Morphology Specific Lateral Wall Reconstruction Techniques Using Cerclage Wires in Unstable Trochanteric Fractures
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Morphology Specific Lateral Wall Reconstruction Techniques Using Cerclage Wires in Unstable Trochanteric Fractures Zackariya Mohamed Jafarullah1 · Girinivasan Chellamuthu1 · Durga Prasad Valleri1 · Velmurugesan Purnaganapathy Sundaram1 · Devendra Agraharam1 · Dheenadhayalan Jayaramaraju1 · Rajasekaran Shanmuganathan2 Received: 12 May 2020 / Accepted: 1 August 2020 © Indian Orthopaedics Association 2020
Abstract Trochanteric lateral wall fracture (LWF) indicates instability and is found to be an important predictor of reoperations following trochanteric fracture fixation. A single unified technique for lateral wall reconstruction may not adequately stabilize all the fracture patterns. We have presented morphology specific lateral wall reconstruction techniques using cerclage wire around proximal femoral nails. Various LWF patterns have been simplified into three types. Type-specific lateral wall reconstruction techniques using cerclage wire were adopted in 49 consecutive unstable trochanteric fractures presented to our institute between 2016 and 2018. We analyzed the fracture pattern, fixation method used, union time, and complications. The functional outcome was analyzed using the Harris hip score (HSS). The mean follow-up period was 13 months (range 10–36 months). The mean age of the population was 66 years (range 36–91 years). There were 15 patients with type 1 LWF pattern, 26 patients with type 2, and 8 were of type 3 pattern. The mean operating time was 66 min. The mean union time was 14 weeks (10–24 weeks). HSS was excellent in 9 patients, good in 33 patients, fair in 4 patients, and poor in 5 patients. Complications include one patient with avascular necrosis (AVN) of the femoral head, varus collapse with non-union in one patient, screws back out in one patient, superficial infection in 4 patients, and distal screw breakage in one patient. Type 2 is the most common LWF type in our study. In unstable trochanteric fractures, morphology specific lateral wall reconstruction using cerclage wire loops around the proximal femoral nail is a simple technique with promising results with minimal complications. Keywords Intertrochanteric · Cerclage wiring · Lateral wall reconstruction · Unstable · Trochanteric fractures
Introduction It was estimated in 2004 that there were about 600,000 elderly hip fractures in India of which trochanteric fractures were very common [1]. The incidence is expected to significantly increase as the proportion of the aged population is
on a rise [2]. Unstable intertrochanteric fractures (AO OTA 31A2 and A3 fractures) pose a great challenge to operating surgeons [3, 4]. The fracture is considered unstable if there is a large posteromedial fragment, reverse oblique pattern, subtrochanteric extension, or lateral wall fracture (LWF) [5]. The
* Zackariya Mohamed Jafarullah [email protected]
Dheenadhayalan Jayaramaraju [email protected]
Girinivasan Chellamuthu [email protected]
Rajasekaran Shanmuganathan [email protected]
Durga Prasad Valleri du
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