J Korean Fract Soc.  2013 Jul;26(3):173-177. 10.12671/jkfs.2013.26.3.173.

The Character of Reverse Obliquity Intertrochanteric Fractures in Elderly Patients

• Kim JW
• Chang JS
• Sung JH
• Kim JJ

• KMID: 1431660
• DOI: http://doi.org/10.12671/jkfs.2013.26.3.173

Abstract

PURPOSE
To discriminate the characteristics between reverse obliquity fractures in the elderly and that of young adults using three-dimensional computed tomography (3D CT).
MATERIALS AND METHODS
Eighteen patients who had reverse obliquity intertrochanteric fractures were enrolled from January 2007 to March 2012. The fracture pattern was analyzed using the 3D CT. The area showing low density (bone defect) of trochanter and femoral neck region was measured. Patients were divided into two groups: Group I, less than 65 years old and Group 2, 65 years and over.
RESULTS
In all 9 cases of group 1, the proximal fragment had a 'V' shape with an average of 5.6 cm below the vastus ridge; however, the fracture of 8 cases (88.97%) in group 2 had a 'Lambda' shape of the distal fragment at the level of vastus ridge and an additional fracture line extending to the greater trochanter tip. The bone defect volume of the trochanter and femoral neck region was larger significantly in group 2 than in group 1.
CONCLUSION
Reverse obliquity intertrochanteric fracture in the elderly demonstrated a pattern of bursting fracture with 4 parts, which had different patterns from that of young patients. We believe that the larger volume of bone defects resulted in the difference of fracture patterns between the two groups.

Keyword

Femur; Hip fracture; Reverse obliquity fracture; Fracture pattern

MeSH Terms

Aged
Femur
Femur Neck
Hip Fractures
Humans
Young Adult

Figure

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  Fig. 1 (A) Region of interest in trochanter from the greater trochanter tip to the upper part of lesser trochanter. (B) Measurement of bone defect of the trochanter and femoral neck region.

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  Fig. 2 Three-dimensional image of reverse obliquity fracture in the young group (group 1). (A) Anterior-posterior view showing a typical reverse obliquity pattern. (B) Lateral view showing a 'V' shape apex of proximal fragment.

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  Fig. 3 Three-dimensional image of reverse obliquity fracture in the elderly group (group 2). (A) Anterior-posterior view showing a typical reverse obliquity pattern with additional fracture line along the trochanteric line. (B) Lateral view showing a 'Λ' shape apex of distal fragment and additional vertical splitting of the greater trochanter.

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