Research progress on anteromedial cortical positive support reduction in treatment of intertrochanteric fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WEI Zhen , CHEN Shiyi ,  ZHANG Shimin

Department of Orthopedic Surgery, Yangpu Hospital, Tongji University, Shanghai, 200090, P.R.China;

Corresponding author：

ZHANG Shimin, Email: shiminchang11@aliyun.com

Keywords：

Intertrochanteric fracture; fracture reduction; positive cortical support; anteromedial cortex; internal fixation

DOI：

10.7507/1002-1892.201904154

Video：

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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.

Citation： WEI Zhen, CHEN Shiyi, ZHANG Shimin. Research progress on anteromedial cortical positive support reduction in treatment of intertrochanteric fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(10): 1216-1222. doi: 10.7507/1002-1892.201904154 Copy

1.	张世民, 胡孙君, 张立智, 等. 老年髋部转子间骨折. 北京: 科学出版社, 2019: 30-31.
2.	Tang P, Hu F, Shen J, et al. Proximal femoral nail antirotation versus hemiarthroplasty: A study for the treatment of intertrochanteric fractures. Injury, 2012, 43(6): 876-881.
3.	Li AB, Zhang WJ, Wang J, et al. Intramedullary and extramedullary fixations for the treatment of unstable femoral intertrochanteric fractures: a meta-analysis of prospective randomized controlled trials. Int Orthop, 2017, 41(2): 403-413.
4.	Olson SA, Schemitsch G, Morwood M, et al. Hot topics in biomechanics: hip fracture fixation. J Orthop Trauma, 2015, 29(Suppl 12): S1-S5.
5.	Sernbo I, Johnell O, Gentz CF, et al. Unstable intertrochanteric fractures of the hip. Treatment with Ender pins compared with a compression hip-screw. J Bone Joint Surg (Am), 1988, 70(9): 1297-1303.
6.	Baumgaertner MR, Curtin SL, Lindskog DM, et al. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg (Am), 1995, 77(7): 1058-1064.
7.	Fogagnolo F, Kfuri M Jr, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg, 2004, 124(1): 31-37.
8.	Ramanoudjame M, Guillon P, Dauzac C, et al. CT evaluation of torsional malalignment after intertrochanteric fracture fixation. Orthop Traumatol Surg Res, 2010, 96(8): 844-848.
9.	Kim TY, Lee YB, Chang JD, et al. Torsional malalignment, how much significant in the trochanteric fractures? Injury, 2015, 46(11): 2196-2200.
10.	Gotfried Y. The Gotfried (nonanatomic, closed) reduction of unstable subcapital femoral fractures. Tech Orthop, 2012, 27(4): 259-261.
11.	Gotfried Y, Kovalenko S, Fuchs D. Nonanatomical reduction of displaced subcapital femoral fractures (Gotfried reduction). J Orthop Trauma, 2013, 27(11): e254-e259.
12.	Zhang YQ, Chang SM. Mechanism of " Gotfried reduction” in femoral neck fracture. J Orthop Trauma, 2013, 27(12): e291.
13.	丁舒晨, 虞荣斌, 葛云林, 等. Gotfried 阳性支撑复位结合空心螺钉内固定治疗中青年股骨颈骨折的近期疗效. 中华创伤骨科杂志, 2016, 18(8): 655-661.
14.	王琦, 高波, 张禹. Gotfried 阳性支撑复位联合内固定治疗股骨颈骨折一年随访观察. 中国实用医刊, 2017, 44(21): 35-38.
15.	Xiong WF, Chang SM, Zhang YQ, et al. Inferior calcar buttress reduction pattern for displaced femoral neck fractures in young adults: a preliminary report and an effective alternative. J Orthop Surg Res, 2019, 14(1): 70.
16.	张世民, 张英琪, 李清, 等. 内侧皮质正性支撑复位对老年股骨粗隆间骨折内固定效果的影响. 中国矫形外科杂志, 2014, 22(14): 1256-1261.
17.	Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg, 2015, 135(6): 811-818.
18.	Nie B, Chen X, Li J, et al. The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study. J Orthop Surg Res, 2017, 12(1): 197.
19.	李双, 张世民, 张立智, 等. 不同组合前内侧皮质支撑复位对股骨转子间骨折髓内钉术后稳定性影响的生物力学研究. 中华创伤骨科杂志, 2019, 21(1): 57-64.
20.	Park YC, Yoon SP, Yang KH. The effects of extramedullary reduction in unstable intertrochanteric fracture: A biomechanical study using cadaver bone. J Korean Fract Soc, 2018, 31(3): 79-86.
21.	王勇, 肖志坚, 张宇航, 等. 前内侧皮质稳定复位对髓内钉系统治疗老年股骨粗隆间骨折效果的影响. 现代实用医学, 2016, 28(5): 642-644.
22.	张江, 乔晓红, 牛建军, 等. 股骨转子间骨折内侧皮质正性支撑复位对股骨近端防旋髓内钉内固定效果的影响. 中华临床医师杂志 (电子版), 2017, 11(9): 1512-1517.
23.	冼树强, 李学良, 潘德悦. 阳性支撑对股骨粗隆间骨折内固定效果的影响. 创伤外科杂志, 2018, 20(10): 770-773.
24.	曹兴兵, 吕斌, 许腊梅, 等. PFNA 治疗股骨转子间骨折刀片过度侧方滑移的危险因素分析. 南京医科大学学报 (自然科学版), 2018, 38(3): 351-355, 379.
25.	侯宇, 姚琦, 张亘瑷, 等. 第三代 Gamma 钉与防旋股骨近端髓内钉治疗股骨粗隆间骨折术后股骨近端短缩的比较研究. 中国修复重建外科杂志, 2018, 32(3): 338-345.
26.	Ramachandran K, Manoj KKA, Sankar AV. Critical analysis of factors determining mechanical failures in proximal femoral nailing. Int J Res Orthop, 2019, 5(2): 275-282.
27.	赵璞, 王洪彪, 刘永国, 等. 非解剖复位治疗股骨转子间骨折的临床观察. 中国中医骨伤科杂志, 2018, 26(4): 50-53.
28.	Cho MR, Lee JH, Kwon JB, et al. The effect of positive medial cortical support in reduction of pertrochanteric fractures with posteromedial wall defect using a dynamic hip screw. Clin Orthop Surg, 2018, 10(3): 292-298.
29.	Russell TA, Sanders R. Pertrochanteric hip fractures: time for change. J Orthop Trauma, 2011, 25(4): 189-190.
30.	Chang SM, Zhang YQ, Du SC, et al. Anteromedial cortical support reduction in unstable pertrochanteric fractures: a comparison of intra-operative fluoroscopy and post-operative three dimensional computerised tomography reconstruction. Int Orthop, 2018, 42(1): 183-189.
31.	杜守超, 张世民, 张英琪, 等. 不稳定股骨转子间骨折前内侧皮质支撑复位的影像学研究. 中国矫形外科杂志, 2018, 26(18): 1633-1638.
32.	Li J, Zhang L, Zhang H, et al. Effect of reduction quality on post-operative outcomes in 31-A2 intertrochanteric fractures following intramedullary fixation: a retrospective study based on computerised tomography findings. Int Orthop, 2019, 43(8): 1951-1959.
33.	Xiong WF, Zhang YQ, Chang SM, et al. Lesser trochanteric fragments in unstable pertrochanteric hip fractures: a morphological study using three-dimensional computed tomography (3-D CT) reconstruction. Med Sci Monit, 2019, 25: 2049-2057.
34.	Kaufer H. Mechanics of the treatment of hip injuries. Clin Orthop Relat Res, 1980, (146): 53-61.

1. 张世民, 胡孙君, 张立智, 等. 老年髋部转子间骨折. 北京: 科学出版社, 2019: 30-31.
2. Tang P, Hu F, Shen J, et al. Proximal femoral nail antirotation versus hemiarthroplasty: A study for the treatment of intertrochanteric fractures. Injury, 2012, 43(6): 876-881.
3. Li AB, Zhang WJ, Wang J, et al. Intramedullary and extramedullary fixations for the treatment of unstable femoral intertrochanteric fractures: a meta-analysis of prospective randomized controlled trials. Int Orthop, 2017, 41(2): 403-413.
4. Olson SA, Schemitsch G, Morwood M, et al. Hot topics in biomechanics: hip fracture fixation. J Orthop Trauma, 2015, 29(Suppl 12): S1-S5.
5. Sernbo I, Johnell O, Gentz CF, et al. Unstable intertrochanteric fractures of the hip. Treatment with Ender pins compared with a compression hip-screw. J Bone Joint Surg (Am), 1988, 70(9): 1297-1303.
6. Baumgaertner MR, Curtin SL, Lindskog DM, et al. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg (Am), 1995, 77(7): 1058-1064.
7. Fogagnolo F, Kfuri M Jr, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg, 2004, 124(1): 31-37.
8. Ramanoudjame M, Guillon P, Dauzac C, et al. CT evaluation of torsional malalignment after intertrochanteric fracture fixation. Orthop Traumatol Surg Res, 2010, 96(8): 844-848.
9. Kim TY, Lee YB, Chang JD, et al. Torsional malalignment, how much significant in the trochanteric fractures? Injury, 2015, 46(11): 2196-2200.
10. Gotfried Y. The Gotfried (nonanatomic, closed) reduction of unstable subcapital femoral fractures. Tech Orthop, 2012, 27(4): 259-261.
11. Gotfried Y, Kovalenko S, Fuchs D. Nonanatomical reduction of displaced subcapital femoral fractures (Gotfried reduction). J Orthop Trauma, 2013, 27(11): e254-e259.
12. Zhang YQ, Chang SM. Mechanism of " Gotfried reduction” in femoral neck fracture. J Orthop Trauma, 2013, 27(12): e291.
13. 丁舒晨, 虞荣斌, 葛云林, 等. Gotfried 阳性支撑复位结合空心螺钉内固定治疗中青年股骨颈骨折的近期疗效. 中华创伤骨科杂志, 2016, 18(8): 655-661.
14. 王琦, 高波, 张禹. Gotfried 阳性支撑复位联合内固定治疗股骨颈骨折一年随访观察. 中国实用医刊, 2017, 44(21): 35-38.
15. Xiong WF, Chang SM, Zhang YQ, et al. Inferior calcar buttress reduction pattern for displaced femoral neck fractures in young adults: a preliminary report and an effective alternative. J Orthop Surg Res, 2019, 14(1): 70.
16. 张世民, 张英琪, 李清, 等. 内侧皮质正性支撑复位对老年股骨粗隆间骨折内固定效果的影响. 中国矫形外科杂志, 2014, 22(14): 1256-1261.
17. Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg, 2015, 135(6): 811-818.
18. Nie B, Chen X, Li J, et al. The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study. J Orthop Surg Res, 2017, 12(1): 197.
19. 李双, 张世民, 张立智, 等. 不同组合前内侧皮质支撑复位对股骨转子间骨折髓内钉术后稳定性影响的生物力学研究. 中华创伤骨科杂志, 2019, 21(1): 57-64.
20. Park YC, Yoon SP, Yang KH. The effects of extramedullary reduction in unstable intertrochanteric fracture: A biomechanical study using cadaver bone. J Korean Fract Soc, 2018, 31(3): 79-86.
21. 王勇, 肖志坚, 张宇航, 等. 前内侧皮质稳定复位对髓内钉系统治疗老年股骨粗隆间骨折效果的影响. 现代实用医学, 2016, 28(5): 642-644.
22. 张江, 乔晓红, 牛建军, 等. 股骨转子间骨折内侧皮质正性支撑复位对股骨近端防旋髓内钉内固定效果的影响. 中华临床医师杂志 (电子版), 2017, 11(9): 1512-1517.
23. 冼树强, 李学良, 潘德悦. 阳性支撑对股骨粗隆间骨折内固定效果的影响. 创伤外科杂志, 2018, 20(10): 770-773.
24. 曹兴兵, 吕斌, 许腊梅, 等. PFNA 治疗股骨转子间骨折刀片过度侧方滑移的危险因素分析. 南京医科大学学报 (自然科学版), 2018, 38(3): 351-355, 379.
25. 侯宇, 姚琦, 张亘瑷, 等. 第三代 Gamma 钉与防旋股骨近端髓内钉治疗股骨粗隆间骨折术后股骨近端短缩的比较研究. 中国修复重建外科杂志, 2018, 32(3): 338-345.
26. Ramachandran K, Manoj KKA, Sankar AV. Critical analysis of factors determining mechanical failures in proximal femoral nailing. Int J Res Orthop, 2019, 5(2): 275-282.
27. 赵璞, 王洪彪, 刘永国, 等. 非解剖复位治疗股骨转子间骨折的临床观察. 中国中医骨伤科杂志, 2018, 26(4): 50-53.
28. Cho MR, Lee JH, Kwon JB, et al. The effect of positive medial cortical support in reduction of pertrochanteric fractures with posteromedial wall defect using a dynamic hip screw. Clin Orthop Surg, 2018, 10(3): 292-298.
29. Russell TA, Sanders R. Pertrochanteric hip fractures: time for change. J Orthop Trauma, 2011, 25(4): 189-190.
30. Chang SM, Zhang YQ, Du SC, et al. Anteromedial cortical support reduction in unstable pertrochanteric fractures: a comparison of intra-operative fluoroscopy and post-operative three dimensional computerised tomography reconstruction. Int Orthop, 2018, 42(1): 183-189.
31. 杜守超, 张世民, 张英琪, 等. 不稳定股骨转子间骨折前内侧皮质支撑复位的影像学研究. 中国矫形外科杂志, 2018, 26(18): 1633-1638.
32. Li J, Zhang L, Zhang H, et al. Effect of reduction quality on post-operative outcomes in 31-A2 intertrochanteric fractures following intramedullary fixation: a retrospective study based on computerised tomography findings. Int Orthop, 2019, 43(8): 1951-1959.
33. Xiong WF, Zhang YQ, Chang SM, et al. Lesser trochanteric fragments in unstable pertrochanteric hip fractures: a morphological study using three-dimensional computed tomography (3-D CT) reconstruction. Med Sci Monit, 2019, 25: 2049-2057.
34. Kaufer H. Mechanics of the treatment of hip injuries. Clin Orthop Relat Res, 1980, (146): 53-61.

Chinese Journal of Reparative and Reconstructive Surgery

Research progress on anteromedial cortical positive support reduction in treatment of intertrochanteric fracture

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