不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉子骨折課件

不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉子骨折不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉子骨折不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉子骨折EpidemicSurveyingDataHalfofthefracturesaroundthehipareintertrochantericfractures(T)SenthilN,etal.,EurJOrthopSurgTraumatol,2016Approximately35to40%ofITfracturesareconsideredunstableGrimsrudC,etal.,JArthroplasty,2008Givenouragingpopulation,thenumberofITfracturesisexpectedtoincreasedramaticallyinthenextdecadeSudhirsetal.JCDR.2014UnstableintertrochantericFracturesFig.2.AO/OTAclassificationofunstablepertrochanterichipfracturesTypesA2.2,A2.3,A3.1,A3.2,andA3.3areconsideredasunstablefractures不保留股骨距人工股骨頭置換不保留股骨距人工股骨頭置換治療高齡1EpidemicSurveyingDataHalfofthefracturesaroundthehipareintertrochantericfractures(T)SenthilN,etal.,EurJOrthopSurgTraumatol,2016Approximately35to40%ofITfracturesareconsideredunstableGrimsrudC,etal.,JArthroplasty,2008Givenouragingpopulation,thenumberofITfracturesisexpectedtoincreasedramaticallyinthenextdecadeSudhirsetal.JCDR.2014EpidemicSurveyingData2UnstableintertrochantericFracturesFig.2.AO/OTAclassificationofunstablepertrochanterichipfracturesTypesA2.2,A2.3,A3.1,A3.2,andA3.3areconsideredasunstablefracturesUnstableintertrochantericFra3&NCBIResourcesvHowTovPubMed.WhatMakesanIntertrochantericFractureUnstablein201USNationalLibraryofCreateRSsCreatealertAdvancedstitutesofHealthFormatAbstractSee1citationfoundbytitlematchingyoursearchORthopTrauma,2015Apr29Suppl4S4-9.doi:10.1097/80T.0000000000000284Whatmakesanintertrochantericfractureunstablein2015?Doesthelateralwallplayaroleinthedecisionmatrix?TawarAA,KempegowdaH,SukM,HortzDS4Authorinformationtertrochanteric(m)fracturesposeatremendousburdentothehealthcaresystem.AlthoughconsistentlygoodresultsareobtainedwhiletreatingstableITfractures,treatmentfailurerateswithunstablefracturesaremuchhigher,andhence,itisimperativetoidentnstablepattens.Presently,theconventionallyclassifiedunstableconfigurations(fracturewithposteromedialcomminution,reverseblique.ITwithsubtrochantencextension)andtherecentlyaddedfracturepattens(Tfractureswithavulsedgreatertrochanterandteralwallbreach)qualifyasunstableITfractureshowever,thelistiscertainlynotexhaustive.DisruptionoflateralwallconvertsanITfractureintoareverseobliquefractureequivalentandshouldbegivenastrongconsiderationinthedecisionmatrixMD:25756825Do:101097oT0000000000024&NCBIResourcesvHowTov4ConventionalUnstabletPosteromedialcomponentFIGURE1Preoperative(AandB),intraoperative(CandD,andpostoperative(EandF)imagesofanunstable/Tfracturewithposteromedialcomminution.Notethehealingwithposteriorsagseeninthepostoperativeimagepiteobtain-ingexcellentalignmentintraoperatively.ConventionalUnstablet5ConventionalUnstableTReverseObliqueFractureFIGURE2Preoperative(AandB)andpostoperative(CandD)imagesofaAreverseoblique/Tfracture.NotethefracturelineisparalleltotheheadfixationdeviceConventionalUnstableT6Conventiona/UnstabletITFracturewithSubtrochantericExtensionFIGURE3Preoperative(AandB)andpost-operative(CandD)imagesshowing/TfracturewithsubtrochantericextensionConventiona/Unstablet7RecentadditionsLateralwallblow-OutFIGURE4An/Tfractureinanextremelyosteoporoticbone(AandB)AfixedwithanSHS(C)Notethelatera/wallblow-outtheimmediatepostoperativeimage(D)Recentadditions8RecentAdditionsReverseObliquevariant■OsteoporosisFIGURE5Preoperative(AandB)andpostoperative(candD)imagesofthereverseobliquevariantpatternNotethetypical/Tfracturepatternappearanceintheanteroposteriorview(A)andtheobliquity(BandDinthelateralviewRecentAdditions9TypeofAO/OTAA2.3Female,72yrs,OsteoporosisWemustdobetter!!TypeofAO/OTAA2.310不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉子骨折課件11不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉子骨折課件12不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉子骨折課件13不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉子骨折課件14不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉子骨折課件15不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉子骨折課件16不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉子骨折課件17不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉子骨折課件18不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉子骨折課件19不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉子骨折課件20不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉子骨折課件21不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉子骨折課件22不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉子骨折不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉子骨折不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉子骨折EpidemicSurveyingDataHalfofthefracturesaroundthehipareintertrochantericfractures(T)SenthilN,etal.,EurJOrthopSurgTraumatol,2016Approximately35to40%ofITfracturesareconsideredunstableGrimsrudC,etal.,JArthroplasty,2008Givenouragingpopulation,thenumberofITfracturesisexpectedtoincreasedramaticallyinthenextdecadeSudhirsetal.JCDR.2014UnstableintertrochantericFracturesFig.2.AO/OTAclassificationofunstablepertrochanterichipfracturesTypesA2.2,A2.3,A3.1,A3.2,andA3.3areconsideredasunstablefractures不保留股骨距人工股骨頭置換不保留股骨距人工股骨頭置換治療高齡23EpidemicSurveyingDataHalfofthefracturesaroundthehipareintertrochantericfractures(T)SenthilN,etal.,EurJOrthopSurgTraumatol,2016Approximately35to40%ofITfracturesareconsideredunstableGrimsrudC,etal.,JArthroplasty,2008Givenouragingpopulation,thenumberofITfracturesisexpectedtoincreasedramaticallyinthenextdecadeSudhirsetal.JCDR.2014EpidemicSurveyingData24UnstableintertrochantericFracturesFig.2.AO/OTAclassificationofunstablepertrochanterichipfracturesTypesA2.2,A2.3,A3.1,A3.2,andA3.3areconsideredasunstablefracturesUnstableintertrochantericFra25&NCBIResourcesvHowTovPubMed.WhatMakesanIntertrochantericFractureUnstablein201USNationalLibraryofCreateRSsCreatealertAdvancedstitutesofHealthFormatAbstractSee1citationfoundbytitlematchingyoursearchORthopTrauma,2015Apr29Suppl4S4-9.doi:10.1097/80T.0000000000000284Whatmakesanintertrochantericfractureunstablein2015?Doesthelateralwallplayaroleinthedecisionmatrix?TawarAA,KempegowdaH,SukM,HortzDS4Authorinformationtertrochanteric(m)fracturesposeatremendousburdentothehealthcaresystem.AlthoughconsistentlygoodresultsareobtainedwhiletreatingstableITfractures,treatmentfailurerateswithunstablefracturesaremuchhigher,andhence,itisimperativetoidentnstablepattens.Presently,theconventionallyclassifiedunstableconfigurations(fracturewithposteromedialcomminution,reverseblique.ITwithsubtrochantencextension)andtherecentlyaddedfracturepattens(Tfractureswithavulsedgreatertrochanterandteralwallbreach)qualifyasunstableITfractureshowever,thelistiscertainlynotexhaustive.DisruptionoflateralwallconvertsanITfractureintoareverseobliquefractureequivalentandshouldbegivenastrongconsiderationinthedecisionmatrixMD:25756825Do:101097oT0000000000024&NCBIResourcesvHowTov26ConventionalUnstabletPosteromedialcomponentFIGURE1Preoperative(AandB),intraoperative(CandD,andpostoperative(EandF)imagesofanunstable/Tfracturewithposteromedialcomminution.Notethehealingwithposteriorsagseeninthepostoperativeimagepiteobtain-ingexcellentalignmentintraoperatively.ConventionalUnstablet27ConventionalUnstableTReverseObliqueFractureFIGURE2Preoperative(AandB)andpostoperative(CandD)imagesofaAreverseoblique/Tfracture.NotethefracturelineisparalleltotheheadfixationdeviceConventionalUnstableT28Conventiona/UnstabletITFracturewithSubtrochantericExtensionFIGURE3Preoperative(AandB)andpost-operative(CandD)imagesshowing/TfracturewithsubtrochantericextensionConventiona/Unstablet29RecentadditionsLateralwallblow-OutFIGURE4An/Tfractureinanextremelyosteopor