不保留股骨距人工股骨頭置換治療高齡不穩(wěn)定轉(zhuǎn)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(zhuǎn)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(zhuǎn)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(zhuǎn)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,andA3.3areconsideredasunstablefracturesEpidemicSurveyingDataHalfofthefracturesaroundthehipareintertrochantericfractures(T)SenthilN,etal.,EurJOrthopSurgTraumatol,2016Approximately35to40%ofITfracturesareconsideredunstableGrimsrudC,etal.,JArthroplasty,2008Givenouragingpopulation,thenumberofITfracturesisexpectedtoincreasedramaticallyinthenextdecadeSudhirsetal.JCDR.2014UnstableintertrochantericFracturesFig.2.AO/OTAclassificationofunstablepertrochanterichipfracturesTypesA2.2,A2.3,A3.1,A3.2,andA3.3areconsideredasunstablefractures&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:101097oT0000000000024ConventionalUnstabletPosteromedialcomponentFIGURE1Preoperative(AandB),intraoperative(CandD,andpostoperative(EandF)imagesofanunstable/Tfracturewithposteromedialcomminution.Notethehealingwithposteriorsagseeninthepostoperativeimagepiteobtain-ingexcellentalignmentintraoperatively.ConventionalUnstableTReverseObliqueFractureFIGURE2Preoperative(AandB)andpostoperative(CandD)imagesofaAreverseoblique/Tfracture.NotethefracturelineisparalleltotheheadfixationdeviceConventiona/UnstabletITFracturewithSubtrochantericExtensionFIGURE3Preoperative(AandB)andpost-operative(CandD)imagesshowing/TfracturewithsubtrochantericextensionRecentadditionsLateralwallblow-OutFIGURE4An/Tfractureinanextremelyosteoporoticbone(AandB)AfixedwithanSHS(C)Notethelatera/wallblow-outtheimmediatepostoperativeimage(D)RecentAdditionsReverseObliquevariant■OsteoporosisFIGURE5Preoperative(AandB)andpostoperative(candD)imagesofthereverseobliquevariantpatternNot