title: Three-Dimensional Computed Tomographic Analysis for Comminution of Pertrochanteric Femoral Fracture: Comminuted Anterior Cortex as a Predictor of Cutting Out.
abstract: BACKGROUND
  Fixed angle sliding hip screw devices allow controlled impaction between the head neck fragment and the femoral shaft fragment in the surgical treatment of pertrochanteric fractures. This study was performed to evaluate the frequency and pattern of comminution at the fracture site, which may prevent the intended impaction.
  
  
  METHODS
  Three-dimensional computed tomography was used to investigate 101 pertrochanteric fractures treated with fixed angle sliding hip screw devices, with emphasis on the comminuted cortex. A comminuted fracture was defined as a fracture that had a third fracture fragment at the main fracture line.
  
  
  RESULTS
  There were 40 fractures without comminution and 61 with comminution. All 61 comminuted fractures had a comminuted posterior cortex, and 3 of 61 fractures also had comminution at the anterior cortex. The prevalence of cutting out of the implant from the femoral head was significantly higher in cases involving comminution at both the posterior and anterior cortices than in cases involving comminution only at the posterior cortex (66.7 % and 3.4 %, p < 0.0001).
  
  
  CONCLUSIONS
  The posterior cortex was comminuted in 60.4% of pertrochanteric fractures and the anterior cortex in 3.0%. Intended impaction at the fracture site could not be obtained at any cortex in cases with comminution at both the anterior and posterior cortices; comminution at the anterior cortex may be a predictor of cutting out.
authors.affiliation: Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, Niigata, Japan.
authors.forename: Sachiyuki
authors.initials: S
authors.lastname: Tsukada
authors.affiliation: Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, Niigata, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Wakui
authors.affiliation: Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, Niigata, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshizawa
authors.affiliation: Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, Niigata, Japan.
authors.forename: Masunao
authors.initials: M
authors.lastname: Miyao
authors.affiliation: Department of Rehabilitation, Nekoyama Miyao Hospital, Niigata, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Honma
keywords: Cut out; hip fracture; nakano classification; osteoporosis; radiology; trochanteric