例。x线片显示假体原位稳定,无下沉迹象。结论:采用所提出的内固定技术有助于恢复外展水平臂和多平面稳定性,使康复效果更好,临床和放射学结果良好,机械故障风险最小。
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