Search Results (25)

Lateral femoral neck and peritrochanteric fractures are common and clinically challenging injuries, particularly in the elderly population, with significant implications for morbidity, mortality, and functional recovery. Traditional classification systems are widely used to guide treatment, yet their reproducibility and clinical applicability remain debated. Increasing attention has been directed toward trabecular architecture and its role in fracture behavior and reduction strategies. This review aims to summarize current evidence on classification systems, trabecular-based fracture patterns, pre-operative reduction techniques, and fixation strategies. A narrative review was conducted using PubMed/MEDLINE, Embase, and Scopus databases up to May 2026. Original studies, reviews, and biomechanical investigations focusing on proximal femur fracture classification, reliability, trabecular alignment, reduction techniques, and fixation methods were included. Data were qualitatively analyzed, with emphasis on interobserver reliability, biomechanical implications, and clinical outcomes. Conventional classification systems, including anatomical, Evans–Jensen, and AO/OTA frameworks, demonstrated variable and generally moderate reproducibility, with reported interobserver agreement ranging from approximately κ = 0.30 to 0.60. Emerging evidence highlights the importance of trabecular architecture, distinguishing intradigital fractures—confined within trabecular pathways and relatively stable—from extradigital fractures, which disrupt load-bearing structures and are associated with increased mechanical instability and higher failure rates. Biomechanical and clinical studies indicate that inadequate reduction with trabecular misalignment significantly increases the risk of varus collapse and implant cut-out. Reduction strategies tailored to fracture pattern, such as internal rotation for intradigital fractures and external or combined maneuvers for extradigital patterns, improve alignment and load transfer. In terms of fixation, dynamic hip screws remain effective in stable fractures, whereas cephalomedullary nails demonstrate superior performance in unstable patterns, with lower reoperation rates reported (approximately 5–8% vs. 10–15%). Management of lateral femoral neck and peritrochanteric fractures should extend beyond traditional classification systems to incorporate trabecular biomechanics. Restoration of trabecular alignment, alongside established parameters such as neck–shaft angle and tip–apex distance, is critical for optimizing outcomes. Further prospective studies are needed to validate trabecular-based classifications and standardize reduction strategies. Full article

Purpose: The treatment of proximal humerus fractures (PHFs) remains debated, and similar fracture patterns may be managed with different strategies. The aim of this retrospective single-center case series without a control group was to evaluate clinical and radiographic outcomes after treatment of selected PHFs with the Galaxy Fixation System. The primary endpoint was functional recovery at 12 months, assessed using the Constant Shoulder Score and QuickDASH. Secondary endpoints included radiographic maintenance of reduction, quality of life, treatment-related complications, and need for revision surgery. Methods: We retrospectively analyzed 48 consecutive patients with proximal humeral fractures treated at the Orthopaedic and Traumatology Unit of Versilia Hospital, Viareggio, Italy, between November 2017 and February 2022. Fractures were assessed using trauma-series radiographs and computed tomography when required, and were classified by two senior surgeons according to the Neer, AO/OTA, and Hertel classifications. Eligible patterns included 2-part, 3-part, and selected 4-part fractures with at least two-thirds of intact metaphyseal bone stock. Results: Forty-six patients completed the 12-month follow-up; two patients died during follow-up from causes unrelated to the index procedure. The mean Constant Shoulder Score improved from 62.7 at 6 months to 69.3 at 12 months, and the mean QuickDASH improved from 9.4 to 8.1. The mean postoperative head-shaft angle was 137.2 degrees and remained substantially stable at 135.1 degrees at 12 months. Pin-tract infection occurred in 5 patients, pin migration in 4, algodystrophic syndrome in 1, and avascular necrosis requiring revision arthroplasty in 1. Conclusions: In this retrospective uncontrolled series, external fixation with the Galaxy system was associated with progressive functional recovery, satisfactory radiographic maintenance of reduction, and a low rate of revision surgery in carefully selected PHFs. These findings should be interpreted cautiously because of the retrospective design, limited sample size, absence of a control group, incomplete availability of some baseline variables, and lack of formal comparative or cost-effectiveness analyses. Full article

Background and Objectives: Intertrochanteric hip fractures (ITFs) are common in older adults and frequently coexist with knee osteoarthritis (KOA). Although both conditions share key biomechanical risk factors, the specific relationship between KOA severity and ITF stability has not been well defined. Recent evidence suggests that degenerative knee changes may alter lower-limb load distribution and increase susceptibility to unstable fracture patterns. This study evaluated whether KOA severity, graded using the Kellgren–Lawrence (KL) system, is associated with ITF stability according to the 2018 AO/OTA classification. Materials and Methods: A retrospective observational study was conducted on 138 patients with IHFs treated between 2018 and 2023. KOA severity was assessed using KL grades I–IV on non-weight-bearing anteroposterior knee radiographs. Lateral wall thickness (LWT) was measured using the Hsu method, with <20.5 mm indicating fracture instability. Statistical analyses included correlation, linear regression, logistic regression, and receiver operating characteristic (ROC) curve analysis to examine the association between KL grade and fracture stability. Results: Among 138 patients, 98 (71.0%) had unstable ITFs. Advanced KOA was significantly more common in the unstable group (KL III 45.9%, KL IV 48.0%; p < 0.001). KL grade showed a significant inverse correlation with LWT (Pearson’s r = −0.394, p < 0.001). Each one-grade increase in KL severity was associated with a 3.8 mm reduction in LWT (p < 0.001). In multivariable logistic regression, KL grade remained an independent predictor of fracture instability (adjusted OR = 4.9, 95% CI: 2.8–8.8, p < 0.001), whereas age and comorbidities were not significant. ROC analysis demonstrated good discriminatory power (AUC = 0.79). A KL ≥ III threshold achieved 95% sensitivity and 56% specificity for predicting instability. Conclusions: Higher KOA severity is strongly associated with unstable ITF patterns. KL grade independently predicts instability and may serve as a simple, accessible radiographic indicator of biomechanical vulnerability and fracture risk in older adults. Incorporating KOA severity into the preoperative evaluation may enhance risk stratification, guide selection of fixation strategy, and support individualized rehabilitation planning. Full article

Background and Objectives: Pelvic ring injuries with symphyseal disruption are classically associated with high-energy mechanisms such as motor vehicle collisions. Recently, waterslides have emerged as an underrecognized but distinct source of severe pelvic trauma. Waterslide-related pelvic trauma represents a distinct biomechanical entity characterized by a supine or semi-supine body position at splashdown, extreme forced hip abduction, asymmetric lower-limb positioning, and abrupt hydrodynamic deceleration. The high descent velocity, abrupt hydrodynamic deceleration, and forced hip abduction at water entry may combine to generate open-book-type pelvic injuries. Evidence guiding diagnosis and surgical management in this setting remains scarce. Materials and Methods: We retrospectively analyzed a consecutive series of adult patients sustaining waterslide-related anterior–posterior compression type II (APC2) pelvic ring injuries. Demographic data and the body mass index (BMI), fracture classification, surgical strategy, complications, and functional outcomes were reviewed. Only patients with complete imaging, operative records, and follow-up were included. Results: Four patients (38–72 years) met the inclusion criteria. All sustained rotationally unstable open-book pelvic injuries and were classified as APC2; three were AO/OTA 61B2.3 and one 61B3.3. All patients were overweight or obese (BMI 27.2–31.2). Pelvic binders provided an effective acute reduction in symphyseal diastasis; however, in one bilateral injury, CT imaging obtained with the binder in situ masked posterior ligamentous instability. Definitive surgical fixation was performed in all cases. Early mechanical failure occurred in two patients treated with short anterior symphyseal plate constructs. In the bilateral injury, isolated anterior fixation failed repeatedly until posterior sacroiliac stabilization was added. No deep infections or thromboembolic events occurred. Although two patients required short observational ICU stays, none were admitted for hemodynamic instability or pelvic bleeding. Conclusions: At 12-month follow-up, three patients achieved pain-free ambulation without assistive devices, while one patient required intermittent use of a single crutch; all patients regained independence in daily activities. Waterslide accidents represent a high-energy injury mechanism capable of producing severe APC2 pelvic disruptions, particularly in patients with an elevated BMI. Awareness of this mechanism and meticulous assessment of posterior stability are essential to avoid under-treatment and mechanical failure. Full article

Background/Objectives: Unstable intertrochanteric femur fractures (IFFs) in geriatric patients are associated with high rates of morbidity and mortality due to poor bone quality, multiple comorbidities, and limited functional capacity. This study aimed to compare the clinical outcomes of cementless bipolar hemiarthroplasty (BHA) performed via a transtrochanteric approach and proximal femoral nailing (PFN) in elderly patients with unstable IFFs. Methods: This retrospective comparative study included 131 patients aged ≥70 years who underwent surgery for AO/OTA 31-A2 and 31-A3 unstable fractures between January 2021 and July 2025 were retrospectively reviewed. 64 patients received cementless BHA and 67 underwent PFN. Eligible patients were ambulatory prior to fracture (independently or with a cane/walker); patients with pathological fractures/malignancy, alternative procedures (cemented or posterolateral BHA, total hip arthroplasty, tumor prosthesis, or other osteosynthesis methods), incomplete records, or <6 months of follow-up were excluded. Demographics, perioperative variables, mechanical complications, revision requirement, time to mobilization, and 1- and 6-month mortality rates were analyzed. Primary outcomes were mortality and perioperative clinical parameters. Results: The two groups were comparable in age, sex, ASA scores, and fracture patterns. Intraoperative blood loss and transfusion requirements were significantly higher in the BHA group (both p < 0.001). Mobilization was observed earlier in patients treated with BHA (1 [1,2] vs. 3 [2,3] days; p < 0.001). Mechanical complications were more frequently observed after PFN, which was associated with a higher revision requirement (17.9% vs. 4.7%; p = 0.018). Operative time, hospital stay, and 1- and 6-month mortality rates showed no significant differences between the groups. Conclusions: In geriatric patients with unstable IFFs, cementless BHA performed via a transtrochanteric approach may be considered a viable surgical option with appropriate patient selection, taking into account its association with earlier mobilization and the observed mechanical complication profile. PFN offers advantages of reduced blood loss and lower transfusion needs. Surgical decision-making should be individualized based on fracture morphology, bone quality, and the patient’s overall medical condition. Given the heterogeneity of unstable fractures within the AO/OTA classification and the retrospective nature of the present study, larger, multicenter prospective investigations incorporating functional outcomes are warranted to further clarify optimal treatment strategies. Full article

Background and Purpose: Surgical treatment of lower-extremity fractures can result in postoperative complications. Irrespective of specific surgical procedures, postoperative outcomes may be influenced by pre-existing comorbidities, as well as by the severity of the injury. This study investigates whether (I) internal factors and (II) external factors are associated with (III) postoperative complication rates. Material and Methods: A prospective study was conducted at a Level I trauma center between 2014 and 2018. A cohort of 416 patients with surgical treatment after traumatic long bone fractures of the lower extremities was assessed, with comorbidities along with factors such as age, malnutrition, and impaired mobility systematically evaluated. Injury severity was classified using the Abbreviated Injury Scale; fracture type and location using the AO/OTA classification; and postoperative complications using the Clavien–Dindo system. Results: Across the cohort, internal factors such as immobility and malnutrition were associated with an increased complication rate. Age showed a weak correlation. Obesity demonstrated a trend toward a protective effect. Patients with femoral fractures exhibited a higher prevalence of cardiovascular comorbidities, with heart failure representing the most pronounced risk factor. In the subgroup with lower leg fractures, chronic heart disease also remained a significant predictor of complications. Correlation analysis further revealed a significant positive association between injury severity and the occurrence of complications across the overall cohort. Conclusions: This study provides valuable insights into risk factors for complicated postoperative courses. Injury severity appears to be a promising predictor of complication risk in patients with leg fractures. Reduced mobility and malnutrition, likewise, were significantly associated with increased complication rates; these may represent the most readily addressable modifiable risk factors. All data were collected using validated, user-friendly classification systems that may be suitable for predictive modeling. Full article

Background: Fractures of the distal humerus (DHFs) represent challenging intra-articular injuries that are often followed by postoperative complications, most notably ulnar neuropathy. There is still debate regarding the best method of handling the ulnar nerve during open reduction and internal fixation (ORIF). Objective: The primary objective was to evaluate the incidence of postoperative ulnar neuropathy (UN) in patients who underwent open reduction and internal fixation (ORIF) for DHFs, comparing anterior transposition (AT) with in situ decompression (ISD) of the ulnar nerve. Additionally, we investigated the influence of AT on individuals presenting with preoperative UN. Methods: A retrospective review was conducted on 68 patients (26 females and 42 males; mean age: 46.3 years) who underwent ORIF for intra-articular DHF between 2018 and 2022. Patients were divided into two groups: anterior transposition (n = 14) and in situ decompression (n = 54). Ulnar neuropathy was evaluated using the modified McGowan classification, and radiographic outcomes were assessed with AO/OTA fracture classification. Results: Sixty-eight patients (26F/42M) were included. The mean age was 46.3 years (20–77 years) and the mean follow-up time was 53 months (36–76 months). The postoperative UN incidence was 30.8% (21/68). Neuropathy was significantly higher in the transposition group compared to in situ decompression (57.1% vs. 24%; p = 0.012). Olecranon osteotomy (36.3% vs. 20%; p = 0.042) and parallel plate configuration (33.3% vs. 12.5%; p = 0.037) were also associated with increased neuropathy risk. Among patients with preoperative ulnar neuropathy (n = 12), functional recovery was more favorable with transposition, where 71% experienced full resolution compared to 60% in the in situ group. Conclusions: Routine anterior transposition of the ulnar nerve during ORIF for DHF is associated with an increased risk of postoperative neuropathy and should be avoided in patients without preoperative symptoms. However, transposition appears beneficial in patients with pre-existing ulnar neuropathy. Surgeons should individualize ulnar nerve management to balance surgical risks and neurological outcomes. Full article

Background and Objectives: Ankle fractures represent one of the most common injuries to the lower limb, particularly impacting women and the elderly. The coronavirus disease 2019 (COVID-19) pandemic greatly disrupted both the incidence of these fractures and their treatment patterns globally. This retrospective epidemiological study analyzed 1010 cases of ankle fractures treated at the Orthopedics Department of Policlinico University Hospital in Catania from 2018 to 2023. The study aimed to evaluate trends in incidence, patient demographics, fracture types, treatment modalities, and hospital stay across the pre-COVID-19, COVID-19, and post-COVID-19 periods. Materials and Methods: A retrospective observational study was conducted including all patients diagnosed with ankle fractures from 1 January 2018 to 31 December 2023. Data were collected from hospital medical records using ICD-9-CM codes and radiographic classification systems (Danis–Weber, Lauge-Hansen, and AO/OTA). Variables analyzed included demographics, fracture type and side, treatment modality, and hospitalization details. Statistical analyses were performed using t-tests, chi-square tests, and linear regression, with significance set at p < 0.05. Results: In 2020, there was a 31.7% decrease in fracture incidence. Although overall fracture rates rebounded after COVID-19, they did not reach pre-pandemic levels. During the pandemic, trimalleolar fractures increased significantly, occurring more frequently in older women, likely due to bone fragility. The rate of surgical treatments rose during and after the pandemic, with a distinct shift from ORIF to external fixation. Hospital stays were longer, especially for patients with cardiovascular risk factors. Conclusions: The pandemic significantly altered the epidemiology, treatment strategies, and outcomes of ankle fractures. These findings highlight the necessity for adaptable care models and preventive strategies, particularly for vulnerable populations such as older women. Full article

Background: Pertrochanteric fractures of the proximal femur present a common challenge for traumatologists, with intramedullary nailing emerging as the preferred treatment. Complication rates are around 20%, including screw jamming, refractures, implant breakage, or medial migration, with cut-out being the most common. A tip–apex distance (TAD) of >25 mm and incorrect cephalic screw position are predictive factors for cut-out. This study assesses outcomes using the Elos intramedullary nail, based on the experience of the Department of Orthopedics and Traumatology at Ospedale Maggiore in Bologna. Methods: We conducted a retrospective cohort study of 344 patients treated with the Elos intramedullary nail for pertrochanteric femoral fractures from 1 January 2017 to 31 December 2022. The Elos^®-Intrauma nail was implanted using the standard technique. Initial X-rays classified fractures according to the AO-OTA classification, and postoperative X-rays confirmed the cephalic screw’s placement per Cleveland’s regions. Patients were divided into two groups: optimal cephalic screw position (positions 5-8-9) and other positions. We evaluated TAD, calcar-referred TAD (CalTAD), and postoperative reduction quality using Chang’s criteria. The incidence of cut-out and other complications were assessed in connection with these measurements. Results: Among the 344 patients, 227 (65.9%) had the screw in positions 5-8-9, while 117 (34.1%) had it in other positions. The median TAD was 19.47 ± 6.26 mm (range 3.96–46.6), with TAD ≤ 25 mm in 265 patients (77%). The median CalTAD was 22.37 ± 5.65 mm (range 8.75–45.3), with CalTAD ≤ 25 mm in 231 patients (67.1%). According to Chang’s criteria, 8 cases (2.3%) had poor reduction, 139 cases (40.4%) had acceptable reduction, and 197 cases (57.3%) had excellent reduction. Cut-out occurred in four cases (1.19%). Multivariate analysis revealed only poor reduction and TAD > 25 mm as independent predictors of cut-out (p < 0.05), while cephalic screw position, CalTAD, and fracture type did not impact cut-out incidence. Conclusions: This study indicates that optimal TAD and quality of reduction are crucial for minimizing cut-out risks. The Elos intramedullary nail shows favorable outcomes with a low cut-out incidence when these parameters are met. Emphasis should be placed on achieving a TAD ≤ 25 mm and excellent reduction quality to reduce complications. Full article

Background/Objectives: Patellar fractures are rare but clinically significant due to their impact on knee function. These injuries vary from simple transverse to complex comminuted patterns. Computed tomography (CT) offers superior visualization compared to radiographs, enabling accurate classification and surgical planning. This study utilized CT-based fracture mapping to analyze fracture patterns and evaluate the impact of age, trauma-center level, and AO/OTA classification. Methods: This retrospective study included 237 patients diagnosed with patellar fractures who underwent CT imaging. Fractures were classified using the AO/OTA system, and fracture mapping was performed by overlaying fracture lines onto a standardized template. Statistical analysis assessed correlations between patient demographics, trauma-center level, and fracture patterns. Results: The cohort comprised 107 males and 130 females with a mean age of 56.9 ± 20.9 years. Males were significantly younger than females (49.2 vs. 63.3 years, p < 0.001). Fractures were evenly distributed between the right (46%) and left (54%) patellae. Type C fractures were the most common (54.4%), followed by Type B (29.9%) and Type A (15.6%). Trauma-center level was inversely associated with fracture severity (p < 0.001), with complex fractures more common at lower-level centers. Age was positively correlated with fracture severity (p = 0.001). Fracture mapping revealed the central patella as the most frequently affected region, with transverse fractures extending medially and laterally, sparing the upper and lower poles. Conclusions: CT imaging enhances the classification and mapping of patellar fractures, highlighting the central patella as the primary site of injury. Fracture severity correlates with age and trauma-center level. These findings support CT-based mapping as a valuable tool for improving surgical planning and treatment outcomes. Full article

Background: We have applied an anterior locking compression mini plate in addition to a conventional superior locking compression plate for the treatment of wedge or multifragmentary clavicular fractures. Methods: Medical and radiologic data were retrospectively reviewed for patients who underwent surgical fixation with an anterior locking compression mini plate and conventional anatomical locking compression plate in a clavicle fracture of AO/OTA 15.2 B and 15.2 C. The primary outcome was bone union, and the secondary outcome was postoperative complications associated with the procedure. The functional outcomes included the Visual Analog Scale (VAS), University of California at Los Angeles Shoulder Scale (UCLASS), and Constant Shoulder Scale (CSS). Results: Nineteen patients with AO/OTA 15.2 B and 2 C clavicular fractures were followed for an average of 16 months (range: 12–30). The average patient age was 41 (range: 21–76) years, and 17 male and 2 female patients were included. The most common cause of clavicle fractures was sports activity (36.8%). A total of 10 patients had AO/OTA classification 15.2 C, and 9 patients had AO/OTA classification 15.2 B clavicular fractures. Primary fracture union healing was observed in all 19 (100%) patients, and the average time to bone union was 11 weeks (range: 7~21). There was no fixation failure or postoperative infection. The mean VAS, UCLASS, and CSS scores at the final follow-up were 0.6, 33.4, and 65 on a 75-point scale (87 on a 100-point scale), respectively. Conclusions: Dual plating using an anterior mini plate with a superior LCP could be considered as an option to minimize soft-tissue injury in comminuted mid-shaft clavicle fractures. Full article

Background/Objectives: Hip fractures present a global public health concern, with a forecasted rise in incidence and having associated increased mortality rates. This study aimed to investigate whether the AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification of a first hip fracture can predict the location and severity of a subsequent contralateral fracture. Methods: We retrospectively evaluated patients with non-simultaneous bilateral hip fractures between January 2000 and February 2021 and analyzed the type and severity of each fracture using the AO/OTA classification system, interval between fractures (TI), and patients’ characteristics, including sex, age at time of each fracture, and radiographic measurements of hip morphology. Results: The study included 182 fractures in 91 patients (68% women, mean age: 79.5 and 82.2 years at first and second fractures, respectively; mean TI: 975 days). A strong association (lambda = 0.437, p < 0.001) was demonstrated between the first and second fracture classifications, which was higher in men (lambda = 0.60, p < 0.001) and for TI < 3 years (lambda = 0.625–0.688, p < 0.001). The mean TI was significantly shorter between the first and subsequent identical fractures than between different fracture types. However, mean hip morphological features did not significantly differ between groups. Conclusions: The initial hip fracture classification significantly predicted the type and severity of a subsequent contralateral fracture, particularly within 3 years and in men. Providing appropriate patient guidance and preventive measures is crucial, particularly for those with primary fractures that are associated with higher morbidity and mortality. Specific fracture-focused interventions, such as preventive intramedullary nail fixation, should be considered. Full article

Background: Tibiofibula fractures occur across all age groups, and postoperative complications are frequent. An accurate and rapid classification methodology for these fractures could significantly assist physicians. Clinically, tibiofibula fractures occur at various locations, and the fracture types are not evenly distributed. Methods: This paper presents a deep learning model for the interpretable multi-label classification of tibiofibula fractures in two-dimensional (2D) CT scan images, addressing the challenges posed by a limited sample size and an uneven distribution of fracture types. We retrospectively collected 2494 2D CT images from 168 patients with tibia or fibula fractures. The types of fractures identified in the CT scan images were classified according to the AO/OTA fracture classification. A deep learning model was developed to classify composite fractures in 2D CT images, providing visual interpretation for each identified class. The visual interpretation was given with the saliency maps constructed by the Grad-CAM++ method. The deep learning model was trained using data augmentation techniques to address class imbalance and the limited dataset size. Results: Our experiments demonstrated that the proposed model achieved a mean average precision (mAP) of 95.71%. Conclusions: The saliency map-based visual interpretation enables the verification of whether the model provides reliable decision-making for classification. Full article

Background: Acetabular fractures continue to pose a major challenge in clinical practice, not least because of the growing geriatric population. While the influence of the force vectors on fracture formation is well established, the impact of anatomical factors on fracture morphology remains poorly understood. The aim of this study was to investigate patient-specific hip joint geometry, identify structural risk factors and correlate these with the resulting fracture patterns. Methods: This retrospective cohort analysis included 226 patients (Mdn age = 58 yrs.) with acetabular fracture categorized by Judet/Letournel and the AO/OTA classification. Computed tomography (CT) datasets of the injured and contralateral sides were analyzed using multiplanar reconstruction. Parameters included modified center-edge (CE) angle (Wiberg), rotation angles (Ullmann and Anda), acetabular sector angle (Anda), true caput-collum-diaphyseal (CCD) angle, femoral head diameter and volume, as well as femoral neck length, circumference, and diameter. In addition, intrarater reliability within a subcohort was assessed for the metric measurements and inter-rater analysis for the classification of the entire sample. Results: The primary analysis showed direct effects of femoral head diameter, femoral neck length and femoral head size on the fracture type according to AO/OTA (type A/B/C), whereby this effect was particularly seen between type A and type C fractures (p = 0.001). Ordinal regression identified femoral head diameter as the only significant predictor (p = 0.02), with a 25% increased likelihood of complex fractures per unit of change. Low-energy trauma doubled the risk of severe fractures. Specific findings include a higher acetabular anteversion in anterior column fractures. Age correlated positively with the cause of injury and fracture type. The inter-rater reliability for fracture classification was excellent, as was the intrarater reliability of the measurements. Conclusions: This study suggests that anatomical factors, particularly proximal femoral geometry, have an impact on acetabular fracture morphology—in addition to factors such as trauma type and patient demographics. Full article

Background and Objectives: Rotational malformation after intramedullary nailing of intertrochanteric fractures is a relatively common, possibly severe, and difficult-to-detect complication, since intraoperative radiographic imaging allows for the assessment of the quality of reduction in the frontal and sagittal planes, but not in the transverse plane. The purpose of this study is to evaluate the rotational malalignment after intramedullary nailing of intertrochanteric fractures and to investigate a possible connection with specific patients’ or fractures’ characteristics. Materials and Methods: 74 patients treated with intramedullary nailing due to an intertrochanteric fracture underwent a postoperative CT of the pelvis-hips and knees. The value of the anteversion was measured both in the operated-on (angle 1) and in the healthy hip (angle 2) based on the technique described by Jeanmart et al. and the difference in anteversion (D angle = angle 1 minus angle 2) was calculated. A positive D angle indicated the presence of excessive internal overcorrection of the distal fragment during fracture reduction, while a negative D angle indicated the presence of excessive external overcorrection. The absolute value of the D angle represents the postoperative difference in anteversion between the two hips. The patients were divided into three groups according to this value: group A, with D < 5° (physiological difference); group B, with 5° < D < 15° (acceptable rotational alignment); and group C, with D ≥ 15° (rotational deformity). Results: Group A constitutes 56.8%, group B 12.2%, and group C 31.1% of the study population. Overall, 79.7% of the patients presented a positive angle D, while, for group C, the percentage was even higher at 91.3%. According to the AO/OTA classification system, 37.8% of the cases were stable fractures, 47.3% were unstable fractures, and 14.9% were reverse oblique fractures. Based on our analysis, the type of fracture has a serious impact on the rotational alignment, since the statistical significance of the mean angle D for the three types of fracture is reliable (p = 0.029). Stable fractures present the lowest anteversion difference values, while reverse oblique fractures present the highest difference. Conclusions: Our study reveals that the percentage of rotational malalignment after the intramedullary nailing of intertrochanteric fractures remains high (31.1%), despite the proper use of radiographic imaging during the intraoperative fracture reduction. In most cases (91.3%), this malalignment appears to be a matter of internal overcorrection. A clear correlation between hip’s rotational deformity and patients′ functional outcome has yet to be proven, and constitutes our objective in the near future. Full article