Do Coronal-Plane Fragments in Intertrochanteric Fractures Affect Operative Outcomes? A 10-Year Retrospective Analytic Study of Postoperative Outcomes at Bangkok Hospital
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Abstract
OBJECTIVES: To compare post-operative outcomes between patients with coronal and non-coronal plane fractures, and to assess the quality of fixation and reduction techniques.
MATERIALS AND METHODS: A retrospective review of 73 cases from 2012-2022 at Bangkok Hospital, focusing on post-operative outcomes; primary outcome is union time, and secondary outcomes are post-operative parameters, and complications.
RESULTS: Patients with coronal fractures demonstrated increased fracture instability and altered fixation outcomes compared to non-coronal fractures. There is no significant difference between coronal and non-coronal plane fractures groups in terms of union time (coronal plane; 3 months, non-coronal plane; 3.1 months, p-value = 0.632), neck-shaft angle (coronal fracture mean is 133.6 degree, non-coronal fracture mean is 134.9 degree, p-value = 0.465), cortical support index, tip-apex distance (coronal fracture mean is 2.0 cm, non-coronal fracture mean is 2.0 cm, p-value = 0.830), garden alignment index also shows no statistical difference (p-value = 0.7) between the 2 groups. However, proper reduction and fixation quality significantly impacted outcomes.
CONCLUSION: Presence of coronal plane fracture in intertrochanteric fractures does not affect the union time and complication rates, provided the reduction and fixation quality is optimized in both anteroposterior (AP) and lateral planes. Therefore, surgeons should always carefully assess the preoperative radiographs for the presence of unstable fracture patterns and provide careful reduction and fixation to ensure optimal fixation stability.
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