Lateral Femoral Wall Thickness for Predicting Implant Failure: A Prospective Cohort Study скачать в хорошем качестве

Lateral Femoral Wall Thickness for Predicting Implant Failure: A Prospective Cohort Study

A Selim, E Ani, N Seoudi, I Algeaidy, AS Barakat Reliability of the lateral femoral wall thickness for detecting the potential for treatment failure and implant choice in patients with trochanteric hip fractures; A prospective cohort study Amr Selim Authors A. Selim, E. Anni, N. Seoudi, I. Algeaidy, A. S. Barakat Institution Royal Cornwall Hospital Trust Abstract Background Trochanteric Hip fractures represent one of the most challenging injuries in orthopaedic practice due to the associated morbidity, mortality and financial burden they impose on the health care system. DHS remains the gold standard in management of these fractures. Lateral femoral wall thickness (LWT) is an evolving parameter for detecting the potential for lateral wall fracture with subsequent medialisation and implant failure. The aim of this study is to determine the mean and cut off levels for LWT that warrant lateral wall fracture and the implications of that on implant failure, revision rates and implant choice Method This prospective cohort study included 42 patients with a mean age of 70.43y with trochanteric hip fractures treated with DHS fixation by the same surgeon from April 2019 to December 2019. LWT was assessed in all patients preoperatively using Surgimap (Nemaris, NY, USA) software. Patients were divided into two groups according to the post-operative integrity of the lateral femoral wall, where group (A) sustained a lateral femoral wall fracture, while in group (B) the lateral femoral wall remained intact. All patients were regularly followed up for a period of 12 months. Results At 12 months five patients (12%) suffered a postoperative lateral wall fracture, while in 37 patients (88%) the lateral femoral wall remained intact. The mean preoperative LWT of patients with a postoperative lateral wall fracture was 18.04 mm (SD ± 1.58) compared to 26.22mm (SD ± 5.93) in the group without a lateral wall fracture. Treatment failure meriting a revision surgery was 40 % in group (A) and 8% in group (B) denoting a statistically significant difference. The cut-off point of LWT below which there is a high chance of post-operative lateral wall fracture when fixed with DHS is 19.6mm Conclusion Preoperative measurement of LWT in elderly patients with trochanteric hip fractures is decisive. The cut off point for postoperative lateral wall fracture according to our study is 19.6 mm; hence, intramedullary fixation has to be considered in this situation.