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.

Factors affecting Fixation Failure in Treatment of Intertrochanteric Fracture of the Femur by Dynamic Compression Hip Screw

PURPOSE: The purpose of this study was to analyze the factors affecting fixation failures of intertrochanteric fractures of the femur treated by dynamic compression hip screw in elderly patients. MATERIALS AND METHODS: Between March 1999 and February 2005, we evaluated 164 cases of intertrochanteric fractures of the femur treated by dynamic compression hip screw. The failure group (group 1) contained 14 cases, and the control group (group 2) contained 150 cases. We compared the fracture pattern, type of reduction, method of fixation, tip-apex distance, location of screw within head, and presence of lateral trochanteric wall fracture between the two groups. The average patient age was 76.1 years (range 63-92) in group 1 and 75.0 years (range 63-93) in group 2. RESULTS: The mode of fixation failure in group 1 included 6 cases of nonunion, 5 cases of varus and cutting-out, 2 cases of excessive sliding of lag screw, and 1 case of plate debonding. There was a significant relationship between the fracture pattern, tip-apex distance, position of lag screw (especially the posterior location), and presence of lateral wall fracture when compared against postoperative fixation failure (P<0.05). The use of bone cement augmentation and the central location of lag screw within the head correlated with the avoidance of cutting-out of lag screw through the head. However, there was no relationship between the type of reduction, the use of additional fixation with a screw, or greater trochanter stabilizing plate when compared against fixation failure. CONCLUSION: The structural integrity of lateral wall support is thought to be an essential factor in successful treatment of unstable intertrochanteric fractures of the femur. Furthermore, methods such as concentric screw placement in the head, minimal tip-apex distance, and cement augmentation may be useful for preventing cutting-out through obtaining secure purchase of the lag screw in the head.