Analysis of Low-Energy Trochanter Fracture Using the Multiplanar Computed Tomography Image: Application for Intramedullary Nail Fixation

Gu-Hee Jung; Sung-Keun Heo; Hyun-Je Seo

doi:10.12671/jkfs.2015.28.3.155

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Jung, Heo, and Seo: Analysis of Low-Energy Trochanter Fracture Using the Multiplanar Computed Tomography Image: Application for Intramedullary Nail Fixation

Original Article

Journal of the Korean Fracture Society 2015; 28(3): 155-162.

Published online: 22 July 2015

DOI: https://doi.org/10.12671/jkfs.2015.28.3.155

Analysis of Low-Energy Trochanter Fracture Using the Multiplanar Computed Tomography Image: Application for Intramedullary Nail Fixation

Gu-Hee Jung, M.D., Ph.D., Sung-Keun Heo, M.D., Ph.D.^*, Hyun-Je Seo, M.D.

Department of Orthopaedic Surgery, Kosin University College of Medicine, Busan, Korea.

^*Department of Orthopaedic Surgery, Gijang Hospital, Busan, Korea.

Address reprint requests to: Gu-Hee Jung, M.D., Ph.D. Department of Orthopaedic Surgery, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 602-702, Korea. Tel: 82-51-990-6467, Fax: 82-51-243-0181, jyujin2001@kosin.ac.kr

Received 16 March 2015 Revised 24 April 2015 Accepted 8 May 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this radiologic study was to evaluate the geographic patterns of low-energy trochanteric fractures using multiplanar computed tomography (CT) images for application of intramedullary nailing.

Materials and Methods

In this study, 117 trochanteric fractures (stable fracture, 39 cases, unstable fractures, 78 cases) sustained from simple slip-down were assessed. The mean age was 78.4 years (range, 60-96 years). Multiplanar CT images were assessed for evaluation of geographic features of trochanteric fracture, and the fracture exit and geographic patterns were analyzed.

Results

The medial and lateral exit of the trochanteric fracture showed no statistical difference by age, bone density, and comorbid disease. The exit was located at an average distance of 10.2 mm (range, 1.0-22.2 mm) from the tip of the greater trochanter (GT), and the medial exit, average distance of 8.1 mm (range, 0.0-18.3 mm) from the tip of the lesser trochanter. It was also found that there was no comminution around the anteromedial cortex of the fracture, and its contact loss was from fracture deformity.

Conclusion

Because of no comminution, the contact restoration of the anteromedial cortex resulted in correction of fracture deformity and reduction. Trochanteric nailing by GT tip could be fixed through the proximal fragment of the fracture because the lateral exit is placed at an average distance of 10.2 mm from the GT tip.

Keywords: Femur, Trochanteric fracture, Intramedullary nail fixation

Figures and Tables

Fig. 1

Images of a trochanter fracture overlap each other (A, B) using Photoshop CS6® according to 50% opacity (C) and 20% opacity (D).

Fig. 2

Image of an overlapped trochanter fracture on a normal femur image. The lateral exit of the trochanteric fracture is located at an average distance of 10.2 mm without lateral wall fracture and not below the vastus ridge.

Fig. 3

Image of an overlapped trochanter fracture on a normal femur image. The medial exit is located at an average distance of 8.1 mm.

Fig. 4

The anteromedial cortex of the trochanter fracture was not comminuted, and however, showed several types.

Fig. 5

Immediate postoperative radiographs show that the proximal fragment of the trochanter fracture is displaced and widened inferiorly because of incorrect intramedullary nail insertion along the fracture site.

Table 1

Summary of Demographic Data (n=117)

Values are presented as number only or median (range).

Table 2

Summary of the Outcomes (n=117)

^*Vertical distance from greater trochanter to fracture line. ^†Vertical distance from proximal boundary of lesser trochanter to fracture line. ^‡The angle between the fracture line of the distal fragment and anatomical axis of the femur.

Notes

^{Financial support} None.

^{Conflict of interest} None.

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