Cut out complications and anisomelia of the lower limbs in surgery with valgus reduction for intertrochanteric fractures

Abstract

Background: The proximal fractures of the femur are counted among the group of orthopedic and traumatic pathologies which consume most of the financial resources set aside for health worldwide. Surgical treatment continues to be the treatment of choice for intertrochanteric fractures of the femur. However, although the surgical treatment of the proximal fracture of the femur is widely known and accepted in the orthopedic field, it is not without risk with the cut out being the most feared complication. Objective: This paper describes the complications of cut out or the anisomelia of the lower limbs of patients with intertrochanteric fractures who underwent valgus reduction surgery. Methods: Sixty-one patients with 3rd and 4th degree, according to Tronzo classification, intertrochanteric fractures underwent surgery with the use of Dynamic hip screw type sliding screw and valgus reduction. The data were analyzed one year after surgery, when a functional assessment was made by scanometry, Tip-Apex Distance index diaphyseal cervical angle and the modified Merle d'Aubigné & Postel questionnaire. Kruskal-Wallis and Mann-Whitney tests were used for the statistical analysis, Spearman's correlation test for the quantitative variables and the chi-squared test for the qualitative variables. Results: The correlation between the Tip-Apex Distance index and the diaphyseal cervical angle was statistically significant (rho=0.391, p=0.002), while the correlations between the Tip-Apex Distance index and the scanometry and the diaphyseal cervical angle and the scanometry were not significantly correlated. In accordance with the modified Merle d'Aubigné & Postel questionnaire, 23 patients (37.7%) achieved a very good result, 29 patients (47.5%) had a good result, five patients (8.2%) obtained a moderately good result, one patient (1.6%) presented a reasonable result and three patients (4.9%) obtained a poor result. Conclusion: No cut out complications occurred in the 3rd and 4th degree intertrochanteric fractures with a Baumgaertner index ≥ 25 mm, when the reduction and valgus fixation of the intertrochanteric fracture was performed with the Dynamic hip screw type sliding pin, as there was also, in the majority of patients, no anisomelia of the lower limbs.