A Study on the Intertrochanteric Fracture / 대한정형외과학회잡지

ABSTRACT

As trochanteric fractures frequently occur in the elderly patients and complications such as pneumonia, thrombo-embolic disease, decubitus ulcer, and urinary tract infection are common, early mobilization after open reduction and internal fixation with hip nail are the standard treatment. Since 1931 when Smith-Peterson first introduced a tri-flanged nail, further more, since 1941 when Jewett pioneered the one-piece nail by adding a solid plate to a Smith-Peterson nail, numorous implants including threaded pins, screws, nails, and plates have been modified and desiged for fractured hips till now to achieve early ambulation and to maintain stable reduction. In 1955 Pugh and Ken introduced a sliding nail-plate and Schumpelick described the use of sliding screw-plate, which was modified further by Callender and Holt pioneered the concept of heavy nail in 1963. Recently compression sliding screw-plate is popular. Also many surgeons such as Evans, Dimon and Hughston, Sarmiento, and Boyd and Anderson have attempted to provide stable fixation of fracture by altering the position of fracture fragments to improve the mechanical resistances of bone to disruptive forces of weight-bearing. The surgical procedures of open reduction and internal fixation were carried out and followed for more than 6 months on 45 intertrochanteric fractures at Department of Orthopedic Surgery, Seoul National University Hospital, from Jan. 1968 to June. 1975 and the results were observed as follows. 1. Of 45 cases of inter-trochanteric fractures 28 cases occurred in man, 17 cases in woman and each mean age was 54 years in man, 74 years in woman. 2. Of fixation devices, Smith-Peterson nail-plates were used in 19 cases, Jewett nails in 15 cases, compression sliding screw-plates in 9 cases, Smith-Peterson nail in 1 case, and Ken sliding nail-plate in 1 case. 3. Stable fractures occurred in 10 cases were fixed internaly after anatomical reduction. 4. Dimon-Hughston reductions and Jewett Nailing were achieved in 11 cases of 12 unstabIe fractures and had disadvantages such as some limitation of R.O.M. of the affected hip, shortening, and valgus deformity. 5. Of 9 unstable fractures treated by compression sliding screw-plate 7 cases were reduced as anatomicaly as possible and 2 cases were reduced non-anatomicaly because of impossible anatomical reduction but good results were obtained except one failed nailing. 6. Of 7 failures, 6 cases resuIted from failures of nailing during operation and only 1 failure resulted in varus defermity after Dimen-Hughston reduction with Jewett nail.