J Korean Fract Soc.  2017 Oct;30(4):192-197. 10.12671/jkfs.2017.30.4.192.

Comparison of the Treatment Results between Reduction with Percutaneous Wiring and Reduction without Percutaneous Wiring in Reverse Oblique Trochanteric Fractures (AO Classification 31-A3.3)

• Park JW
• Shon OJ
• Lim SW

• KMID: 2424131
• DOI: http://doi.org/10.12671/jkfs.2017.30.4.192

Abstract

PURPOSE
The aim of this study was to investigate the utility of percutaneous wiring in the reduction of reverse oblique trochanteric fractures (AO classification 31-A3.3) by analyzing the treatment results with or without the use of percutaneous wiring.
MATERIALS AND METHODS
Thirty-five cases from January 2008 to August 2014 that could be followed-up for at least one year were selected among patients with unstable trochanteric fractures who underwent either internal fixation or open reduction. Seventeen patients underwent surgery with percutaneous wire fixation but another 18 patients underwent surgery without it. All patients received a closed reduction and internal fixation with an intramedullary nail. The factors evaluated were as follows: the length of operation, loss of blood, length of in-hospital stay, lower limb function scale, return to preinjury daily life, change in femur neck shaft angle, postoperative gap of the fracture site, time taken for bone attachment, quality of post-operative reduction, and complications.
RESULTS
No significant difference in the mean operative time, loss of blood, length of in hospital stay, lower limb function scale, return to pre-injury daily life, change in femur neck shaft angle, postoperative gap of the fracture site, and quality of postoperative reduction was observed between the two groups. A significant difference was noted in the time taken for bone attachment (p=0.032). Bone attachment took 13.3 weeks (9-17 weeks) on average when fixed with percutaneous wiring and no patient was found to have any complications. When treated without percutaneous wiring, however, bone attachment took 17.8 weeks (12.5-28.0 weeks) on average and three cases resulted in delayed union.
CONCLUSION
Percutaneous wiring is a recommended treatment option for patients with an unstable trochanteric fracture.

Keyword

Unstable trochanteric fracture; Comminuted fractures; Percutaneous wiring

MeSH Terms

Classification*
Femur Neck
Femur*
Fractures, Comminuted
Hip Fractures*
Humans
Length of Stay
Lower Extremity
Operative Time

Figure

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  Fig. 1 After anatomical reduction was achieved, a nail was inserted and then final reduction was made with percutaneous cerclage wiring.

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  Fig. 2 Wire passer system (Synthes) used in percutaneous cerclage wiring.

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  Fig. 3 (A) A 48-year-old man with wiring: initial, immediately after surgery, 2-month follow-up (F/U) and 3-month F/U on a simple radiograph. (B) A 59-yearold man without wiring: initial, immediately after surgery, 3-month F/U and 6-month F/U on a simple radiograph. PostOP: postoperative.

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