Extract
We appreciate the interest by Dr. Gotfried in our recent article and are
delighted that he finds our study to be particularly important. In a large
number of patients, our study does, in fact, confirm previous reports of the
importance of the integrity of the lateral femoral wall, including the fact
that a fracture of the lateral femoral wall is most often an iatrogenic
complication.Dr. Gotfried raises good questions regarding the nomenclature used in the
article. The general nomenclature for these fractures is quite confusing. As
the terms trochanteric, pertrochanteric, pantrochanteric, and
intertrochanteric, etc., are often mixed up, we also find it highly relevant
to achieve international consensus on this matter. In our article, we simply
used the term intertrochanteric for all type 31-A fractures, in part,
because we found that Dr. Gotfried also previously did
this1, although not
in a later article2
referred to in our study. We now agree that using the terms
pertrochanteric for the type 31-A1 and 31-A2 fractures and
intertrochanteric only for the type 31-A3 fractures would have been
more precise. On the other hand, we still find that we enable the reader to
distinguish between the fracture types by using the AO/OTA classification
numbers, including the very important subtypes in the text and tables, and by
showing an illustrating diagram.
We appreciate the interest by Dr. Gotfried in our recent article and are
delighted that he finds our study to be particularly important. In a large
number of patients, our study does, in fact, confirm previous reports of the
importance of the integrity of the lateral femoral wall, including the fact
that a fracture of the lateral femoral wall is most often an iatrogenic
complication.
Dr. Gotfried raises good questions regarding the nomenclature used in the
article. The general nomenclature for these fractures is quite confusing. As
the terms trochanteric, pertrochanteric, pantrochanteric, and
intertrochanteric, etc., are often mixed up, we also find it highly relevant
to achieve international consensus on this matter. In our article, we simply
used the term intertrochanteric for all type 31-A fractures, in part,
because we found that Dr. Gotfried also previously did
this1, although not
in a later article2
referred to in our study. We now agree that using the terms
pertrochanteric for the type 31-A1 and 31-A2 fractures and
intertrochanteric only for the type 31-A3 fractures would have been
more precise. On the other hand, we still find that we enable the reader to
distinguish between the fracture types by using the AO/OTA classification
numbers, including the very important subtypes in the text and tables, and by
showing an illustrating diagram.
We agree that new definitions of biomechanical complications are necessary
and that the knowledge that the lateral femoral wall is an iatrogenic
complication could contribute to a better understanding of the treatment of
these fractures. We currently treat type 31-A1 and 31-A2.1 fractures with a
sliding hip screw fixed to a lateral plate and type 31-A3 fractures with a
sliding hip screw fixed to an intramedullary nail.
As a third of the 31-A2.2 and 31-A2.3 fractures in our study were converted
to 31-A3 fractures, we now also treat these fractures using the sliding hip
screw fixed to an intramedullary nail. In the future, perhaps other systems
designed specifically to avoid a perioperative fracture of the lateral femoral
wall1 might prove to
be superior to treat these specific fracture subgroups. To date, it has not
been feasible to categorize fractures into all of the AO/OTA subgroups as this
demands very large groups of patients.
Gotfried Y. Percutaneous compression
plating of intertrochanteric hip fractures. J Orthop Trauma.2000;14:
490-5.14490
2000
[PubMed][CrossRef]
Gotfried Y. The lateral trochanteric
wall: a key element in the reconstruction of unstable pertrochanteric hip
fractures. Clin Orthop Relat Res.2004;425:
82-6.42582
2004
[PubMed][CrossRef]
Im GI, Shin YW, Song YJ. Potentially
unstable intertrochanteric fractures. J Orthop Trauma.2005;19:
5-9.195
2005
[PubMed][CrossRef]
Fracture and dislocation compendium. Orthopaedic Trauma Association
Committee for Coding and Classification. J Orthop Trauma.1996;10Suppl 1:
v-ix, 1-154.10v
1996
[PubMed]
Gotfried Y. Pantrochanteric hip
fracture: an entity. J Bone Joint Surg Br. (Suppl
III) 2000;82:
235.82235
2000