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.

The Compression Hip Screw with Trochanter Stabilizing Plate for Internal Fixation of Unstable Intertrochanteric Fractures

PURPOSE: To evaluate trochanter stabilizing plate and compression hip screw can prevent excessive impaction and cutting-out in unstable intertrochanteric fractures. MATERIALS AND METHODS: One hundred twenty-one patients with intertrochanteric fractures were treated between December 1999 and March 2002. Of the patients, twenty-four patients were treated with an additional TSP on the CHS. Nineteen patients were followed for more than six months. The fractures were classified according to the AO classification. Impactions of compression lag screw were measured immediate postoperatively and postoperatively three months later on simple radiographs. Functional results were followed Salvati-Wilson assessment score at postoperative six months later. RESULTS: The group consisted of seven men and twelve women, and the mean age was 73 years. Two were classified as A2.2, six A2.3, one A3.2, and ten A3.3 fractures. Mean impaction was 5.4 mm (range 1.8 to 11.4 mm). Functional results were excellent in 32% and good in 53%. Eighteen patients had healed after operation. One complication required a bipolar hemiarthroplasty due to cutting-out of lag screw. CONCLUSION: In three-part and four-part intertrochanteric fractures with lateral cortex breakage or vertical fracture in greater trochanter, the addition of TSP to CHS can prevent abductor muscle weakness due to fracture impaction, limb shortening and additional lateral cortical fracture. It also helps early weight bearing and bone healing.