J Korean Fract Soc.  2015 Jul;28(3):155-162. 10.12671/jkfs.2015.28.3.155.

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

• Jung GH
• Heo SK
• Seo HJ

• KMID: 2184407
• DOI: http://doi.org/10.12671/jkfs.2015.28.3.155

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.

Keyword

Femur; Trochanteric fracture; Intramedullary nail fixation

MeSH Terms

Bone Density
Congenital Abnormalities
Femur*
Fracture Fixation, Intramedullary
Hip Fractures

Figure

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  Fig. 1 Images of a trochanter fracture overlap each other (A, B) using Photoshop CS6® according to 50% opacity (C) and 20% opacity (D).

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  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.

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  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.

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  Fig. 4 The anteromedial cortex of the trochanter fracture was not comminuted, and however, showed several types.

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  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.

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