Outcomes of Internal Fixation with Compression Hip Screws in Lateral Decubitus Position for Treatment of Femoral Intertrochanteric Fractures / 대한고관절학회지

PURPOSE: Internal fixation using compression hip screws (CHS) and traction tables placing patients in the supine position is a gold standard option for treating intertrochanteric fractures; however, at our institution, we approach this treatment with patients in a lateral decubitus position. Here, the results of 100 consecutive elderly (i.e., ≥45 years of age) patients who underwent internal fixation with CHS in lateral decubitus position are analyzed. MATERIALS AND METHODS: Between March 2009 and May 2011, 100 consecutive elderly patients who underwent internal fixation with CHS for femoral intertrochanteric fracture were retrospectively reviewed. Clinical outcomes (i.e., Koval score, Harris hip score [HHS]) and radiographic outcomes (i.e., bone union time, amount of sliding of lag screw, tip-apex distance [TAD]) were evaluated. RESULTS: Clinical assessments revealed that the average postoperative Koval score decreased from 1.4 to 2.6 (range, 0–5; P < 0.05); HHS was 85 (range, 72–90); and mean bone union time was 5.0 (range, 2.0–8.2) months. Radiographic assessments revealed that anteroposterior average TAD was 6.95 (range, 1.27–14.63) mm; lateral average TAD was 7.26 (range, 1.20–18.43) mm; total average TAD was 14.21 (range, 2.47–28.66) mm; average lag screw sliding was 4.63 (range, 0–44.81) mm; and average angulation was varus 0.72°(range, −7.6°−12.7°). There were no cases of screw tip migration or nonunion, however, there were four cases of excessive screw sliding and six cases of varus angulation at more than 5° CONCLUSION: CHS fixation in lateral decubitus position provides favorable clinical and radiological outcomes. This technique is advisable for regular CHS fixation of intertrochanteric fractures.

A Comparison of Clinical Results between Compression Hip Screw and Proximal Femoral Nail as the Treatment of AO/OTA 31-A2.2 Intertrochanteric Femoral Fractures / 대한정형외과학회잡지

PURPOSE: This study compared the clinical results between compression hip screw (CHS) and proximal femoral nail (PFN) after the treatment of AO/OTA A2.2 intertrochanteric (ITC) fractures. MATERIALS AND METHODS: We retrospectively reviewed 125 cases of AO/OTA A2.2 ITC fracture, treated with either CHS (group I, 34 cases) or PFN (group II, 91 cases) between March 1994 and December 2014. We evaluated the mean operation time, estimated blood loss and transfusion, hospitalization stay, sliding length of lag screw, tip-apex distance, change of neck shaft angle, mean union time, weight bearing time, mechanical failure, and ambulatory ability by the Parker and Palmer mobility scores. RESULTS: Operative time, estimated blood loss, transfusion, hospitalization stay, tip-apex distance, change of neck-shaft angle, and Parker and Palmer mobility scores were not significantly different between the two groups (p>0.05). However, the mean sliding length of lag screw was 8.15 mm and 3.94 mm for group I and II, respectively, the mean union time was 16.85 weeks and 15.57 weeks, respectively, and the mean full weight bearing time was 4.54 weeks and 2.31 weeks, respectively. The mean sliding length of lag screw, union time, and full weight bearing time all had statistical significance (p<0.05). There were a total of 3 cases of postoperative complications in group I and 4 cases in group II. CONCLUSION: We conclude that PFN is more reliable than CHS as a treatment method for AO/OTA A2.2 intertrochanteric fracture.

Proximal Femoral Shortening after Operation with Compression Hip Screws for Intertrochanteric Fracture in Patients under the Age of 60 Years / 대한고관절학회지

PURPOSE: We aimed to quantify proximal femoral shortening after operation with compression hip screws for intertrochanteric fracture in patients under the age of 60 years. MATERIALS AND METHODS: We followed 37 consecutive patients with intertrochanteric fractures treated with compression hip screws from March 2005 to February 2014. We designated the aspect of the fracture, a defect of the postero-medial wall, a defect of the lateral wall, and the degree of reduction as four potentially important factors we assumed would strongly affect proximal femoral shortening. We quantified proximal femoral shortening and compared the effects of above factors. We divided femoral shortening into two plane vectors; femoral offset in the horizontal plane and leg length discrepancy in the vertical plane. We measured shortening separately during two periods: during operation and after weight bearing (called dynamic compression). RESULTS: After bone union, the average femoral offset shortening was 5.45 mm. Patient groups with anatomic reduction and intact postero-medial wall showed lower femoral offset shortening than the respective opposite groups. As to functional score using modified Harris hip score, low femoral offset shortening group showed more 2.35 scores than high groups. None of the factors significantly affected leg length shortening. CONCLUSION: We found that a stable medial buttress is involved in lower femoral offset shortening. Thus, surgeons need to attempt to recover the defect of the medial wall and to reduce anatomically when operating intertrochanteric fractures with compression hip screws.

Clinical and Radiologic Outcomes among Bipolar Hemiarthroplasty, Compression Hip Screw and Proximal Femur Nail Antirotation in Treating Comminuted Intertrochanteric Fractures / 대한고관절학회지

PURPOSE: In comminuted intertrochanteric fractures, various operative options have been introduced. The purpose of this study was to determine whether there were differences in clinical and radiologic outcomes among bipolar hemiarthroplasty (BH), compression hip screw (CHS) and proximal femur nail antirotation (PFNA) in treating comminuted intertrochanteric fractures (AO/OTA classification, A2 [22, 23]) MATERIALS AND METHODS: We retrospectively evaluated total 150 patients (BH, 50; CHS, 50; PFNA, 50) who were operated due to intertrochanteric fractures from March 2010 to December 2012 and were older than 65 years at the time of surgery. We compared these three groups for radiologic and clinical outcomes at 12 months postoperatively, including Harris Hip Score, mobility (Koval stage), visual analogue scale and radiologic limb length discrepancy (shortening). RESULTS: There was no statistical significance among three groups in clinical outcomes including Harris Hip Score, mobility (Koval stage), visual analogue scale. However, there was significant differences in radiologic limb discrepancy in plain radiographs at 12 months postoperatively (radiologic shortening: BH, 2.3 mm; CHS, 5.1 mm; PFNA, 3.0 mm; P=0.000). CONCLUSION: There were no clinical differences among BH, PFNA, and CHS in this study. However, notable limb length shortening could be originated during fracture healing in osteosynthesis, compared to arthroplasty (BH

The Comparison of Compression Hip Screw and Bipolar Hemiarthroplasty for the Treatment of AO Type A2 Intertrochanteric Fractures / 대한고관절학회지

PURPOSE: The purpose of this study was to compare the outcomes of osteosynthesis using compression hip screw fixation versus bipolar hemiarthroplasty in AO type A2 intertrochanteric fractures. MATERIALS AND METHODS: From March 2003 to December 2009, 89 patients were included in this study. They were treated using compression hip screws (43 cases) or bipolar hemiarthroplasty (46 cases). The mean age of patients was 77.7 years (65-94 years) and the mean follow-up period was 5.9 years (1-8.3 years). For comparison of the outcomes in the two groups, statistical analyses were performed with parameters including anesthesia time, operation time, amount of transfusion, hospital stay, general complications, clinical outcome, time of partial weight-bearing using a walker, and radiological failure rate. RESULTS: Differences in the amount of transfusion, general complications, and clinical outcome (Merle d'Aubigne and Postel score) were not statistically significant between the two groups. The bipolar hemiarthroplasty group showed better results than the compression hip screw group for anesthesia time and the time of partial weight-bearing using a walker. Radiological failures were observed in hips in one case (2.2%) of bipolar hemiarthroplasty, and in four cases (9.3%) of compression hip screw fixation. CONCLUSION: Among elderly individuals with AO type A2 intertrochanteric fractures, patients treated with bipolar hemiarthroplasty were able to perform early ambulation. However, no significant difference in operation time, amount of postoperative transfusion, clinical results, hospital stay, and radiological failure rate was observed between the bipolar hemiarthroplasty and compression hip screw fixation groups.

Results of Use of Compression Hip Screw with Trochanter Stabilizing Plate for Reverse Oblique Intertrochanteric Fracture

PURPOSE: The aim of this study was to analyze the use of a compression hip screw with a trochanter stabilizing plate for treatment of reverse oblique intertrochanteric fractures. MATERIALS AND METHODS: We reviewed the results of 33 cases of reverse oblique intertrochanteric fracture treated with a compression hip screw with a trochanter stabilizing plate from January 2000 to December 2012 which were followed-up for more than one year. We evaluated postoperative bone union period, change of neck-shaft angle, sliding of hip screw, and other complications. RESULTS: Of 33 patients, satisfactory reduction was achieved in 28 patients. Five patients had an unsatisfactory reduction, with two cases of excessive screw sliding, one of broken metal, one of varus deformity, and one of internal rotation deformity. We performed corrective osteotomy in varus and internal rotation deformity and partial hip replacement in a case of excessive screw sliding. Bone union was achieved in 29 patients, and the average bone union period was 19.2 weeks. CONCLUSION: We consider that a compression hip screw with a trochanteric stabilized plate is a good option for treatment of reverse oblique intertrochanteric femoral fractures. However, adequate fracture reduction and ideal implant placement are a basic necessity for successful treatment.

A Comparison between Compression Hip Screw and Intramedullary Nail for the Treatment of AO/OTA A2.2 Intertrochanteric Femoral Fracture

PURPOSE: To compare the result between the compression hip screw (CHS) and intramedullary (IM) nail for the treatment of AO/OTA A2.2 intertrochanteric fracture. MATERIALS AND METHODS: We retrospectively reviewed 95 cases of AO/OTA A2.2 intertrochanteric fracture, which were treated with CHS or IM nail by one surgeon from March 1994 to December 2009. One group was treated with CHS (Group I, 28 cases) and the other was treated with IM nail (Group II, 67 cases). We evaluated the mean operation time, the amount of bleeding and transfusion, hospital duration, radiological results and the clinical outcome with the mobility score of Parker and Palmer. RESULTS: Radiologically, the tip-apex distance, change of neck-shaft angle, and union time were not significantly different between both groups (p>0.05). Clinically, the mean operation time, the amount of bleeding and transfusion, hospital duration and the mobility score were not significantly different (p>0.05). The post-operative complications were lag screw slippage over 25 mm (1 case) and loosening of device (1 case) in group I. In group II, there were perforation of the femoral head (1 case), nail breakage (1 case) and deep infection (1 case). CONCLUSION: There was no significant differences that are clinical and radiological results in the treatment of AO/OTA A2.2 intertrochanteric fracture, using CHS and IM nail.

Comparison of the Radiologic Outcomes following the Kinds of Implants in Treating Unstable Osteoporotic Intertrochanteric Fracture / 대한골다공증학회지

OBJECTIVES: To determine whether kinds of implants would influence on the radiologic outcomes in the treatment of unstable osteoporotic intertrochanteric fractures. MATERIALS AND METHODS: In this retrospective study, radiologic outcomes of 151 patients with unstable osteoporotic intertrochanteric fractures undergoing surgical treatments were compared based on the types of fixation implants as follows : PFNA (53 cases, group I), gamma nail 3(31 cases, group II), CHS with TSP (43 cases, group III), and helical blade type LCP-DHS with TSP (24 cases, group IV). On the follow-up radiographs after operations, we assessed differences of bone union durations, neck-shaft ankle changes, lag screw or helical blade slippages, and varus alpha angle changes among the study groups. RESULTS: All the radiologic outcomes evaluated in this study were not significantly different among the study groups. The average bone union durations of the group I, II, III and IV were 17.7, 18.0, 18.2, and 17.8 weeks, respectively (P=0.429). The average variation of neck-shaft angle of the group I, II, III and IV were 3.6degrees, 3.1degrees, 3.7degrees and 2.9degrees, respectively (P=0.273). The average lag screw or blade slippage of the group I, II, III and IV were 5.1 mm, 3.3 mm, 3.6 mm and 2.7 mm, respectively (P=0.154). The average variation of varus alpha of the group I, II, III and IV were 5.3degrees, 4.7degrees, 4.1degrees and 4.6masculine, respectively (P=0.894). CONCLUSIONS: This study indicates that four typical types of fixation implants for treating unstable osteoporotic intertrochanteric fractures would not lead to differences in postoperative radiological outcomes.

Treatment of Unstable Intertrochanteric Fractures of the Femur Using an Anti-Hypersliding Compression Hip Screw and TSP

PURPOSE: This study evaluated the result of fixation of unstable intertrochanteric fractures using an anti-hypersliding compressive hip screw and a trochanter stabilizing plate. MATERIALS AND METHODS: One hundred patients with unstable intertrochanteric fractures who were given an anti-hypersliding compressive hip screw (Group A) or conventional compressive hip screw (Group B) were analyzed. The mean follow-up period was 23.5 months. Radiographic evaluation included the changes of neck-shaft angle, lateral displacement of proximal fragment, distal migration of the lag screw, fixation failure, and union time using plain radiographs taken at postoperative and last follow-up time. RESULTS: Lateral displacement of the proximal fragment averaged 1.62 mm in Group A and 3.97 mm in Group B, which was statistically significant (p<0.05). The neck-shaft angle was increased in Group B, but has no significance. The average of the Harris hip score and walking ability after surgery is higher in Group A than B, but there was no significant difference. The complication rate was significantly lower in Group A. But union time showed no difference in each group. CONCLUSION: Anti-hypersliding compression hip screw with a TSP, which reduces sliding of the lag screw and extreme change of the moment arm, is a another good option for the treatment of intertrochanteric femoral fractures against an increase of the failure rate from the hypersliding of the lag screw.

Comparison of the Compression Hip Screw (CHS) and the Proximal Femoral Nail Antirotation (PFNA) for Intertrochanteric Femoral Fracture

PURPOSE: To evaluate the radiologic, clinical results between who had intertrochanteric fracture, treated with Compression Hip Screw (CHS) and Proximal Femoral Nail Antirotation (PFNA). MATERIALS AND METHODS: We retrospectively reviewed each 36 and 48 patients of intertrochanteric fracture which were treated with CHS or PFNA by one surgeon from January 2005 to June 2009. We evaluated mean operation time, amount of bleeding, radiologic results, and the clinical outcomes with the mobility score of Parker and Palmer, social function scoring system. RESULTS: The mean operation time, amount of bleeding were less in the PFNA group, there were 116.7 min, 486.1 ml for the CHS group versus 87.7 min, 289.6 ml for the PFNA group. The radiologic results were not significantly different. Decrease of mobility score of Parker and Palmer, social function score were similar. Proximal migration of leg screw and perforation of femoral head was 2 case and deep infection was 1 cases in CHS group. CONCLUSION: There were no significant differences that are clinical and radiological results in treatment of intertrochanteric fracture using the CHS and PFNA. But PFNA is less invasive device than CHS, therefore it may be useful device in elderly patients.

Analysis of the Causes for Failed Compression Hip Screws in Femoral Intertrochanteric Fracture and Hip Reconstruction Operation

PURPOSE: To analyze the causes of fixation failure of compression hip screw and evaluate outcomes of hip arthroplasty for reconstruction. MATERIALS AND METHODS: We reviewed 108 femoral intertrochanteric fractures that underwent compression hip screw between January 1997 and December 2007. Failure group (group I) contained 28 cases who had hip arthroplasty for failed compression hip screw and the control group (group II) contained 80 cases who had successive compression hip screw. We analyzed the causes of failure of compression hip screw and evaluated the results of hip arthroplasty for reconstruction. RESULTS: In group I, 21 cases (75%) were unstable fractures. Group II, 14 cases (17%) were unstable fractures. Tip-apex distance was 26.5 (18~35) mm in group I and 18.6 (8~22) mm in group II. Lateral wall fracture of greater trochanteric area was combined in 24 cases (85.7%) in group I and 9 cases (11.3%) in group II. Harris Hip Score improved from 33.5 (22~43) points to 84.2 (75~93) points after salvage hip arthroplasty. CONCLUSION: We considered the causes of failed compression hip screw to be fracture instability, increased tip-apex distance and presence of lateral wall fracture of greater trochanter. Hip arthroplasty was found to be a useful method for failed compression hip screw.

Proximal Femoral Nail Antirotation versus Compression Hip Screw with Trochanter Stabilizing Plate for Unstable Intertrochanteric Hip Fractures

PURPOSE: To analyze and compare the clinical and radiologic results of treatments in unstable intertrochanteric fractures of the femur with proximal femoral nail antirotation (PFNA) and compression hip screw with trochanter stabilizing plate (CHS with TSP). MATERIALS AND METHODS: We retrospectively reviewed the results of 66 cases of unstable intertrochanteric fractures of the femur treated with PFNA (Group I) and CHS with TSP (Group II) which could be followed up for minimum a year. We evaluated several comparative factors such as operation time, blood loss, time to bone union, changes in neck-shaft angle, sliding of screw (or blade), complications, postoperative pain, social-function score of Jensen, and mobility score of Parker and Palmer. RESULTS: Group I showed shorter operation time and less blood loss with significance than group II (p0.05). Two cases of cutting out of the blade through the femoral head were found in group I. One case of cutting out of the screw, one case of the breakage of the plate, and loosening of the plate were found in group II as complications. CONCLUSION: We think that there were no significant differences between PFNA and CHS with TSP in view point of radiologic and clinical outcomes in unstable intertrochanteric fractures of the femur, but PFNA is less invasive device than CHS with TSP, therefore it may be useful device in elderly patients.

Treatment of Reverse Oblique Trochanteric Fracture with Compression Hip Screw

PURPOSE: To investigate the results of treatment of reverse oblique trochanteric fractures with compression hip screw. METHODS: We reviewed the results of 12 cases of reverse oblique trochanteric fracture treated with compression hip screw from January 2000 to December 2006 which could be followed up for more than 1 year. The mean follow up period was 26 months (15~40). The mean age was 48 years old. Injury mechanism was composed of 6 cases of traffic accident and 6 cases of fall down. 8 persons were man. We investigated the union time, degree of neck-shaft angle change, amount of sliding of compression hip screw, complications, functional and clinical results. RESULTS: 10 cases were united and the mean union time were 5 months (3~8). The mean neck-shaft angle change was 3.5 degrees (0~12). The amount of sliding of compression hip screw was 8.9 mm (2~24). There were six coxa vara, six leg due to coxa vara shortening, two nonunion, and one superficial infection. Unsatisfactory results of Jensen's social function score and Parker and Palmer's mobility score were studied. CONCLUSION: The results of treatment of reverse oblique trochanteric fractures with compression hip screw were relatively unsatisfied.

Treatment of Unstable Intertrochanteric Fracture Using Short Barrel Compression Hip Screws and a Trochanteric Stabilizing Plate / 대한정형외과학회잡지

PURPOSE: To assess the effectiveness of additional fixation using a trochanter stabilizing plate for the case of an unstable intertrochanteric fracture of the femur. MATERIALS AND METHODS: Between February 2003 and February 2009, one hundred twenty-one consecutive patients with unstable intertrochanteric fractures were treated with CHSs and a TSP with or without additional screws and wiring. The follow up period was an average of twenty-eight months (range: six to sixty-one months). The fractures were classified according to the Jensen classification. We retrospectively evaluated the fracture healing time, the sliding length, the incidence of fixation failure and clinical failure, and the functional recovery. RESULTS: The mean time to radiologic bony union was 16.2weeks. The average amount of lag screw sliding was 8.4 mm. Overall, 119 of 121 patients had bony union and 2 patients showed nonunion. Mechanical failure was noted in 5 patients and 8 patients showed clinical failure. Ninety-four patients (78%) had at least returned to their pre-fracture level of walking ability. CONCLUSION: Fixation with compression hip screws (CHSs) and a trochanter stabilizing plate (TSP) for treating unstable intertrochanteric fracture of the femur seemed to be helpful for decreasing excessive sliding and the rate of fixation failure. Short barrel CHSs and TSP fixation with additional screws and wiring are necessary for treating unstable intertrochanteric fracture of the femur, and especially for the cases with a large posterior greater trochanteric fragment or a displaced lesser trochanter.

Surgical Treatment of Femur Intertrochanteric and Subtrochanteric Fracture

Femur intertrochanteric and subtrochanteric fractures are extracapsular hip fractures and they show a bimodal age distribution. Most hip fractures in young patient are subtrochanteric or basicervical fractures that are caused by high energy injury. Most of the hip fractures in old patients are intertrochanteric fractures related to osteoporosis and low energy injury. For proximal hip fractures, the muscles around the hip joint make reduction difficult and the position of the lag screws affects healing of the fracture. To lower the complications of these fractures, surgeons can use an appropriate implant along with performing good reduction and good lag screw positioning. We report here on our review of femur intertrochanteric and subtrochanteric fractures, the characteristics of compression hip screws, the intramedullary devices and the technical pitfalls.

Treatment of Unstable Intertrochanteric Fracture in Elderly Patients : Comparison between the Results of Internal Fixation Using Compression Hip Screw and Cemented Bipolar Hemiarthroplasty

PURPOSE: To perform comparative analysis between the results of internal fixation using compression hip screw and cemented bipolar hemiarthroplasty in unstable intertrochanteric fracture in elderly patients. MATERIALS AND METHODS: From January 2001 to October 2006, we reviewd 73 patients, who were treated surgically for unstable intertrochanteric fractures, with a minimum of 2 years follow up. The patient's age was older than 60 year old. The patients were divided into two groups and evaluated, retrospectively. One group was treated with cemented bipolar hemiarthroplasty (Group A, 34 cases), and the other group was treated with compression hip screw (Group B, 39 cases). We evaluated the amount of intraoperative bleeding, operative time, clinical results and complications between the two groups. RESULTS: The amount of intraoperative bleeding and operative time were no statistically significant between the two groups. Group A showed a better result than Group B for clinical outcome using Johnson Daily Activity of Life. Complications in the group A were comprised of dislocation (1 case), nonunion of greater trochanter (1 case), infection (1 case) and loosening (1 case), and those in the group B were comprised of loss of fixation (8 cases) and infection (1 case). CONCLUSION: We found that short-term outcomes of cemented bipolar hemiarthroplasty for unstable intertrochanteric fractures were satisfactory. However, a longer-follow up period is necessary to clarify the efficacy of cemented bipolar hemiarthroplasty.

Effect of a Trochanter-stabilizing Plate in Unstable IntertrochantericFractures : A Clinical and Biomechanical Study

PURPOSE: To evaluate the effectiveness of a trochanter-stabilizing plate (TSP) for the treatment of unstable intertrochanteric fractures. MATERIALS AND METHODS: In the clinical aspect of the study, 48 patients who were treated surgically for unstable intertrochanteric fractures were evaluated. One group of patients was treated with CHS [spell out with 1st use] only (group 1, n=23) and the other group was treated with CHS and TSP (group 2, n=25). In the biomechanical aspect of the study, an AO type A2.2 intertrochanteric fracture was reproduced in 10 proximal femur models. Five models were reduced and fixed using CHS only (group 1) and 5 models were fixed using CHS with TSP (group 2). A load of 750 N (300 cycles) was applied using Instron. RESULTS: In the clinical aspect of the study, the extent of lag screw sliding, greater trochanter lateralization, and neckshaft angle varus change was less in group 2 than in group 1. In the biomechanical aspect of the study, the extent of lag screw sliding was less in group 2 than in group 1, but the neck-shaft angle varus change was greater in group 2 than in group 1. CONCLUSION: The use of TSP is effective for the buttress effect on the proximal fragment. It decreases the excessive sliding of the lag screw, lateral displacement of the greater trochanter, and neck-shaft angle varus change. Therefore, TSP may be a useful treatment for unstable intertrochanteric fractures.

Treatment of Intertrochanteric Fractures in Patients with Severe Osteoporosis with Dynamic Compression Hip Screws

PURPOSE: The purpose of this study was to compare the clinical results in the treatment of femoral intertrochanteric fractures with dynamic compression hip screws (DHS) in patients with or without osteoporosis. MATERIALS AND METHODS: Between March 2003 and February 2006, the clinical results in the treatment of intertrochanteric fractures of the femur with DHS in patients with severe osteoporosis (T score-2.5; 46 patients [group 2]) were reviewed. We retrospectively compared the mortality rate, the incidence of postoperative complications or fixation failures, and the patterns between the two groups. RESULTS: The mortality rate in group 1 was 30.4% at postoperative 1 year and 21.4% at 6 months. The mortality rate at 1 year was 21.8% in group 2 (p<0.05). There were no differences in fracture patterns according to the AO/OTA classification between the two groups. However, the incidence of fixation failures were 19.6% in group 1 vs. 13.0% in group 2 (p<0.05). CONCLUSION: There was a higher postoperative mortality rate at 1 year (30.4% vs. 21.4%), and the incidence of fixation failures (19.6% vs. 13.0%) in the treatment of osteoporotic intertrochanteric fractures by DHS in osteoporotic compared to non-osteoporotic fractures.

Orthopaedic Surgical Treatment of Hip Fractures

Hip fracture is much more common after the age of 65 year old, and this malady has increased because to the longer average life span with the advances of medical care. Despite the development of the treatments and rehabilitation techniques, hip fracture is well known for having high rates of complications and mortality. The risk factors, mechanisms of injury and the underline disease of hip fracture are also well known, and this has helped these patients to recover as soon as possible and to walk and move earlier after appropriate surgical operations. Most fractures must be treated by an open operation and performing rigid internal fixation or arthroplasty. We report here on the major operational treatments for femur neck fracture and intertrochanter fracture.

Comparison of the Targon(R)Proximal Femoral Nail and the Compression Hip Screw for Treating Intertrochateric Fracture of the Femur

PURPOSE: We wanted to compare the clinical and radiological outcomes of using compression hip screws with those of using Targon proximal femoral nails for the treatment of intertrochanteric fracture of the femur. MATERIALS AND METHODS: From April 2001 to December 2005, we reviewed 93 patients who suffered with intertrochanteric fracture and they had a minimum follow up for 6 months (47 cases of Targon(R) proximal femoral nail (Group 1) and 46 cases of compression hip screw (Group 2))Both groups were compared with regard to the operation time, the number of transfusions, pain as analyzed by the visual analogue scale (VAS), the timing of maximum tolerable weight-bearing and the complications. Radiological assessment was directed toward the time of boney union, and we also assessed the changes observed between the immediate postoperative roentgenograms and final follow-up roentgenograms according to various parameters RESULTS: Group 1 had significantly better clinical results for the mean operation time, the number of transfusions and the mean time to self ambulation. Radiologically, there were fewer complications such as a medially displaced femoral shaft, cut out of the lag screw and nonunion in Group1 CONCLUSION: Better clinical and radiological results can be achieved with using Targon proximal femoral nails compared with that of using compression hip screws for the treatment of intertrochanteric fracture of the femur