Accuracy of detecting burst of the lateral wall in intertrochanteric hip fractures with plain radiographs: Is postoperative CT necessary?
Background: Postoperative burst of the lateral femoral wall is thought to be the main predictor of reoperation for intertrochanteric fractures, which is routinely evaluated using plain radiographs. We retrospectively compared computed tomography (CT) scans and radiographs regarding the ability to de...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-02-01
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| Series: | Heliyon |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844024014208 |
| _version_ | 1797304516011360256 |
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| author | Xiaoyang Jia Minfei Qiang Kun Zhang Qinghui Han Gengxin Jia Tianhao Shi Ying Wu Yanxi Chen |
| author_facet | Xiaoyang Jia Minfei Qiang Kun Zhang Qinghui Han Gengxin Jia Tianhao Shi Ying Wu Yanxi Chen |
| author_sort | Xiaoyang Jia |
| collection | DOAJ |
| description | Background: Postoperative burst of the lateral femoral wall is thought to be the main predictor of reoperation for intertrochanteric fractures, which is routinely evaluated using plain radiographs. We retrospectively compared computed tomography (CT) scans and radiographs regarding the ability to detect burst of the lateral wall. We also investigated whether intramedullary nails may cause iatrogenic burst of the lateral wall. Methods: From January 2010 to December 2021, patients aged 65 years and older who undergone intertrochanteric fractures treated with the proximal femoral nail antirotation 2 (PFNA-Ⅱ) were included. The incidence of burst of the lateral wall was evaluated with two different imaging modalities by two observers. Two rounds of evaluation were performed: (1) with plain radiographs alone; and (2) with CT scans combined with radiographs. Interobserver and intraobserver agreement (κ value) for evaluation of the lateral wall burst was assessed. Results: A total of 1507 patients were included (362 males and 1145 females). Compared with radiographs alone (12.0 %, 181/1507 patients), a higher rate of lateral wall burst was found by CT scans combined with radiographs (72.9 %, 1098/1507 patients) for observer 1 at first reading (P < 0.001). Similar results were seen in other evaluations. Interobserver and intraobserver agreement was substantial for radiographs alone (κ, 0.659–0.727) and almost perfect for CT scans combined with radiographs (κ, 0.847–0.926). Conclusions: Computed tomography combined with radiographs is superior to radiographs alone for detecting burst of the lateral wall after intertrochanteric fracture fixation. Additionally, PFNA-Ⅱ could cause iatrogenic burst of the lateral wall for intertrochanteric fractures in the elderly. |
| first_indexed | 2024-03-08T00:10:39Z |
| format | Article |
| id | doaj.art-ef61620d7a674698a0c150e4bd5851d2 |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-03-08T00:10:39Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-ef61620d7a674698a0c150e4bd5851d22024-02-17T06:40:59ZengElsevierHeliyon2405-84402024-02-01103e25389Accuracy of detecting burst of the lateral wall in intertrochanteric hip fractures with plain radiographs: Is postoperative CT necessary?Xiaoyang Jia0Minfei Qiang1Kun Zhang2Qinghui Han3Gengxin Jia4Tianhao Shi5Ying Wu6Yanxi Chen7Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, ChinaDepartment of Orthopedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, ChinaResearch and Development Department, Yangfeng (Shanghai) Science and Technology CO., LTD, Shanghai, 200439, ChinaDepartment of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Shanghai, 200120, ChinaDepartment of Orthopedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, ChinaDepartment of Orthopedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, ChinaDepartment of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangdong, Guangzhou, 510515, ChinaDepartment of Orthopedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China; Corresponding author.Background: Postoperative burst of the lateral femoral wall is thought to be the main predictor of reoperation for intertrochanteric fractures, which is routinely evaluated using plain radiographs. We retrospectively compared computed tomography (CT) scans and radiographs regarding the ability to detect burst of the lateral wall. We also investigated whether intramedullary nails may cause iatrogenic burst of the lateral wall. Methods: From January 2010 to December 2021, patients aged 65 years and older who undergone intertrochanteric fractures treated with the proximal femoral nail antirotation 2 (PFNA-Ⅱ) were included. The incidence of burst of the lateral wall was evaluated with two different imaging modalities by two observers. Two rounds of evaluation were performed: (1) with plain radiographs alone; and (2) with CT scans combined with radiographs. Interobserver and intraobserver agreement (κ value) for evaluation of the lateral wall burst was assessed. Results: A total of 1507 patients were included (362 males and 1145 females). Compared with radiographs alone (12.0 %, 181/1507 patients), a higher rate of lateral wall burst was found by CT scans combined with radiographs (72.9 %, 1098/1507 patients) for observer 1 at first reading (P < 0.001). Similar results were seen in other evaluations. Interobserver and intraobserver agreement was substantial for radiographs alone (κ, 0.659–0.727) and almost perfect for CT scans combined with radiographs (κ, 0.847–0.926). Conclusions: Computed tomography combined with radiographs is superior to radiographs alone for detecting burst of the lateral wall after intertrochanteric fracture fixation. Additionally, PFNA-Ⅱ could cause iatrogenic burst of the lateral wall for intertrochanteric fractures in the elderly.http://www.sciencedirect.com/science/article/pii/S2405844024014208Hip fractureIntertrochanteric fractureLateral femoral wallComputed tomographyRadiographs |
| spellingShingle | Xiaoyang Jia Minfei Qiang Kun Zhang Qinghui Han Gengxin Jia Tianhao Shi Ying Wu Yanxi Chen Accuracy of detecting burst of the lateral wall in intertrochanteric hip fractures with plain radiographs: Is postoperative CT necessary? Heliyon Hip fracture Intertrochanteric fracture Lateral femoral wall Computed tomography Radiographs |
| title | Accuracy of detecting burst of the lateral wall in intertrochanteric hip fractures with plain radiographs: Is postoperative CT necessary? |
| title_full | Accuracy of detecting burst of the lateral wall in intertrochanteric hip fractures with plain radiographs: Is postoperative CT necessary? |
| title_fullStr | Accuracy of detecting burst of the lateral wall in intertrochanteric hip fractures with plain radiographs: Is postoperative CT necessary? |
| title_full_unstemmed | Accuracy of detecting burst of the lateral wall in intertrochanteric hip fractures with plain radiographs: Is postoperative CT necessary? |
| title_short | Accuracy of detecting burst of the lateral wall in intertrochanteric hip fractures with plain radiographs: Is postoperative CT necessary? |
| title_sort | accuracy of detecting burst of the lateral wall in intertrochanteric hip fractures with plain radiographs is postoperative ct necessary |
| topic | Hip fracture Intertrochanteric fracture Lateral femoral wall Computed tomography Radiographs |
| url | http://www.sciencedirect.com/science/article/pii/S2405844024014208 |
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