A Clinical Study of the Subtrochanteric Fractures of the Femur / 대한정형외과학회잡지

The subtrochanteric fracture of the femur is often comminuted because the subtrochanteric area is composed mainly of cortical bone and high compression force biomechanically and its proximal fragment is severely displaced by adjacent strong muscles. Therefore, it is difficult to maintain accurate reduction and rigid fixation and delayed or nonunion, limb shortening, varus deformity, metal failure, and many other problems can be encountered. Although various devices of internal fixation have been developed to solve these problems, we found many problems to select the fixation device in different fracture type properly. We studied 40 subtrochanteric fractures treated with various devices at our hospital from 1981 to Feb. 1987. The results were obtained as follows: 1. Male (28 patients, 70%) was predominant. The majority of patients (representing 55%) were between 31 and 60 years of age. While 10 of 12 female patients were after 50 years of age. 2. In 36 of 40 patients, the fracture resulted from high energy trauma, traffic accident or fall from height. 3. Pelvic bone fracture (4 cases)and head trauma (3 cases) were the most common associated injuries. 4. Fielding's type II(19 cases) fracture and Seinsheimer's type IV (10 cases) & V (9 cases) fractures were most common. 5. Of the 40 cases, 38(95%) were treated by open reduction and internal fixation. Of fixation devices, a Jewett nail was most commonly used in 23 cases (60.5%) 6. The average time from operation to partial weight bearing was 12.2 weeks. 7. The mean duration of bony union was 25 weeks. And more longer period was needed in union as fractures goes distally 8. Of the 40 cases, 4 (10%) complications occured, those are : metal failure and fixation screw loosening (2 cases), infection (1 case), varus deformity (1 case). 9. From these series, these fractures should be treated as rigid internal fixation and Jewett nail or many other devices such as compression hip screw, condylar plate, or Judet plate could be applied successfully for the rigid fixation of subtrochanteric fractures of the femur according to the fracture displacement and stability.

The Treatment of Trochanteric Fracture Using Jewett Nail / 대한정형외과학회잡지

The prime objective in treating the trochanteric fracture is to achieve bony stability at the fracture site by internal fixation as it provide satisfactory reduction and fixation of the fractures allowing early mobilization of the patient thus avoiding general and local complication following this sort of trauma. The operative management of trochanteric fracture using Jewett nail was performed in eighty-three patients who were admitted at the department of orthopedic surgery, Kyungpook National University Hospital from 1978 to 1985. Of eighty-three patients, only fifty-five patients were able to be analysed completely. The results were as followed: 1. Of the83 cases of the trochanteric fracture, 56 cases were in man, 27 cases were in female, with peak age at 7th decade. 2. The most common cause of fracture was traffic accident in 34 cases, fall down in 26 cases and slip down in 23 cases. 3. According to the classification of the intertrochanteric fracture by Tronzo, most common type was type III in 30 cases, and in the subtrochanteric fracture by Fielding classification, type I in 6 cases, type II in 9 cases and type III in 6 cases. 4. Of the 83 cases of the trochanteric fractures, reduction with medialization was done in 13 cases. 5. The average time until weight bearing was 7.1 weeks in intertrochanteric fracture and 10.8 weeks in subtrochanteric fracture. 6. The average bony union time was 16.8 weeks in intertrochanteric fracture, and 20.2 weeks in subtrochanteric fracture. 7. Of the 32 cases of unstable intertrochanteric fracture, late varus deformity was noticed with 6.0° in cases of anatomical reduction, 4.5° in cases of medialization and leg shorteing was 1.0cm in cases of anatomic reduction, 1.4cm in cases of medialization. 8. Complication was encountered in 14 cases. Limping in 9 cases, surgical wound infection in 2 cases, nail penetration into hip joint in 2 cases and refracture in 1 case. 9. By evaluation of overall, result was good in 34 cases, moderate in 18 cases and poor in 3 cases.

A Clinical Study of Trochanteric Fracture of the Femur / 대한정형외과학회잡지

It is generally accepted that trochanteric fractures are best treated by internal fixation as it provide satisfactory reduction and fixation of the fractures allowing early mobilization of the patient thus avoiding general and local complication following this sort of trauma. Fourty-seven cases of trochanteric fracture of the femur were treated at the Department of Orthopedic Surgery, Paik Hospital, Seoul, Inje Medical College from June 1974 to June 1982 and clinical analysis was made with particular emphasis on the comparision between compression hip screw fixation and Jewett nail technique. The result of the analysis are as follows: l. 63% of the male patient belongs to active age group in contrary to common belief in age incidence and the common causes of the injury was traffic accidents and fall from height. 2. By the Tronzo classification of the intertrochanteric fracture, the most common type is type III and type V was predomonant in the traffic accidents group and 87% of all cases belongs to unstable category. 3. Of the seventeen associated injuries, visceral injuries, fracture of the lower extremities, fractures of the upper extremities, fractures of the pelvis were observed in order of frequency. 4. More general complications were observed among the conservatively treated group and local complications occurred mainly in the group treated with Jewett naiL 5. The compression hip screw method seemed to be superior to Jewett nail owi#ng to shorter operation time, less blood loss and less complications. 6. Ender nail appears to be a promising method of treatment in the elderly patient because it had shorter operation time, negligible blood loss, minimal stress to the patient and early mobilization and weight bearing.

A Clinical Study on Trochanteric Fractures of the Femur / 대한정형외과학회잡지

A clinical study was done for 103 cases of the trochanteric fractures which were admitted and treated at the department of orthopedic surgery, Kyungpook National University Hospital during the period of 9 yeras from January 1972 to December 1980. Following results were obtained: 1. Of the 103 cases of the trochanteric fractures, 73 cases were in man, with peak age at 6th decade and 21 out of 30 in woman were over 50 years of age. 2. Causes of the fracture were ear accidents in 67 cases and “slip or fall down” in 36 cases. 3. According to the classification of the trochanteric fractures by Boyd and Griffin, most common type was type 11 in 40 cases and followed by type 111 in 27, type 1 in 24 and type 1V in 12. 4. Upon the treatment, 53 out of 103 cases were conservatively treated with Thomas splint and skeletal tractior. Those cases were mostly combined injury on other organs. Open reduction and internal fixation was done on 50 cases with Jewett nail in 48, Zickel nail in 1 and Judet plate with screw in 1. Most of unstable fractures were reduced by Dimon-Hughston method and fixed with Jewett nail. 3. Union of thef ractures ranged from 10 to 16 weeks, average 13 weeks, by open reduction with internal fixation and from 12 to 24 weeks, average 17. 5 weeks, by conservative treatment. 6. Complications were encountered 31% of those cases with conservative treatment and 16% of those cases with operative treatment. Major complicationss after the conservative treatment were decubitus ulcer in 14 cases (27%), coxa vara deformity in 8(16%) and urinary tract infections in 5(10%).