Trauma Risk Score Matching for Observational Studies in Orthopedic Trauma.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declaration of Competing Interest None 9. Chin Med J (Engl). 2019 Nov 5;132(21):2534-2542. doi: 10.1097/CM9.0000000000000493. Predictors and reduction techniques for irreducible reverse intertrochanteric fractures. Hao YL(1), Zhang ZS(2), Zhou F(1), Ji HQ(1), Tian Y(1), Guo Y(1), Lyu Y(1), Yang ZW(1), Hou GJ(1). Author information: (1)Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China. (2)Trauma Center, Peking University Third Hospital, Beijing 100191, China. BACKGROUND: Reverse intertrochanteric fractures are usually initially treated with closed reduction. However, sometimes these fractures are not amenable to closed reduction and require open reduction. To date, few studies have been conducted on predictors of and reduction techniques for irreducible reverse intertrochanteric fractures. Therefore, this study aimed to summarize the displacement patterns of irreducible reverse intertrochanteric fractures and corresponding reduction techniques, and explore predictors of irreducibility. METHODS: We reviewed 1174 cases of trochanteric fractures treated in our hospital from January 2006 to October 2018, 113 of which were reverse intertrochanteric fractures. An irreducible fracture was determined according to intra-operative fluoroscopy imaging after closed manipulation. Fractures were assessed for displacement patterns, radiographic features of irreducibility, and reduction techniques. Logistic regression analysis was performed on potential predictors for irreducibility, including gender, age, body mass index, AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification, and radiographic features. RESULTS: Seventy-six irreducible fractures were identified, accounting for 67% of reverse intertrochanteric fractures. Six patterns of fracture displacement after closed manipulation were identified; the most common pattern was medial displacement and posterior sagging of the femoral shaft relative to the head-neck fragment. Multivariate logistic regression analysis identified three predictors of irreducibility: a medially displaced femoral shaft relative to the head-neck fragment on the anteroposterior (AP) view (odds ratio [OR], 8.00; 95% confidence interval [CI], 3.04-21.04; P