A Survey of Current Practices and Preferences for Internal Fixation of Trochanteric Fractures of the Femur in Brazil.

Vincenzo Giordano,Marcos Giordano,Thiago A Alvim,Hilton A Koch,Anderson Freitas,Rafael G Tinoco,Denner N Ribeiro

doi:10.7759/cureus.2286

Abstract

ObjectiveThe primary aim of this study was to survey current practices and preferences behind internal fixation of trochanteric femoral fractures among Brazilian orthopedic surgeons. The secondary aim was to identify the main reason for these preferences.MethodsA survey containing 20 images of trochanteric fractures of the femur was presented to a group of 62 orthopedists, all members of the Brazilian Society of Orthopedics and Traumatology (SBOT). The first part of the questionnaire was created to identify the surgeons’ degree of professional experience, type of practice, and areas of greatest interest and performance within the specialty. The second part of the questionnaire contained options for fixating different trochanteric fracture patterns in the femur for participants to choose, along with the main reason for their decision. Statistical analysis was descriptive and profiled the surgeons’ major area of interest, treatment option, and the main reason for their therapeutic decision.ResultsOf the 62 orthopedists who participated in the study, 10 (16.0%) stated that their area of greatest interest was orthopedic trauma and 52 (83.9%) reported greater interest in another area of the specialty; these two groups were classified as the Trauma Group and Orthopedics Group, respectively. To treat AO 31A1 type fractures, the trauma group selected the sliding hip screw (SHS) in 66.7% of cases, while the orthopedics group chose the SHS in 65.8% of cases. For 31A2 type fractures, the trauma group chose the intramedullary (IM) nail in 64.0% of the cases, while the orthopedics group chose the IM nail in 76.7% of the cases. For 31A3 type fractures, the trauma group opted for the IM nail in 70.0% of the cases, while the orthopedics group selected the IM nail in 88.0% of the cases. The two most important factors in implant selection for the three types of fracture were fracture pattern and implant availability.ConclusionThe sliding hip screw is preferred by most Brazilian orthopedic surgeons for fixation of 31A1 type trochanteric femoral fractures. For 31A2 and 31A3 type fractures, the IM nail is preferred.

Highlights

Treatment of trochanteric fracture of the femur seems well-defined in the literature
Of the 62 orthopedists who participated in the study, 10 (16.0%) stated that their area of greatest interest was orthopedic trauma and 52 (83.9%) reported greater interest in another area of the specialty; these two groups were classified as the Trauma Group and Orthopedics Group, respectively
After changes that resulted from recognition of the importance of soft tissue to bone biology, the search for minimally invasive techniques has led to different options for fixation and techniques to treat the proximal extremity of the femur [4]

Summary

Introduction

Treatment of trochanteric fracture of the femur seems well-defined in the literature. Previous studies indicated that the sliding hip screw (SHS) was preferred by most authors [4,5] This implant provides stability for the fracture by dividing the load between the bone and the implant, allowing a controlled collapse of the proximal fragment over the distal fragment [5,6]. Use of the SHS is questioned for more unstable fracture patterns, such as those involving reverse obliquity, extension of the fracture into the subtrochanteric region, or involvement of the lateral wall of the femur [2,7,8] In these cases, intramedullary (IM) implants are generally recommended for their more favorable biomechanical characteristics, which reduce the risk of fixation failure as well as the rate of complications [2]. Debate continues over which internal fixation method is ideal for treating most trochanteric fractures

Methods

Results

Conclusion