Accurate understanding of the lateral wall of intertrochanteric fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WU Kejian , TANG Junjun

Department of Trauma Orthopedics, the Forth Medical Center of the General Hospital of People’s Liberation Army of China, Beijing, 100039, P.R.China;

Corresponding author：

WU Kejian, Email: wkjian@163.com

Keywords：

Intertrochanteric fracture; lateral wall; internal fixation

DOI：

10.7507/1002-1892.201907008

Video：

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With the deepening of the research on intertrochanteric fracture, the importance of " lateral wall” of femur is gradually recognized. The integrity of the lateral wall can affect the stability of intertrochanteric fractures, the choice of surgical methods and internal fixation, and the outcome of patients after surgery, which has become a research hotspot. However, there is no unified understanding on the definition of lateral wall, the judgement of injury status and the treatment of lateral wall fracture. This article reviews the literature, and combines with the clinical understanding of the role of the lateral femoral wall, in order to provide reference for orthopaedic surgeons and relevant researchers.

Citation： WU Kejian, TANG Junjun. Accurate understanding of the lateral wall of intertrochanteric fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(10): 1210-1215. doi: 10.7507/1002-1892.201907008 Copy

1.	Tan WL, Low SL, Shen L, et al. Osteoporotic hip fractures: 10-year review in a Singaporean hospital. J Orthop Surg (Hong Kong), 2015, 23(2): 150-154.
2.	杨明辉, 孙旭, 韩巍, 等. 老年股骨转子间骨折的手术时机对院内结果的影响. 中华创伤骨科杂志, 2016, 18(6): 461-464.
3.	Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg (Br), 1949, 31B(2): 190-203.
4.	Boyd HB, Griffin LL. Classification and treatment of trochanteric fractures. Arch Surg, 1949, 58(6): 853-866.
5.	Jensen JS, Michaelsen M. Trochanteric femoral fractures treated with McLaughlin osteosynthesis. Acta Orthop Scand, 1975, 46(5): 795-803.
6.	Müller ME, Nazarian S, Koch P. Classification AO des fractures. Berlin, Heidelberg, New York: Springer, 1987: 117-122.
7.	Müller ME, Koch P, Nazarian S, et al. The Comprehensive Classification of Fractures of Long Bones. Berlin: Springer-Verlag, 1990: 119-120.
8.	Jensen JS. Classification of trochanteric fractures. Acta Orthop Scand, 1980, 51(5): 803-810.
9.	Gotfried Y. The lateral trochanteric wall: a key element in the reconstruction of unstable pertrochanteric hip fractures. Clin Orthop Relat Res, 2004, (425): 82-86.
10.	Ritter G, Degreif J. Basic considerations in fractures of the trochanter major in and after angle plate osteosynthesis. Unfallchirurgie, 1991, 17(2): 106-110.
11.	Gotfried Y. Percutaneous compression plating of intertrochanteric hip fractures. J Orthop Trauma, 2000, 14(7): 490-495.
12.	Gotfried Y, Cohen B, Rotem A. Biomechanical evaluation of the percutaneous compression plating system for hip fractures. J Orthop Trauma, 2002, 16(9): 644-650.
13.	Yechiel G. The pantrochanteric hip fracture: an iatrogenic entity. J Orthop Trauma, 2012, 26(4): 197-199.
14.	Simpson AH, Varty K, Dodd CA. Sliding hip screws: modes of failure. Injury, 1989, 20(4): 227-231.
15.	Haidukewych GJ. Intertrochanteric fractures: ten tips to improve results. J Bone Joint Surg (Am), 2009, 91(3): 712-719.
16.	Koval KJ, Zuckerman JD. Hip fractures: a practical guide to management. New York: Springer, 2000: 2-3.
17.	Waddell JP. Fractures of the proximal femur: improving outcomes. Philadelphia: Elsevier, 2010: 114-120.
18.	Boopalan PR, Oh JK, Kim TY, et al. Incidence and radiologic outcome of intraoperative lateral wall fractures in OTA 31A1 and A2 fractures treated with cephalomedullary nailing. J Orthop Trauma, 2012, 26(11): 638-642.
19.	Palm H, Jacobsen S, Sonne-Holm S, et al. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg (Am), 2007, 89(3): 470-475.
20.	Hsu CE, Shih CM, Wang CC, et al. Lateral femoral wall thickness. A reliable predictor of post-operative lateral wall fracture in intertrochanteric fractures. Bone Joint J, 2013, 95-B(8): 1134-1138.
21.	Tan BY, Lau AC, Kwek EB. Morphology and fixation pitfalls of a highly unstable intertrochanteric fracture variant. J Orthop Surg (Hong Kong), 2015, 23(2): 142-145.
22.	Gérard D, Degreif J, Runkel M. Experimental studies in weakening the stability of the trochanter major by lateral fenestration. Unfallchirurgie, 1993, 19(4): 208-212.
23.	Puthezhath K, Jayaprakash C. Is calcar referenced tip-apex distance a better predicting factor for cutting out in biaxial cephalomedullary nails than tip-apex distance? J Orthop Surg (Hong Kong), 2017, 25(3): 2309499017727920.
24.	Hardy DC, Descamps PY, Krallis P, et al. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg (Am), 1998, 80(5): 618-630.
25.	Kim Y, Bahk WJ, Yoon YC, et al. Radiologic healing of lateral femoral wall fragments after intramedullary nail fixation for A3.3 intertrochanteric fractures. Arch Orthop Trauma Surg, 2015, 135(10): 1349-1356.
26.	侯宇, 姚琦, 张亘瑷, 等. 第 3 代 Gamma 钉拉力螺钉钉尾距股骨外侧皮质距离与术后拉力螺钉移位或切出关系研究. 中国修复重建外科杂志, 2018, 32(1): 40-44.
27.	陈志祥, 周振宇, 刘璠, 等. PFNA 联合重建锁定钛板治疗累及外侧壁的粉碎性股骨粗隆间骨折. 中国骨伤, 2018, 31(9): 840-845.
28.	Khurana B, Mandell JC, Rocha TC, et al. Internal rotation traction radiograph improves proximal femoral fracture classification accuracy and agreement. AJR Am J Roentgenol, 2018, 211(2): 409-415.
29.	Tornetta III P, Yin J. Traction views aid in the assessment of lateral wall intefrity in intertrochanteric hip fractures. OTA 2016, SCIENTIFIC POSTER #83.
30.	Kielbasinski Podlaszewska O, Bekvalac J, Williams RL, et al. The innominate tubercle of the femur: Application to anterior surgical approaches to the hip. Clin Anat, 2017, 30(5): 578-584.
31.	Siebenrock KA, Ekkernkamp A, Ganz R. The corrective intertrochanteric adduction osteotomy without removal of a wedge. Operative Orthopaedics and Traumatology, 2000, 8(1): 1-13.
32.	Apivatthakakul T. Commentary: Morphology and fixation pitfalls of a highly unstable intertrochanteric fracture variant. J Orthop Surg (Hong Kong), 2015, 23(2): 140.
33.	Sun LL, Li Q, Chang SM. The thickness of proximal lateral femoral wall. Injury, 2016, 47(3): 784-785.
34.	Cho JW, Kent WT, Yoon YC, et al. Fracture morphology of AO/OTA 31-A trochanteric fractures: A 3D CT study with an emphasis on coronal fragments. Injury, 2017, 48(2): 277-284.
35.	Meinberg EG, Agel J, Roberts CS, et al. Fracture and dislocation classification compendium-2018. J Orthop Trauma, 2018, 32 Suppl 1: S33-S34.

1. Tan WL, Low SL, Shen L, et al. Osteoporotic hip fractures: 10-year review in a Singaporean hospital. J Orthop Surg (Hong Kong), 2015, 23(2): 150-154.
2. 杨明辉, 孙旭, 韩巍, 等. 老年股骨转子间骨折的手术时机对院内结果的影响. 中华创伤骨科杂志, 2016, 18(6): 461-464.
3. Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg (Br), 1949, 31B(2): 190-203.
4. Boyd HB, Griffin LL. Classification and treatment of trochanteric fractures. Arch Surg, 1949, 58(6): 853-866.
5. Jensen JS, Michaelsen M. Trochanteric femoral fractures treated with McLaughlin osteosynthesis. Acta Orthop Scand, 1975, 46(5): 795-803.
6. Müller ME, Nazarian S, Koch P. Classification AO des fractures. Berlin, Heidelberg, New York: Springer, 1987: 117-122.
7. Müller ME, Koch P, Nazarian S, et al. The Comprehensive Classification of Fractures of Long Bones. Berlin: Springer-Verlag, 1990: 119-120.
8. Jensen JS. Classification of trochanteric fractures. Acta Orthop Scand, 1980, 51(5): 803-810.
9. Gotfried Y. The lateral trochanteric wall: a key element in the reconstruction of unstable pertrochanteric hip fractures. Clin Orthop Relat Res, 2004, (425): 82-86.
10. Ritter G, Degreif J. Basic considerations in fractures of the trochanter major in and after angle plate osteosynthesis. Unfallchirurgie, 1991, 17(2): 106-110.
11. Gotfried Y. Percutaneous compression plating of intertrochanteric hip fractures. J Orthop Trauma, 2000, 14(7): 490-495.
12. Gotfried Y, Cohen B, Rotem A. Biomechanical evaluation of the percutaneous compression plating system for hip fractures. J Orthop Trauma, 2002, 16(9): 644-650.
13. Yechiel G. The pantrochanteric hip fracture: an iatrogenic entity. J Orthop Trauma, 2012, 26(4): 197-199.
14. Simpson AH, Varty K, Dodd CA. Sliding hip screws: modes of failure. Injury, 1989, 20(4): 227-231.
15. Haidukewych GJ. Intertrochanteric fractures: ten tips to improve results. J Bone Joint Surg (Am), 2009, 91(3): 712-719.
16. Koval KJ, Zuckerman JD. Hip fractures: a practical guide to management. New York: Springer, 2000: 2-3.
17. Waddell JP. Fractures of the proximal femur: improving outcomes. Philadelphia: Elsevier, 2010: 114-120.
18. Boopalan PR, Oh JK, Kim TY, et al. Incidence and radiologic outcome of intraoperative lateral wall fractures in OTA 31A1 and A2 fractures treated with cephalomedullary nailing. J Orthop Trauma, 2012, 26(11): 638-642.
19. Palm H, Jacobsen S, Sonne-Holm S, et al. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg (Am), 2007, 89(3): 470-475.
20. Hsu CE, Shih CM, Wang CC, et al. Lateral femoral wall thickness. A reliable predictor of post-operative lateral wall fracture in intertrochanteric fractures. Bone Joint J, 2013, 95-B(8): 1134-1138.
21. Tan BY, Lau AC, Kwek EB. Morphology and fixation pitfalls of a highly unstable intertrochanteric fracture variant. J Orthop Surg (Hong Kong), 2015, 23(2): 142-145.
22. Gérard D, Degreif J, Runkel M. Experimental studies in weakening the stability of the trochanter major by lateral fenestration. Unfallchirurgie, 1993, 19(4): 208-212.
23. Puthezhath K, Jayaprakash C. Is calcar referenced tip-apex distance a better predicting factor for cutting out in biaxial cephalomedullary nails than tip-apex distance? J Orthop Surg (Hong Kong), 2017, 25(3): 2309499017727920.
24. Hardy DC, Descamps PY, Krallis P, et al. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg (Am), 1998, 80(5): 618-630.
25. Kim Y, Bahk WJ, Yoon YC, et al. Radiologic healing of lateral femoral wall fragments after intramedullary nail fixation for A3.3 intertrochanteric fractures. Arch Orthop Trauma Surg, 2015, 135(10): 1349-1356.
26. 侯宇, 姚琦, 张亘瑷, 等. 第 3 代 Gamma 钉拉力螺钉钉尾距股骨外侧皮质距离与术后拉力螺钉移位或切出关系研究. 中国修复重建外科杂志, 2018, 32(1): 40-44.
27. 陈志祥, 周振宇, 刘璠, 等. PFNA 联合重建锁定钛板治疗累及外侧壁的粉碎性股骨粗隆间骨折. 中国骨伤, 2018, 31(9): 840-845.
28. Khurana B, Mandell JC, Rocha TC, et al. Internal rotation traction radiograph improves proximal femoral fracture classification accuracy and agreement. AJR Am J Roentgenol, 2018, 211(2): 409-415.
29. Tornetta III P, Yin J. Traction views aid in the assessment of lateral wall intefrity in intertrochanteric hip fractures. OTA 2016, SCIENTIFIC POSTER #83.
30. Kielbasinski Podlaszewska O, Bekvalac J, Williams RL, et al. The innominate tubercle of the femur: Application to anterior surgical approaches to the hip. Clin Anat, 2017, 30(5): 578-584.
31. Siebenrock KA, Ekkernkamp A, Ganz R. The corrective intertrochanteric adduction osteotomy without removal of a wedge. Operative Orthopaedics and Traumatology, 2000, 8(1): 1-13.
32. Apivatthakakul T. Commentary: Morphology and fixation pitfalls of a highly unstable intertrochanteric fracture variant. J Orthop Surg (Hong Kong), 2015, 23(2): 140.
33. Sun LL, Li Q, Chang SM. The thickness of proximal lateral femoral wall. Injury, 2016, 47(3): 784-785.
34. Cho JW, Kent WT, Yoon YC, et al. Fracture morphology of AO/OTA 31-A trochanteric fractures: A 3D CT study with an emphasis on coronal fragments. Injury, 2017, 48(2): 277-284.
35. Meinberg EG, Agel J, Roberts CS, et al. Fracture and dislocation classification compendium-2018. J Orthop Trauma, 2018, 32 Suppl 1: S33-S34.

Chinese Journal of Reparative and Reconstructive Surgery

Accurate understanding of the lateral wall of intertrochanteric fracture

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