A clinical Study of Trochanteric Fractures / 대한정형외과학회잡지

ABSTRACT

Trochanteric fractures frequently occur in the elderly patients and complications such as pneumonia, thromboembolic disease, decubitus ulcer, and urinary tract infection are common. The principle in the treatment of an elderly patient wlth trochanteric fractures have swung from traction to internal fixation due to such complications. Since the introduction of the Smith-Petersen nail, numerous internal fixation devices such as I-beam nail, Thornton plate, Jewett nail, and Holt nail have been developed. Recently compression hip screw is popular because of rigid internal fixation. 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. This report is based on 104 cases of trochanteric fractures who were seen and treated at our orthopedic department during the 13 years period from January, 1965 to December, 1978. The study includes clinical and radiologic observation on our series of trochanteric fractures. The results were summarized as follows 1. Of 104 cases of trochanteric fractures 79 cases occurred in man, 25 cases in woman and each mean age was 51 years in man, 62 years in woman. 2. The most common cause of fracture was due to traffic accident. 3. Among 104 cases, 73 were treated with open reduction and internal fixation, and 31 were treated conservatively. 4. Of fixation devices, Jewett nails were used in 40 cases, Temple University nails in 9 cases, Mclaughlin nail plates in 5 cases, Moore blade plates in 4 cases, Blount blade plates in 3 cases, Thornton nail plates in 2 cases, Neufeld nail plate in 1 case, Richard compression sliding screw plates in 2 cases, plate and screws in 3 cases, Kuntscher nail in 2 cases, and screws in 2 cases. 5. Of 92 cases of trochanterir fractures, 27 cases were stable fracture and 65 cases were unstable fracture. The method of medial displacement of proximal part of distal fragment in 2 cases with unstable fracture and anatomic reduction in 90 cases with stable and unstable fracture were achieved. 6. The average time to fracture union was 16.6 weeks roentgenologically. There was no significant difference in the union rate between the method of treatment. 7. The average time to weight bearing was 11.8 weeks in operative treatment and 18.3 weeks in conservative treatment. 8. Complicatlon after internal flxation were reduced by early ambulation. 9. The method of medial displacement of proximal part of distal fragment of fracture was achieved in 2 cases of unstable fractures, and obtained satisfactory fracture healing, but had disadvantages such as some limitation of motion of the affected hip, shortening of affected extremlty. 10. Satisfactory result was obtained in 95.5% out of operatlve treatment, and 84% out of non-operative treatment. 11. From a consideration of those series, it was concluded that operative treatment of trochanteric fractures offered the advantages of improved function, economy of hospital beds, less complication, and comfort and early ambulatlon of the patient.