Kenta Momii1, Toshifumi Fujiwara2, Takao Mae3, Masami Tokunaga4, Takeshi Iwasaki5, Kyohei Shiomoto1, Kensuke Kubota1, Toshihiro Onizuka6, Tatsuhiko Miura7, Takahiro Hamada8, Tetsuro Nakamura9, Takashi Itokawa10, Takahiro Iguchi11, Akihisa Yamashita12, Naoshi Kikuchi13, Kazutoshi Nakaie14, Yoshihiro Matsumoto1, Yasuharu Nakashima1. 1. Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan. 2. Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan. Electronic address: to-fu-a@ortho.med.kyushu-u.ac.jp. 3. Department of Orthopaedic Surgery, Saga Prefectural Hospital Koseikan, 400, Ohaza Nakabaru, Kase-Town, Saga, Japan. 4. Department of Orthopaedic Surgery, Fukuoka Orthopaedic Hospital, 2-10-50 Yanagouchi, Minami-ku, Fukuoka, Japan. 5. Department of Anatomic Pathology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan. 6. Department of Orthopaedic Surgery, Kyushu Rosai Hospital, 1-1 Sone north town, Kokura Minami-ku, Kitakyushu city, Japan. 7. Department of Orthopaedic Surgery, Iizuka Hospital, 3-83 Yoshio town, Iizuka city, Fukuoka, Japan. 8. Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1 Shiobaru, Minami-ku, Fukuoka, Japan. 9. Department of Orthopaedic Surgery, Japan Community Healthcare Organization Kyushu Hospital, 1-8-1 Kishinoura, Yahata Nishi-ku, Kitakyushu, Japan. 10. Department of Orthopaedic Surgery, Fukuoka City Hospital, 13-1 Yoshizukamotomachi, Hakata-ku, Fukuoka, Japan. 11. Department of Orthopaedic Surgery, Hamanomachi Hospital, 3-3-1 Nagahama, Chuo-ku, Fukuoka, Japan. 12. Department of Orthopaedic Surgery, Shimonoseki City Hospital, 1-13-1 Kouyouchou, Shimonoseki, Yamaguchi, Japan. 13. Department of Orthopaedic Surgery, Miyazaki Prefectual Miyazaki Hospital, 5-30 Kitatakamatsu town, Miyazaki, Japan. 14. Department of Orthopaedic Surgery, National Hospital Organization Fukuoka-higashi Medical Center, 1-1-1 Chidori, Koga city, Fukuoka, Japan.
Abstract
INTRODUCTION: The application of a load on the internal fixation of a trochanteric fracture exerts a moment along the lag screw, causing the proximal bone fragment to slide along the lag screw, allowing contact between the proximal and distal bone fragments, which promotes healing. However, excessive sliding is related to poor postoperative outcomes. We aimed to identify the risk factors for excessive sliding. MATERIALS AND METHODS: We conducted a multicenter retrospective study including 115 trochanteric fractures sustained through low-energy trauma in 19 male and 96 female patients aged 60 years or older (mean age: 82.9 years) between September 2013 and December 2014. We measured the postoperative sliding distance after osteosynthesis using a sliding hip screw or intramedullary nailing, and classified participants with ≥8 mm of sliding into the excessive sliding group (ESG) and with <8 mm into non-ESG. Finally, we investigated the risk factors of excessive postoperative sliding. RESULTS: Fifty participants were classified into the ESG and 65 participants into the non-ESG. Female sex (p = 0.0264), an A3 fracture type (p = 0.0003), greater tip-apex distance (p = 0.0250), and poor reduction in either the anteroposterior or lateral radiographic views (p = 0.0156) were identified as risk factors for excessive sliding by multivariate regression analysis. CONCLUSIONS: Female sex, an unstable fracture type, a greater tip-apex distance, and a poor reduction, in either the anteroposterior or lateral views, are associated with excessive postoperative sliding. Therefore, surgery should aim to achieve good reduction and stabilization from both radiographic views.
INTRODUCTION: The application of a load on the internal fixation of a trochanteric fracture exerts a moment along the lag screw, causing the proximal bone fragment to slide along the lag screw, allowing contact between the proximal and distal bone fragments, which promotes healing. However, excessive sliding is related to poor postoperative outcomes. We aimed to identify the risk factors for excessive sliding. MATERIALS AND METHODS: We conducted a multicenter retrospective study including 115 trochanteric fractures sustained through low-energy trauma in 19 male and 96 female patients aged 60 years or older (mean age: 82.9 years) between September 2013 and December 2014. We measured the postoperative sliding distance after osteosynthesis using a sliding hip screw or intramedullary nailing, and classified participants with ≥8 mm of sliding into the excessive sliding group (ESG) and with <8 mm into non-ESG. Finally, we investigated the risk factors of excessive postoperative sliding. RESULTS: Fifty participants were classified into the ESG and 65 participants into the non-ESG. Female sex (p = 0.0264), an A3 fracture type (p = 0.0003), greater tip-apex distance (p = 0.0250), and poor reduction in either the anteroposterior or lateral radiographic views (p = 0.0156) were identified as risk factors for excessive sliding by multivariate regression analysis. CONCLUSIONS: Female sex, an unstable fracture type, a greater tip-apex distance, and a poor reduction, in either the anteroposterior or lateral views, are associated with excessive postoperative sliding. Therefore, surgery should aim to achieve good reduction and stabilization from both radiographic views.