DOS Kongressen 2014 ·
149
Nailing of unstable trochanteric fractures with and
without circumferential wires – a study with focus on
complications and reoperations within two years.
Lasse Birkelund, Michael Brix, Ilija Ban, Henrik Palm, Anders Troelsen
Ortopædkirurgisk, Aabenraa Sygehus
Background:
Open reduction and circumferential wires have long been contro-
versial in trochanteric fractures treated with an intramedullary nail (IMN) be-
cause of concerns about compromising the periosteal blood supply leading to
bone necrosis. We hypothesize that wires may instead facilitate optimal implant
position and fracture reduction
Purpose / Aim of Study:
To compare per- and postoperative results in pa-
tients with an unstable trochanteric fracture treated with IMN with or without
wires, within 2 year from surgery
Materials and Methods:
51 consecutive patients with trochanteric fractures
treated with IMN and wires were identified in from two prospective databases.
It was compared to, a by age and fracture subtype, matched control group of
51 patients treated with IMN without wires, selected in a third database. ASA,
operation-time, bleeding, fracture reduction postoperative, tip-apex distance
(TAD) and reoperations within two years were assessed from records and ra-
diographs
Findings / Results:
Due to the match method, the 2 groups were alike regard-
ing age and fracture classification. ASA and TAD was NS. Application of wires
resulted in significantly longer operation time (p<0.001) and increased bleeding
(p<0.001), but a superior reduction (p<0.001). 4/51 patients with wires were
reoperated: 1 due to technical failure during osteosynthesis, 1 screw cut out, 1
new fracture after a fall and 1 hardware removal. 9/51 patients without wires
were reoperated: 2 deep infections, 3 new fractures after a fall, 1 screw cut out,
1 nail removal and 2 non- unions
Conclusions:
It appears that open reduction and application of circumferen-
tial wires facilitates a superior fracture reduction, probably worth the increased
bleeding and longer operation time. Future level-1 studies are warranted in-
cluding outcome parameters such as mobilization and pain on short and longer
term
96.
