Tratamiento de las fracturas del antebrazo con placas de compresión dinámica

Introducción: Las fracturas del antebrazo comprometen la diáfisis del radio y el cúbito. Su relación anatómica desempeña un papel importante porque el antebrazo se vincula con los movimientos de la mano para garantizar la función de la extremidad y de los tejidos blandos. Objetivo: Evaluar los resultados del tratamiento de la fractura diafisiarias de antebrazo con placa de compresión dinámica. Métodos: Se realizó un estudio prospectivo, longitudinal y descriptivo en 28 pacientes con fractura diafisaria de antebrazo, intervenidos quirúrgicamente con placa de compresión dinámica en el Hospital Ortopédico Docente "Fructuoso Rodríguez". Los resultados fueron evaluados según la escala funcional de Grace-Eversmann. Resultados: La edad media fue de 38 años, con una proporción entre sexos de 2,1:1. Predominaron las fracturas del tercio medio del radio y del cúbito. Se afectó más el lado izquierdo, pero en el 75 % de los casos hubo un excelente resultado. No se registraron fallas con la técnica quirúrgica aplicada. Conclusiones: La osteosíntesis con placa de compresión dinámica en las fracturas diafisarias de antebrazo es una alternativa adecuada para garantizar tasas de consolidación elevadas y resultados funcionales excelentes.

Introduction: Fractures of the forearm compromise the diaphysis of the radius and ulna. Their anatomical relationship plays an important role because the forearm is linked to hand movements to ensure limb and soft tissue function. Objective: To evaluate the results of treating diaphyseal forearm fracture with dynamic compression plate. Methods: A prospective, longitudinal and descriptive study was carried out in 28 patients with diaphyseal fracture of the forearm. They underwent surgery with a dynamic compression plate at Fructuoso Rodríguez Teaching Orthopedic Hospital. The results were evaluated according to Grace-Eversmann functional scale. Results: The mean age was 38 years, with a gender ratio of 2.1:1. Fractures of the middle third of the radius and ulna predominated. The left side was affected more, but 75% of the cases had excellent result. No failures were recorded with the applied surgical technique. Conclusions: Osteosynthesis with dynamic compression plating in diaphyseal fractures of the forearm is a suitable alternative to guarantee high consolidation rates and excellent functional results.

Results of Surgical treatment of Nonunion of Humeral Shaft Fracture with Dynamic Compression Plate and Cancellous Bone Grafting

Introduction: Nonunion of humeral fractures afterconservative or surgical treatment represents a disablingcondition for the patient and a challenge for the surgeon. Studyaimed to evaluate the outcome of treatment of humeral shaftnonunions with dynamic compression plate and cancellousbone graft.Material and Methods: This study was conducted atDepartment of Orthopaedics, GMC Srinagar from June 2016to December 2019. Twenty patients were operated over thisperiod. Trauma was the cause of injury in majority of thepatients. Nonunion was atrophic in 80% and hypertrophic in20% of the individuals. All the patients had closed fractureat presentation, and 70% had received previous treatmentfrom traditional bone setters and 30% had failure of theconservative cast management.Results: The average time to union was 18 weeks. Treatmentpreviously from traditional bone setters significantly affectedthe time to fracture union (p<0.05). All fractures unitedsuccessfully.Conclusion: we concluded that treatment with dynamiccompression plating and cancellous bone grafting remains aneffective treatment option for nonunion of humeral shaft.

Biomechanical Properties of the Modified Memory Alloy Internal Fixator for Separation of Pubic Symphysis / 医用生物力学

Objective To investigate biomechanical characteristics of the modified memory alloy internal fixator for separation of pubic symphysis. Methods The model of pubic symphysis separation injury was established based on 10 pelvic specimens. The control group was fixed with the dynamic compression plate after reduction, and the experimental group was fixed with the modified memory alloy internal fixator for separation of pubic symphysis after reduction. The biomechanical stability for two kinds of internal fixation was compared. Results There were no loosening and fracture of internal fixation in both groups. The displacement of pubic symphysis in horizontal, anterio-posterior and vertical direction in the experimental group was obviously reduced compared with the control group (P＜0.05). Conclusions Compared with the dynamic compression plate, the modified memory alloy internal fixator for separation of pubic symphysis shows better resistance to the tensile force against horizontal and anterio-posterior direction, as well as better resistance to the vertical shear force.

Comparative study of functional outcome of dynamic compression plating with interlocking nailing for fracture shaft humerus in adults

A prospective observational study was conducted in Government Victoria Hospital, Visakhapatnam from 2013 to 2018 to evaluate Arogyasri scheme. Arogyasri scheme provides end to end cashless services for identified diseases in Andhra Pradesh. During this period, 891 gynecological surgeries were conducted under this scheme. Out of them, 44 were not approved for claim. A total of 10,880,238 rupees were claimed.

Outcome of Close Diaphyseal Fracture of Both Bones Forearm in Adult Treated by Well Fitting Intramedullary (Square) Nail & Dynamic Compression Plate: A Comparative study

Background: The achievement and maintenance of reduction of diaphyseal fractures of forearm are hindered by deforming muscular forces. The aim of this study to compare the results of close diaphyseal fracture of both bones forearm in adult treated by well-fitting intramedullary (square) nail & dynamic compression plate. Material & Methods: The present study comprised of 60 patients with close fracture both bones forearm belonging to either sex of adult age group, treated in the department of orthopedics, Dr. B. R. Ambedkar Medical College, Bengaluru, Karnataka, India. All 60 cases included in this study underwent clinical and radiological examination at the time of admission; and type, site, displacement, rotation and angulation of fractures were determined. At follow up examination interval between injury & this examination was recorded & than clinical & radiological examination were carried out. Results: The present study showed that the mean age of patients was 35 yrs, male to female ratio was 3.6:1 and right side were more common as compared to left side, mostly patients had indirect injuries (55%). comparison of functional end result between Hadden et al4 different modalities of treatment and of our present study. Results of plating is comparable with Hadden et al4 sereis but Nailing is inferior. Conclusion: We concluded that functional end results to be excellent to good, plating is the best mode of treatment for fracture forearm bones as 83% excellent to good results had achieved but nailing also have comparable results as achievement of 76% excellent to good results.

Management of a failed femoral plate in an obese patient: A case report

Femoral nailing is the overall “gold standard” in treating femoral shaft fractures. However, plate osteosynthesis at the femoral shaft is still being done in selected patients. We report a case of right femoral implant failure after a broad limited contact dynamic compression plate (LC-DCP) insertion and its subsequent management using our minimally invasive technique. Our technique is biologically compliant as well as cosmetically friendly. We converted a loadbearing implant into a load-sharing implant in view that obesity is a significant predictive factor of non-union in a femoral fracture treated with locking plate. The patient subsequently recovered well with no complication.

Condicionamento peri-implantar com restaurações provisórias em área estética: técnica de compressão dinâmica e otimização de moldagem na reprodução do perfil de emergência / Peri-implant conditioning with provisional restorations in the aesthetic area: dynamic compression technology and impression optimization to reproduce the emergence profile

A otimização estética de restaurações implantossuportadas é uma combinação da concordância visual entre prótese e arquitetura do tecido mole peri-implantar. A proposta deste artigo consiste na aplicação do método clínico de compressão dinâmica, de condicionamento tecidual ao redor do nível ósseo peri-implantar, utilizando resina flow para reprodução deste condicionamento no processo de moldagem. A técnica tem sido bastante eficaz e difundida em virtude da estabilização do adequado perfil de emergência, a fim de estabelecer a harmonia do contorno gengival com os dentes adjacentes, incluindo altura e largura dos zênites gengivais, tornando o perfil gengival mais triangular e mantendo a estabilidade das áreas de contatos proximais com dentes adjacentes aos implantes.

The esthetic enhancement for implant-supported restorations is a visual combination between prosthesis and its gingival architecture. The aim of this case report is to demonstrate the use of the clinical dynamic compression technique for peri-implant tissues with a flow composite resin during the impression procedures. This technique has proven its efficacy and been well established because it allows for an adequate emergence profile, generating harmony at the gingival contour of the adjacent teeth, including the position of the gingival zeniths, making the gingival profile more tapered while keeping the proximal contact areas between tooth and implants.

The Clinical and Radiological Results of Vancouver Type B1 and C Periprosthetic Fractures

PURPOSE: The purpose of this study is to evaluate the clinical and radiologic results of plate fixation in the Vancouver B1 and C periprosthetic femoral fracture (PFF). MATERIALS AND METHODS: Twenty patients who had sustained a Vancouver type B1 and C periprosthetic fracture after hip arthroplasty (years 2002-2012) were identified. The mean age was 66.0 years (range, 43-85 years) and the mean follow-up duration of the group was 38 months (range, 12-102 months). The dynamic compression plate (DCP) group included 12 patients and the locking compression plate (LCP) group included eight patients. Harris hip score (HHS) and walking ability, knee joint range of motion (ROM) were compared before injury and last follow-up. Fracture union rate and period were compared. RESULTS: The mean HHS score was 90.7 (64-96). There was no statistical difference between the two groups. At the last follow-up, knee joint ROM was 103.3degrees (105degrees-140degrees) in the DCP group and 118.4degrees (110degrees-140degrees) in the LCP group, showing good results in the LCP group (p=0.043). No significant difference in the fracture union rate and union periods was observed between the two groups. CONCLUSION: A better result for the postoperative knee flexion exercise capacity was observed in the LCP group. Use of LCP plate fixation is a good option in management of Vancouver classification B1 and C PFF.

Management of fractures of both bones of forearm with dynamic compression plate with screw fixation.

Background: Study was designed to analyze the effects of surgical management of fractures of both bones of forearm with dynamic compression plate with screw fixation. Material and methods: From August 2008 to October 2010, data from 56 patients with fractures of both the radius and ulna were collected and evaluated retrospectively. Patients were managed with early surgical debridement, open reduction and internal fixation with a DCP. All patients had complete functional and radiographic assessments. Results: Patient regained full range of movements within 6-8 weeks. At 12-14weeks check X-ray showed good radiological union. In this series out of 56 cases 42 (75%) cases are graded excellent, 7 (12.5%) cases are graded good, fair 5 (9%) cases and poor 2 (3.5%) cases. Conclusion: Our study has proven that open reduction and internal fixation of diaphyseal fractures of radius and ulna can be best done with dynamic compression plating technique which has given a good result. The technique of DCP fixation is a simple procedure which can be done by the junior orthopedic surgeon with an excellent result.

Comparison of Locking versus Dynamic Compression Plates for Treatment of Diaphyseal Forearm Fracture

PURPOSE: To compare the clinical and radiologic outcomes of internal fixation using locking compression plate (LCP) or limited contact-dynamic compression plate (DCP) for patients with diaphyseal forearm fractures. METHODS: Forty-four patients with diaphyseal forearm fractures treated with either LCP (22 patients) or DCP (22 patients) were compared in regards to clinical outcomes, range of motion and Grace and Eversmann criteria at the last follow-up. Union rate and mean time to radiological union were also compared depending on comminution. RESULTS: Mean range of motion and Grace and Eversmann criteria between two groups did not show significant differences. Bony union was achieved in all patients. Although mean time to union was not different in simple fractures (15.5 weeks in LCP group vs. 13.8 weeks in DCP group), it was different between two groups in mutifragmentary fractures (14.8 weeks in LCP groups vs. 24 weeks in DCP group). CONCLUSION: Internal fixation using both LCP and DCP for diaphyseal forearm fractures yield satisfactory clinical and radiologic outcomes. In multifragmentary fractures, LCP can shorten radiologic union time than using DCP.

Clinical comparison of dynamic compression plate and limited contact dynamic compression plate fixation in the treatment of limbs long bone fracture / 中国医师进修杂志

Objective To compare the clinical effect of dynamic compression plate (DCP) and limited contact dynamic compression plate (LC-DCP) fixation in the treatment of limbs long bone fracture,provide certain basis for the choice of clinical internal fixation.Methods The clinical data of 172 patients with limbs long bone fracture treated with DCP and LC-DCP fixation were retrospectively analyzed.One hundred and one cases in LC-DCP group,and 71 cases in DCP group,the operation time,intraoperative blood loss,hospitalization time,fracture healing time,incidence of nonunion,daily activity ability and joint function score and clinical curative effect in two groups were compared.Results The operation time,fracture healing time,incidence of nonunion in LC-DCP group were better than those in DCP group[(62 ± 13) min vs.(88 ±20) min,(60.0 ± 20.5) d vs.(85.0 ± 25.5) d,1.0％ (1/101) vs.7.0％ (5/71)],there were significant differences (P ＜ 0.05),but the intraoperative blood loss and hospitalization time between two groups had no significant difference (P ＞ 0.05).Barthel and Harris score in LC-DCP group were better than those in DCP group [(72.61 ± 8.63) scores vs.(52.58 ± 5.53) scores,(69.28 ± 7.63) scores vs.(55.07 ± 6.26) scores],there were significant differences (P ＜ 0.05).The excellent rate in LC-DCP group was better than that in DCP group [99.0％ (100/101) vs.90.1％ (64/71)],there was significant difference (x2 =15.71,P ＜ 0.01).Conclusion Limbs long bone fracture treat with LC-DCP,can improve clinical curative effect and reduce complications,improve the daily ability of joint function in patients and is worth using in clinic.

The efficacy of tibial shaft fractures treated with interlocking nails / 中国医师进修杂志

Objective To investigate the difference of efficacy of interlocking nails and dynamic compression plate in tibial shaft fractures.Methods The clinical data of 137 cases with tibial shaft fractures were reviewed retrospectively.They were divided into two groups according to the various treatments which included interlocking nails group(72 cases with 79 fractures) and dynamic compression plate group(65 cases with 70 fractures).The efficacy,healing fineness rate,function score after operation and complications were compared.Results After operation,the patients were followed up 21.4 months on average.The postoperative callus time,weight-bearing limb time,healing time and postoperative fixation time taken in interlocking nails group was shorter than that in dynamic compression plate group [(2.36 ± 0.46) months vs.(3.12 ± 0.57) months,(2.42 ± 0.51) months vs.(3.14 ± 0.63) months,(7.65 ± 1.29) months vs.(9.33 ±1.54) months,(12.64 ± 3.76) months vs.(16.38 ± 3.15) months],and there was significant difference (P＜ 0.05).The healing fineness rate was 97.5％(77/79) in interlocking nails group,and 92.9％(65/70) in dynamic compression plate group,and there was nosignificant difference (x2 =1.76,P ＞0.05).The incidence of comphcations in interlocking nails group was higher than that in dynamic compression plate group[25％(2H9) vs.12.9％(9H0)],and there was significant difference(P ＜ 0.05).Condmions Interlocking nails have better biomechanical features with high union rate,low infective rate and good recovery of joint function.The clinical result of interlocking nails for the tibial shaft fractures is also better than that of dynamic compression plate.

The effect comparison of anterograde reamed intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus / 中国医师进修杂志

Objective To compare the clinical effects in patients treated with anterograde reamed intramedullary nail (IMN) and dynamic compression plate (DCP) for diaphyseal fractures of the humerus.Methods Forty-seven patients with diaphyseal fractures of the humerus,were divided into two groups by random digits table:IMN group (23 cases) and DCP group (24 cases),IMN and DCP were performed fixation,respectively.After the surgery,perioperative,functional outcomes of shoulder and elbow,postoperative complications between two groups were compared.Results The average follow-up time was (22.3 ± 5.7)months,3 cases were lost in 12-month-follow-up,1 case in IMN group and 2 cases in DCP group.The operation time,intraoperative blood loss in IMN group were significantly shorter than those in DCP group [(67.7 ± 15.3) min vs.(87.0 ± 12.5) min,(106.3 ±57.6) ml vs.(226.7 ±60.2) ml,P＜0.05].The incidence rate of subacromial impingement in IMN group was significantly higher than that in DCP group [18.2％ (4/22) vs.0,P ＜ 0.05].The incidence rate of wound infection in IMN group was significantly better than that in DCP group [4.5％(1/22) vs.22.7％(5/22),P ＜ 0.05].There were no statistically significant differences between two groups in other indexes (P ＞ 0.05).Conclusions DCP has some advantage in perioperative period,but they are comparable in the functional outcomes of shoulder and elbow and complications.

Anillos vasculares como diagnóstico diferencial del asma / Vascular rings in differential diagnosis of asthma

Aortic arch abnormalities and vascular rings are a rare cause of compression of trachea and esophagus causing respiratory and digestive symptoms in adults. We report a 64 years old woman with exercise induced asthma not resolving with adequate treatment. Flow/volume loop shape suggested an intrathoracic major airway obstruction. Chest X ray showed a right sided aortic notch and CT scan revealed a vascular ring composed by a right aortic arch with aberrant left subclavian artery and Kommerell's diverticulum compressing trachea and esophagus. Bronchoscopy confirmed posterior wall compression of trachea exacerbated by tachycardia as a cause of symptoms. We think that is important to consider vascular rings as a differential diagnostic entity in difficult to treat asthma.

Las anomalías del arco aórtico y sus ramas son infrecuentes. La presencia de un anillo vascular determina la aparición de sintomatología relacionada con compresión traqueal o esofágica. El diagnóstico en la edad adulta es extremadamente inusual. Se presenta el caso de una mujer de 64 años con diagnóstico de Asma inducida por ejercicio, refractaria a tratamiento, la cual presentó disnea sibilante en relación al ejercicio, que no cedió con tratamiento bien llevado. La curva flujo-volumen sugirió obstrucción variable de la vía aérea central intratorácica, la radiografía de tórax mostró botón aórtico situado a derecha, la tomografía computada del tórax demostró un anillo vascular formado por un arco aórtico derecho, con la arteria subclavia izquierda aberrante, divertículo de Kommerell comprimiendo el esófago y con la aorta descendente que en su trayecto comprime la pared posterior de la tráquea, lo que es corroborado por videobroncoscopía, describiéndose compresión pulsátil, que se exacerbaba con la taquicardia. Se concluye que la paciente tiene un anillo vascular causante de los síntomas descritos y nos orienta a establecer que en el esquema de estudio de pacientes con asma atípica o de difícil manejo, es necesario incluir las malformaciones del arco aórtico en el diagnóstico diferencial, realizando al menos radiografía de tórax y revisando atentamente la gráfica de la curva flujo-volumen.

Comparison of the hybrid locking plate, standard dynamic compression plate, and standard dynamic compression plate augmented with bone cement for fixation of osteoporotic humeral shaft fractures: A cadaveric biomechanical study

BACKGROUND: Studies comparing the relative strength of polymethylmethacrylate (PMMA) augmented fixation, standard plating and locked compression plate (LCP) system are few. The use of either the bone cement-augmented dynamic compression plate or the Hybrid LCP constructs may provide an additional tool for the treatment of fractures in patients with osteoporosis. METHODS: Eighteen (18) osteoporotic cadaveric humeral bones were assigned randomly to each of three groups (Dynamic Compression Plate [DCP], DCP augmented with bone cement, and the Hybrid LCP system) and tested in anterior-posterior bending and torsion/external rotation. The load to failure values were obtained and the results for each specimen compared. RESULTS: Significant differences were observed between the standard DCP and Hybrid LCP group (p-value=0.012), and in the cement-augmented and Hybrid LCP group (p-value=0.099) in torsion/external rotation loading. No significant difference was observed between the standard DCP and bone-cement augmented group (p-value=0.248). No significant difference was observed among the three groups in terms of stiffness (p-value=0.3868) in the four-point anterior-posterior bending modality. Screw pull-out of the implant was observed only in the regular DCP group in torsion/external rotation loading stress. CONCLUSION: Significant differences were seen between the three constructs in torsion/external rotation but not in anterior-posterior four-point bending. Bone failure, but not screw pull-out, was seen in the Hybrid LCP and bone cement-augmented DCP groups in torsion. This study showed that the LCP system and the bone cement-augmented constructs may provide greater screw purchase to the osteoporotic humerus.

Evaluación de la resistencia de un prototipo de placa de compresión dinámica (PCD)fabricada de polimetilmetacrilato (PMMA) probada en fémur canino osteotomizado / Assessment of the resistance of a polymethylmethacrylate (PMMA) Dynamic Compression plate (DCP) prototype tested on osteotomized canine femurs

Las fracturas de huesos largos encontradas más frecuentemente en animales pequeños son las del fémur. Por su posición anatómica, son difíciles de inmobilizar, entonces, la utilización de fijaciones internas es de gran utilidad. Las placas de compresión dinámica (PCD) proveen gran estabilidad, son durables y al producir compresión interfragmentaria, minimizan el movimiento fragmentario y promueven la cicatrización primaria del hueso. Sus ventajas están asociadas a la reconstrucción anatómica, movilidad temprana y capacidad de carga del miembro. El polimetilmetacrilato (PMMA) es una resina acrílica utilizada en prótesis dentales. Pero, estudios muestran otros usos, tratamientos de tumores óseos, prótesis en deformaciones craneales, vertebroplastias percutáneas y prótesis testiculares en animales, entre otros. El objetivo de este estudio fue fabricar PCD-PMMA y comprobar su resistencia a las distintas fuerzas que están presentes en una fractura. Se fabricaron 48 PCD de 3,5 milímetros de cuatro orificios a partir de un molde de alginato. Se obtuvieron seis fémures de cadáveres caninos de 10 a 20 kg de peso, a los cuales se les realizó una osteotomía que simulaba una fractura oblicua. Posteriormente, se posicionaron las placas en los huesos osteotomizados para someterlas a las distintas fuerzas que participan en una fractura. Las PCD-PMMA resistieron 2,83 newton/metro a la fuerza de torsión y 0,21 kilonewton a las fuerzas de compresión y flexión. La resistencia de la PCD-PMMA obtenida fue en promedio de 20 kg, a cada una de las fuerzas. Se pudo concluir que es posible fabricar una PCD-PMMA de 3,5 mm de cuatro orificios, cuya resistencia es de 20 kg de peso a las tres fuerzas aplicadas. Entonces, pueden ser utilizadas para la estabilización de fracturas de huesos largos que sean sometidos a una presión inferior a 20 kg de fuerza.

Femur fractures are the most frequent long bone fractures in small animals. Due to the femur’s anatomical position, it is difficult to immobilize, and therefore internal fixations are veryuseful. Dynamic compression plates (DCP) provide high stability, are durable, minimize fragment movement and promote primary healing of the bone. Advantages of this treatmentinclude anatomical reconstruction, early mobility and carrying capacity of the affected limb. Polymethylmethacrylate (PMMA) is an acrylic resin that has proved very useful in bone tumor treatment, cranial deformation prosthesis, percutaneous vertebroplasty and testicular prosthesis in animals. The purpose of this study was to manufacture DCP-PMMA and testits resistance to the different forces present in a fracture. Forty-eight (48) 3.5MM x 4-hole DCP were made from an alginate mold. Six (6) femurs were obtained from canine cadavers weighing from 10 to 20 kg, which underwent osteotomy simulating an oblique fracture. The plates were subsequently positioned in the osteotomized bones to submit them to the various forces involved in a fracture. The DCP-PMMA resisted a torque force of 2.83 newton/metres and a compression and flexion force of 0.21 kilonewton. The obtained resistance of the DCP-PMMA was an average of 20 kg per force. The results of this study show that it is possible to make a DCP-PMMA 3.5 mm x 4-hole, the resistance of which is of 20 kg against the three applied forces, and that it can be used to stabilize long bone fractures subjected to a pressure of less than 20 kg.

A Technique for Removal of Forearm Dynamic Compression Plate with Stripped Screws: A Report of Three Cases

Removal of plates is a procedure commonly performed by orthopaedic surgeons and stripped screws are probably the most common problem encountered during this procedure. Stripped screws are caused by slippage between the screwdriver and the screw. Due to the inherent difficulty in removing such screws, surgeons should be knowledgeable in techniques for their removal and should be equipped with the proper instruments to expedite the procedure. There are few published articles about such techniques. This report describes a technique for removal of plates with stripped screws. The tip of a stripped screw is approached from the far cortex and then reamed with a trephine reamer in the direction of the screw until both cortices are cleared. The plate is then removed with stripped screws attached. All the removals utilizing this technique to date have been successful with no complications, and this method is safe, efficient and technically easy to learn.

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.

The Role of Lateral Buttress in Treatment of Jensen type 4 Intertrochanteric Fractures of the Femur using Dynamic Compression Hip Screw in the Elderly / 대한정형외과학회잡지

PURPOSE: To investigate the effect of lateral buttress on the fracture healing of Jensen type 4 intertrochanteric fracture of the femur treated by dynamic compression hip screw (DCS) in elderly patients, retrospectively. MATERIALS AND METHODS: From March 1999 to February 2003, 54 patients, older than 65 years, of Jensen type 4 intertrochanteric fractures of the femur treated by DCS were included. The relationship between the structual integrity of lateral buttress measured by proximal-medial fragment angle (PMFA) and postoperative neck-shaft angle, penetrating length of lag screw, the sliding length and incidence of fixation loss were evaluated. RESULTS: Among 38 patients of group II (PMFA above 50 degree), 6 cases (15.8%) including 4 cases of cutting out of lag screw from femoral head, 1 case of nonunion and 1 case of excessive extrusion of lag screw failed radiologically. But there was no fixation loss case in 16 cases of group I (PMFA 50 and below 50). The neck-shaft angle in last follow-up was 138.1 degree in group I and 132.1 in group II. The sliding length of lag screw was 7.0 mm in group I and 12. 5 mm in group II (p<0.05). CONCLUSION: Preoperative evaluation of intactness of lateral buttress measured by proximal-medial fragmentary angle is an useful method in treatment of Jensen type 4 intertrochanteric fractures treated by DCS in elderly patients.