Zhen Wei1, Shiyi Chen1, Shimin Zhang2. 1. Department of Orthopedic Surgery, Yangpu Hospital, Tongji University, Shanghai, 200090, P.R.China. 2. Department of Orthopedic Surgery, Yangpu Hospital, Tongji University, Shanghai, 200090, P.R.China.shiminchang11@aliyun.com.
Abstract
OBJECTIVE: To introduce the reduction concept of anteromedial cortical support in the treatment of intertrochanteric fracture, summarize the history, characteristics, biomechanics, and clinical applications, discuss the unsolved problems and prospect the future directions. METHODS: Relevant domestic and foreign studies on cortical support reduction of intertrochanteric fracture in recent years were reviewed. Conclusions were drawn combined with clinical experience. RESULTS: The positive cortical supportive reduction of intertrochanteric fracture, as a stable non-anatomical fracture reduction technique, has dual effects on mechanical buttress and biological bone healing. It does not increase the difficulty of doctors' surgical procedure. For patients, it decreases the loss of femoral neck length, the loss of neck-shaft angle, the incidence rate of coxa vara, and maintains stable mechanical structure of the pelvis. It also shows a lower rate of instrument-related complications, and higher limb function scores. The mechanical stability of medial cortex apposition is more important than that of anterior cortex. For the best stability of the fracture, both sides should get positive support reduction pattern. CONCLUSION: Anteromedial cortical support reduction can improve the postoperative stability of intertrochanteric fracture, enable better imaging and functional prognosis. As a kind of non-anatomic form of functional reduction, it can be used as a suboptimal choice secondary to anatomic reduction.
OBJECTIVE: To introduce the reduction concept of anteromedial cortical support in the treatment of intertrochanteric fracture, summarize the history, characteristics, biomechanics, and clinical applications, discuss the unsolved problems and prospect the future directions. METHODS: Relevant domestic and foreign studies on cortical support reduction of intertrochanteric fracture in recent years were reviewed. Conclusions were drawn combined with clinical experience. RESULTS: The positive cortical supportive reduction of intertrochanteric fracture, as a stable non-anatomical fracture reduction technique, has dual effects on mechanical buttress and biological bone healing. It does not increase the difficulty of doctors' surgical procedure. For patients, it decreases the loss of femoral neck length, the loss of neck-shaft angle, the incidence rate of coxa vara, and maintains stable mechanical structure of the pelvis. It also shows a lower rate of instrument-related complications, and higher limb function scores. The mechanical stability of medial cortex apposition is more important than that of anterior cortex. For the best stability of the fracture, both sides should get positive support reduction pattern. CONCLUSION: Anteromedial cortical support reduction can improve the postoperative stability of intertrochanteric fracture, enable better imaging and functional prognosis. As a kind of non-anatomic form of functional reduction, it can be used as a suboptimal choice secondary to anatomic reduction.
Authors: Steven A Olson; Geoffrey Schemitsch; Michael Morwood; Emil Schemitsch; Thomas A Russell; Loren L Latta Journal: J Orthop Trauma Date: 2015-12 Impact factor: 2.512