Journal List > J Korean Fract Soc > v.20(2) > 1037571

Kho, Shin, Kim, Lee, and Kim: Trochanteric Management for Unstable Intertrochanteric Femoral Fracture in the Elderly Patients

Abstract

Purpose

To evaluate the results after fixation with figure of eight and cerclage wiring for comminuted trochanteric fracture. Because comminution of the femoral trochanteric fracture in elderly patients is severer in the operating field than x-ray findings, so the fixation is more difficult.

Materials and Methods

Between March 1998 and March 2004, the clinical records on twenty-eight patients more than 70 years old who underwent the bipolar hemiarthroplaty using calcar replacement type of femoral stem and followed more than 24 months were reviewed. Figure of eight and cerclage wiring was used for the comminuted trochanteric fracture of the femoral intertrochanteric fracture. The mean age was 80.4 (70~103) years. 19 cases were female, 9 cases were male. Mean follow-up period was 58 (24~92) months. We evaluated the results by modified Harris hip score, walking ability, activity of daily living, radiologic findings and union of the fracture.

Results

The mean duration of bony union was 12 weeks. The mean postoperative modified Harris hip score was 82.3. Preoperative walking ability was recovered in 23 cases (82%). Also basic activity of daily living was recovered in 22 cases (79%). Nonunion of trochanter was found in only one case by radiologic evaluation but clinical correlation was not significant.

Conclusion

We consider fixation with figure of eight and cerclage wiring for unstable intertrochanteric fracture of femur in the elderly patient is more appropriate in terms of convenience of fixation, duration of union, early ambulation and cost effectiveness.

Figures and Tables

Fig. 1

(A, B) Both hip anteroposterior and left hip lateral radiography of 81 year-old female patient shows Evans unstable femoral intertrochanteric fracture.

(C, D) After 28 months follow up, bony union has been achieved and the stem is tightly fitted after bipolar hemiarthroplasty with figure of eight and cerclage wiring.
jkfs-20-129-g001
Fig. 2

(A, B) Both hip anteroposterior and right hip lateral radiography of 75 year-old female patient shows Evans unstable femoral intertrochanteric fracture.

(C, D) After 28 months follow up, bony union has been achieved and the stem is tightly fitted after bipolar hemiarthroplasty with cerclage wiring and Dall-Miles cable.
jkfs-20-129-g002
Table 1

Age and sex distribution

jkfs-20-129-i001
Table 2

Mechanism of injury

jkfs-20-129-i002
Table 3

Modified Harris hip score. The score is multiplied by 1.1 to give an assessment out of 100

jkfs-20-129-i003
Table 4

Recovery of walking ability

jkfs-20-129-i004

References

1. Chan KC, Gill GS. Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures. Clin Orthop Relat Res. 2000; 371:206–215.
crossref
2. Chilvers M, Vejvoda H, Trammell R, Allan DG. Trochanteric fixation in total hip arthroplasty using the S-ROM bolt and washer. J Arthroplasty. 2002; 17:740–746.
crossref
3. Chin KR, Brick GW. Reattachment of the migrated ununited greater trochanter after revision hip arthroplasty: the abductor slide technique. A review of four cases. J Bone Joint Surg Am. 2000; 82:401–408.
crossref
4. Grimsrud C, Monzon RJ, Richman J, Ries MD. Cemented hip arthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures. J Arthroplasty. 2005; 20:337–343.
crossref
5. Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg Br. 1949; 31:190–203.
crossref
6. Haentjens P, Casteleyn PP, Opdecam P. Primary bipolar arthroplasty or total hip arthroplasty for the treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Acta Orthop Belg. 1994; 60:Suppl 1. 124–128.
7. Hamadouche M, Zniber B, Dumaine V, Kerboull M, Courpied JP. Reattachment of the ununited greater trochanter following total hip arthroplasty: the use of a trochanteric claw plate. J Bone Joint Surg Am. 2003; 85:1330–1337.
crossref
8. Kim KW, Ahn SH. Elderly trochanteric fractures - principles of treatment -. J Korean Soc Fract. 1994; 7:227–234.
crossref
9. Kitamura S, Hasegawa Y, Suzuki S, et al. Functional outcome after hip fracture in Japan. Clin Orthop Relat Res. 1998; 348:29–36.
crossref
10. Koval KJ, Zuckerman JD. Functional recovery after fracture of the hip. J Bone Joint Surg Am. 1994; 76:751–758.
crossref
11. Lestrange NR. Bipolar arthroplasty for 496 hip fractures. Clin Orthop Relat Res. 1990; 251:7–19.
crossref
12. Koval KJ, Skovron ML, Aharonoff GB, Meadows SE, Zuckerman JD. Ambulatory ability after hip fracture. A prospective study in geriatric patients. Clin Orthop Relat Res. 1995; 310:150–159.
13. Rodop O, Kiral A, Kaplan H, Akmaz I. Primary bipolar hemiprosthesis for unstable intertrochanteric fractures. Int Orthop. 2002; 26:233–237.
crossref
14. Singh M, Nagrazh AR, Maini PS. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg Am. 1970; 52:457–467.
crossref
15. Squires B, Bannister G. Displaced intracapsular neck of femur fractures in mobile independent patients: total hip replacement or hemiarthroplasty. Injury. 1999; 30:345–348.
crossref
16. Vahl AC, Dunki Jacobs PB, Patka P, Haarman HJ. Hemiarthroplasty in elderly, debilitated patients with an unstable femoral fracture in the trochanteric region. Acta Orthop Belg. 1994; 60:274–279.
17. Wang JW, Chen LK, Chen CE. Surgical treatment of fractures of the greater trochanter associated with osteolytic lesions. J Bone Joint Surg Am. 2005; 87:2724–2728.
crossref
18. Yoon ES, Min HJ, Suh JS, et al. Comparison of clinical results between bipolar hemiarthroplasty and compression hip screw on unstable intertrochanteric fractures of the femur in elderly patients. J Korean Fract Soc. 2004; 17:214–220.
crossref
19. Zain Elabdien BS, Olerud S, Karlstrom G. Ender nailing of pertrochanteric fractures. Results at follow-up evaluation after one year. Clin Orthop Relat Res. 1984; 191:53–63.
TOOLS
Similar articles