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Simple guidelines for evaluating intraoperative alignment after the reduction of intertrochanteric fractures

Journal

ASIAN JOURNAL OF SURGERY
Volume 44, Issue 1, Pages 66-71

Publisher

ELSEVIER SINGAPORE PTE LTD
DOI: 10.1016/j.asjsur.2020.10.010

Keywords

3D modeling; Anterior cortical line; Anteversion; Greater trochanter orthogonal line; Intertrochanteric fractures; Neck-shaft angle

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The study provides reliable parameters obtained from analyses of three-dimensional computed tomography images from cadavers to serve as guidelines during the reduction of intertrochanteric fractures. The GTOL and anterior cortical line correlates with specific levels of the femoral head in most samples and are associated with angular alignments. The intraoperative use of these imaginary lines can improve the quality of fracture reduction.
The incidence of intertrochanteric femoral fractures has rapidly increased with the extended lifespan of the elderly population. Surgery enables early ambulation by achieving anatomic reduction and stable internal fixation. However, reduction usually involves postoperative evaluation. Here, we present reliable parameters obtained from analyses of three-dimensional computed tomography images from cadavers to serve as guidelines during the reduction of intertrochanteric fractures. We included 184 three-dimensional modeling samples from cadavers placed in two standardized positions, similar to C-arm imaging. We recorded the level of the orthogonal line from the greater trochanter (GT) tip to the femoral head (GT orthogonal line [GTOL]) in the anteroposterior view and the line along the anterior femoral cortex passing through the femoral head (anterior cortical line) in the axial view. Correlations between these lines and angular alignments were statistically determined. The GTOL passed above the femoral head center at mean 2.36 mm in all patients; 77.17% of such instances were in the upper second quadrant of the femoral head. The anterior cortical line passed under the femoral head center at mean 10.82 mm; 73.37% of such instances were in the inferior one-third of the femoral head. Consistent correlations were found between the GTOL and neck-shaft angle and between the anterior cortical line and anteversion. The GTOL and anterior cortical line passed through a constant level of the femoral head in most samples and were correlated with angular alignments. The intraoperative use of these simple imaginary lines improves the intertrochanteric fracture reduction quality. (C) 2020 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V.

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