Lateral femoral wall thickness in trochanteric hip fractures: a systematic review.

IF 1.3 4区医学 Q3 ORTHOPEDICS

HIP International Pub Date : 2024-09-01 Epub Date: 2024-08-26 DOI:10.1177/11207000241267708

Amr Selim, Nikhil Ponugoti, Ahmed Daoub, Sarah Johnson-Lynn, Shin Jae Rhee

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引用次数: 0

Abstract

Background: Thin lateral femoral wall has been investigated as a sign of instability in trochanteric hip fractures, necessitating lateral wall reconstruction or the use of a cephalomedullary nail (CMN). Various cut-off values have been proposed to guide implant choice. This review aims to determine the clinical significance of the lateral femoral wall thickness (LWT) in trochanteric hip fractures and identify an optimal cut-off value for increased risk of lateral wall (LW) fracture when using Dynamic Hip Screw (DHS).

Methods: A comprehensive search was conducted in databases including Medline, Embase, and the Cochrane library up to July 2023. A predefined strategy was employed, with 5 eligible studies critically appraised using the methodological index for non-randomized studies (MINORS) criteria. Outcomes assessed encompassed the standardised mean difference (SMD) of LWT between the LW fracture and non LW fracture groups, aggregate LWT mean in LW fracture group, and the relation between AO/OTA fracture type with LW fracture utilising the chi-square test.

Results: Among 481 patients from 5 studies, 112 experienced LW fractures, while 369 did not postoperatively. Analysis indicated a significantly lower LWT in the LW fracture group (SMD -1.13, I² = 41.3%, p = 0.146). The mean LWT in the LW fracture group was 18.2 mm, with a 95% confidence interval of 17.29-19.10 mm.

Conclusions: A preoperative thin lateral femoral wall is a critical predictor of fixation failure and suboptimal functional outcomes when using a DHS. Thorough evaluation of pre- and intraoperative x-rays is essential. CMN is recommended over DHS in cases with LWT measurements <19 mm.

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股骨转子间髋部骨折的股骨外侧壁厚度：系统性综述。

背景：据研究，股骨外侧壁薄是转子髋部骨折不稳定的一个信号，需要进行外侧壁重建或使用头髓内钉（CMN）。目前已提出了各种临界值来指导植入物的选择。本综述旨在确定股骨转子间骨折患者股骨侧壁厚度（LWT）的临床意义，并确定使用动态髋螺钉（DHS）时增加侧壁（LW）骨折风险的最佳临界值：方法：对截至 2023 年 7 月的 Medline、Embase 和 Cochrane 图书馆等数据库进行了全面检索。采用预先确定的策略，使用非随机研究方法指数（MINORS）标准对 5 项符合条件的研究进行了严格评估。评估结果包括LWT在LW骨折组和非LW骨折组之间的标准化平均差值（SMD）、LW骨折组的LWT总平均值，以及利用卡方检验（chi-square test）得出的AO/OTA骨折类型与LW骨折之间的关系：在 5 项研究的 481 名患者中，112 人术后出现 LW 骨折，369 人术后未出现 LW 骨折。分析表明，LW骨折组的LWT明显较低（SMD -1.13，I² = 41.3%，p = 0.146）。LW骨折组的平均LWT为18.2毫米，95%置信区间为17.29-19.10毫米：结论：在使用 DHS 时，术前股骨外侧壁过薄是导致固定失败和功能预后不理想的关键因素。对术前和术后X光片进行全面评估至关重要。在有LWT测量值的病例中，建议使用CMN而非DHS

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来源期刊

HIP International 医学-整形外科

CiteScore

4.20

自引率

0.00%

发文量

审稿时长

2 months

期刊介绍： HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice. The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit. HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are: • Biomaterials • Biomechanics • Conservative Hip Surgery • Paediatrics • Primary and Revision Hip Arthroplasty • Traumatology