Outcomes of Low-Energy Basicervical Proximal Femoral Fractures Treated with Cephalomedullary Fixation.

BACKGROUND: Basicervical peritrochanteric fractures are relatively rare, with 1.8% to 7.6% of hip fractures being identified as true basicervical fractures. The compression hip screw traditionally has been considered the "gold standard" for operative fixation of peritrochanteric fractures, with generally good results. The purpose of this study was to report the outcomes of basicervical peritrochanteric fractures of the proximal part of the femur treated with cephalomedullary nailing (CMN). METHODS: We reviewed medical records and radiographs of all patients at our institution with a peritrochanteric fracture treated with CMN from 2010 to 2012 (246 patients). Fourteen patients with a 2-part basicervical fracture were identified. Two of them died less than 6 weeks after injury and another patient did not return for follow-up. Eleven patients were included in the reported series. RESULTS: Five of the 11 patients had fracture-healing without complications. Their average tip-apex distance was 14.9 mm. The fixation failed in the remaining six patients, all of whom had a tip-apex distance of <25 mm, with an average of 17.4 mm. Four of the failures followed an anatomic reduction, and the other 2 followed a nearly anatomic reduction. CONCLUSIONS: CMN may be inadequate for fixation of 2-part basicervical fractures. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Management of Posterior Articular Depression in Tibial Plateau Fractures.

Fractures involving the posterior aspect of the tibial plateau are challenging fractures to treat. Articular depression in tibial plateau fractures is usually addressed by elevation of the fragment(s), filling the residual defect with bone graft or bone substitute, and "raft" support of the articular fracture reduction with screws through a medially and/or laterally based plate. Posterior tibial plateau articular depression presents unique challenges for obtaining and maintaining fracture reduction. To obtain the goals of anatomic reduction and stable fixation, a thorough understanding of the fracture, specific approaches, reduction techniques, and stabilization strategies is needed. This article reviews the most current strategies for treating tibial plateau fracture patients with posterior articular depression.