Comparison between Results of Internal Fixation and Hemiarthroplasty in Unstable Intertrochanter Fracture of Osteoporotic Bone

PURPOSE: To perform comparative analysis between the results of internal fixation and hemiarthroplasty in unstable intertrochanteric fracture of osteoporotic bone. MATERIALS AND METHODS: From February 2003 to February 2006, 36 patients treated surgically for unstable intertrochanteric fractures were evaluated. The patient's age was older than 70 year old; the T-score of preoperative bone mineral density (BMD) was lower than -3.0; they were followed up for more than 1 year. The patient were divided into two groups. One group was treated with dynamic hip screw or proximal femoral nail (Group A, 23 cases), and the other group was treated with bipolar hemiarthroplasty (Group B, 13 cases). The two groups were compared in terms of hip joint function using Clawson classification and radiologically. RESULTS: Nonunion and fixation failure happened in 6 cases (26%) of gruop A. However, all patients in group B showed stable maintenance of implant. Recovery of hip joint function was found in 13 cases (43%) of group A, whereas 12 cases (93%) of group B recovered. CONCLUSION: Nonunion and failure of fixation happened more frequently in internal fixation than bipolar hemiarthroplasty, and the postoperative hip joint function was better in bipolar hemiarthroplasty than internal fixation. Therefore, bipolar hemiarthroplasty might be better operative treatment for unstable intertrochanteric fracture of osteoporotic bone.

Selective Pedicle Screw Fixation with Long Fusion in the Treatment of Spinal Stenosis with Degenerative Scoliosis / 대한척추외과학회지

STUDY DESIGN: This retrospective study was designed to evaluate treatment options for spinal stenosis with degenerative scoliosis. PURPOSE: To evaluate the clinical outcomes based on the degree of spinal deformity for selective pedicle screw fixation with a long fusion for spinal stenosis with degenerative scoliosis. MATERIALS AND METHODS: We reviewed 54 cases performed from March 1996 to March 2006, and divided them into three groups based on osteophyte formation, pedicular rotation, and lateral transition. The three groups were analyzed for degree of correction of scoliotic and lordotic angle and bone fusion rate, as well as radiographically and clinically using the Kirkaldy-Willis questionnaire. RESULTS: Mild or moderate deformities (49 cases) were improved an average of 3 degrees of scoliotic angle, grade 1 of pedicular rotation, and 1 mm of lateral transition and were satisfied clinically. Severe deformities (5 cases) improved an average of 8 degrees of scoliotic angle, grade 2 of pedicular rotation, and 3 mm of lateral transition, but were clinically unsatisfactory. There was insignificant correction of the lordotic angle in all deformities and a fusion rate of 81.5% in mild-to-moderate deformities and 40% in severe deformities. CONCLUSION: Selective pedicle screw fixation with a long fusion for spinal stenosis with degenerative scoliosis is a treatment option for mild to moderate deformities.