Does Hip Abduction during Intramedullary Nail Fixation Help Correct Residual Varus Alignment in Subtrochanteric Fractures? A Retrospective Cohort Study.

IF 1.9 2区 医学 Q2 ORTHOPEDICS
Clinics in Orthopedic Surgery Pub Date : 2025-04-01 Epub Date: 2025-03-14 DOI:10.4055/cios24271
Incheol Kook, Young Woon Gil, Kyu Tae Hwang
{"title":"Does Hip Abduction during Intramedullary Nail Fixation Help Correct Residual Varus Alignment in Subtrochanteric Fractures? A Retrospective Cohort Study.","authors":"Incheol Kook, Young Woon Gil, Kyu Tae Hwang","doi":"10.4055/cios24271","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Varus malalignment is a risk factor for nonunion and mechanical complications in subtrochanteric femoral fractures (SFFs). Although various reduction techniques have been reported to avoid varus malalignment in SFFs, achieving anatomic reduction remains challenging, often resulting in residual varus alignment (RVA) after reduction. This study aimed to investigate the radiographic and clinical outcomes of a novel method resolving RVA by abducting the ipsilateral hip after cephalomedullary fixation with an intramedullary nail and subsequently inserting distal interlocking screws.</p><p><strong>Methods: </strong>This retrospective study, conducted between March 2016 and March 2022, included patients who underwent hip abduction during intramedullary nailing due to RVA. Demographics and fracture patterns (Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopedic Trauma Association [AO/OTA]) and types (typical or atypical) were analyzed. Radiographic outcomes included Baumgaertner reduction quality criteria (BRQC), tip-apex distance (TAD), neck-shaft angle (NSA), lateral cortex residual gap, union, and time to union. Clinical outcomes included ambulatory level using the Palmer-Parker Mobility Score (PPM), complications, and reoperation.</p><p><strong>Results: </strong>This study included 45 patients (mean age, 65.8 years; mean follow-up period, 18.4 months). The most common fracture pattern was 32A2 in 15 patients and 29 were typical and 16 were atypical fractures. The BRQC was good in 36 patients, and TAD was < 25 mm in 43 patients. Pre-abduction NSA (126.0° ± 3.8°) was significantly smaller than post-abduction NSA (129.9° ± 3.4°, <i>p</i> < 0.001). Post-abduction NSA was comparable to contralateral NSA of 128.9° ± 2.8° (<i>p</i> = 0.155). Residual gap was significantly reduced from 6.1 ± 2.9 mm pre-abduction to 1.7 ± 1.0 mm post-abduction (<i>p</i> < 0.001). Union was achieved in 44 patients (97.8%; mean duration, 5.9 months). PPM decreased from 7.8 ± 2.0 pre-injury to 7.0 ± 2.1 1-year postoperatively. One nonunion case required reoperation. Radiographic outcomes did not significantly differ by fracture pattern (<i>p</i> = 0.470 for NSA and <i>p</i> = 0.334 for residual gap).</p><p><strong>Conclusions: </strong>Hip abduction during intramedullary nailing corrects alignment and reduces the gap in SFFs with residual varus alignment. This method can be applied to various fracture patterns in a straightforward manner and considered valuable for managing SFFs.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 2","pages":"194-203"},"PeriodicalIF":1.9000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957815/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinics in Orthopedic Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4055/cios24271","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/14 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Varus malalignment is a risk factor for nonunion and mechanical complications in subtrochanteric femoral fractures (SFFs). Although various reduction techniques have been reported to avoid varus malalignment in SFFs, achieving anatomic reduction remains challenging, often resulting in residual varus alignment (RVA) after reduction. This study aimed to investigate the radiographic and clinical outcomes of a novel method resolving RVA by abducting the ipsilateral hip after cephalomedullary fixation with an intramedullary nail and subsequently inserting distal interlocking screws.

Methods: This retrospective study, conducted between March 2016 and March 2022, included patients who underwent hip abduction during intramedullary nailing due to RVA. Demographics and fracture patterns (Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopedic Trauma Association [AO/OTA]) and types (typical or atypical) were analyzed. Radiographic outcomes included Baumgaertner reduction quality criteria (BRQC), tip-apex distance (TAD), neck-shaft angle (NSA), lateral cortex residual gap, union, and time to union. Clinical outcomes included ambulatory level using the Palmer-Parker Mobility Score (PPM), complications, and reoperation.

Results: This study included 45 patients (mean age, 65.8 years; mean follow-up period, 18.4 months). The most common fracture pattern was 32A2 in 15 patients and 29 were typical and 16 were atypical fractures. The BRQC was good in 36 patients, and TAD was < 25 mm in 43 patients. Pre-abduction NSA (126.0° ± 3.8°) was significantly smaller than post-abduction NSA (129.9° ± 3.4°, p < 0.001). Post-abduction NSA was comparable to contralateral NSA of 128.9° ± 2.8° (p = 0.155). Residual gap was significantly reduced from 6.1 ± 2.9 mm pre-abduction to 1.7 ± 1.0 mm post-abduction (p < 0.001). Union was achieved in 44 patients (97.8%; mean duration, 5.9 months). PPM decreased from 7.8 ± 2.0 pre-injury to 7.0 ± 2.1 1-year postoperatively. One nonunion case required reoperation. Radiographic outcomes did not significantly differ by fracture pattern (p = 0.470 for NSA and p = 0.334 for residual gap).

Conclusions: Hip abduction during intramedullary nailing corrects alignment and reduces the gap in SFFs with residual varus alignment. This method can be applied to various fracture patterns in a straightforward manner and considered valuable for managing SFFs.

髓内钉内固定时髋外展是否有助于纠正转子下骨折残留内翻对准?回顾性队列研究。
背景:股骨转子下骨折(SFFs)的内翻错位是导致骨不连和机械并发症的危险因素。尽管已有各种复位技术报道可避免SFFs的内翻错位,但实现解剖复位仍然具有挑战性,通常会导致复位后的残余内翻对准(RVA)。本研究旨在探讨一种解决RVA的新方法的影像学和临床结果,该方法是在髓内钉头髓内固定后外展同侧髋关节,随后插入远端互锁螺钉。方法:这项回顾性研究于2016年3月至2022年3月进行,纳入了因RVA而在髓内钉期间髋关节外展的患者。分析人口统计学和骨折类型(Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopedic Trauma Association [AO/OTA])和类型(典型或非典型)。影像学结果包括鲍姆加特纳复位质量标准(BRQC)、尖端距离(TAD)、颈轴角(NSA)、外侧皮质残留间隙、愈合和愈合时间。临床结果包括帕尔默-帕克活动能力评分(PPM)的门诊水平、并发症和再手术。结果:本研究纳入45例患者(平均年龄65.8岁;平均随访时间18.4个月)。15例患者中最常见的骨折类型为32A2,其中29例为典型骨折,16例为非典型骨折。36例BRQC良好,43例TAD < 25 mm。绑架前的NSA(126.0°±3.8°)明显小于绑架后的NSA(129.9°±3.4°,p < 0.001)。绑架后的NSA与对侧NSA的128.9°±2.8°相当(p = 0.155)。残余间隙由外展前6.1±2.9 mm显著减少至外展后1.7±1.0 mm (p < 0.001)。44例患者愈合(97.8%;平均持续时间5.9个月)。PPM由伤前7.8±2.0降至术后1年7.0±2.1。1例骨不连需再手术。不同骨折类型的放射学结果无显著差异(NSA为p = 0.470,残余间隙为p = 0.334)。结论:髓内钉术中髋关节外展矫正了内翻残留的SFFs对准,并减少了间隙。该方法可以直接应用于各种裂缝模式,被认为对SFFs的管理很有价值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
3.50
自引率
4.00%
发文量
85
审稿时长
36 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信