不保留股骨距人工股骨头置换治疗高龄不稳定转子骨折课件

不保留股骨距人工股骨头置换治疗高龄不稳定转子骨折不保留股骨距人工股骨头置换治疗高龄不稳定转子骨折不保留股骨距人工股骨头置换治疗高龄不稳定转子骨折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头置换不保留股骨距人工股骨头置换治疗高龄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头置换治疗高龄不稳定转子骨折课件11不保留股骨距人工股骨头置换治疗高龄不稳定转子骨折课件12不保留股骨距人工股骨头置换治疗高龄不稳定转子骨折课件13不保留股骨距人工股骨头置换治疗高龄不稳定转子骨折课件14不保留股骨距人工股骨头置换治疗高龄不稳定转子骨折课件15不保留股骨距人工股骨头置换治疗高龄不稳定转子骨折课件16不保留股骨距人工股骨头置换治疗高龄不稳定转子骨折课件17不保留股骨距人工股骨头置换治疗高龄不稳定转子骨折课件18不保留股骨距人工股骨头置换治疗高龄不稳定转子骨折课件19不保留股骨距人工股骨头置换治疗高龄不稳定转子骨折课件20不保留股骨距人工股骨头置换治疗高龄不稳定转子骨折课件21不保留股骨距人工股骨头置换治疗高龄不稳定转子骨折课件22不保留股骨距人工股骨头置换治疗高龄不稳定转子骨折不保留股骨距人工股骨头置换治疗高龄不稳定转子骨折不保留股骨距人工股骨头置换治疗高龄不稳定转子骨折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头置换不保留股骨距人工股骨头置换治疗高龄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