The Clinical Results of Pressurized Cement-Augmented Richard Compression Hip Screw with Trochanteric Stabilizing Plate for Intertrochanteric Fracture Compared with Pressurized Cement-Augmented Richard Compression Hip Screw Only

ABSTRACT

PURPOSE: We analyzed the radiologic and clinical outcomes of osteosynthesis using a Richard compression hip screw (RCHS) alone or RCHS with a trochanteric stabilizing plate (TSP) in patients with an intertrochanteric fracture. MATERIALS AND METHODS: From January 2006 to December 2008, 23 patients (23 cases) underwent osteosynthesis using only RCHS and 24 patients (25 cases) underwent osteosynthesis using RCHS and TSP. We evaluated the classification of fractures, the amount of collapse and shortening, and the duration of fracture union. We used a Koval classification for the evaluation of clinical outcomes. RESULTS: The amount of collapse and shortening in the RCHS-only group was statistically greater than the amount in the RCHS-with-TSP group. The union duration of fracture was 5.3 months in the RCHS-only group and 6.6 months in the RCHS-with-TSP group. The clinical outcomes in the RCHS-with TSP-group were better than the RCHS-only group. We had one case of fixation failure in the RCHS-only group and none in the RCHS-with-TSP group. There were no perioperative systemic complications or death. CONCLUSION: In patients with unstable intertrochanteric fractures, we can prevent the cut out of the lag screw or screw loosening with the use of pressurized PMMA-augmented RCHS. However, we cannot prevent excessive collapse and shortening, especially in patients with severe osteoporosis, a small diameter of the femur neck, or concealed fractures. In the case of these patients, we recommend you to use RCHS with TSP for the prevention of excessive collapse and shortening.