Comparison between Results of Internal Fixation and Hemiarthroplasty in Unstable Intertrochanter Fracture of Osteoporotic Bone

Haw Jae Jung; Jae Yeol Choi; Hun Kyu Shin; Eugene Kim; Se-Jin Park; Yong Taek Lee; Gwang-Sin Kim; Jong-Min Kim

doi:10.12671/jkfs.2007.20.4.291

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Jung, Choi, Shin, Kim, Park, Lee, Kim, and Kim: Comparison between Results of Internal Fixation and Hemiarthroplasty in Unstable Intertrochanter Fracture of Osteoporotic Bone

Original Article

Journal of the Korean Fracture Society 2007; 20(4): 291-296.

Published online: 14 June 2016

DOI: https://doi.org/10.12671/jkfs.2007.20.4.291

Comparison between Results of Internal Fixation and Hemiarthroplasty in Unstable Intertrochanter Fracture of Osteoporotic Bone

Haw Jae Jung, M.D., Jae Yeol Choi, M.D., Hun Kyu Shin, M.D., Eugene Kim, M.D., Se-Jin Park, M.D., Yong Taek Lee, M.D.^*, Gwang-Sin Kim, M.D., Jong-Min Kim, M.D.

Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

^*Department of Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Address reprint requests to: Jong-Min Kim, M.D. Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, 108, Pyung-dong, Jongro-gu, Seoul 100-634, Korea. Tel: 82-2-2001-2168, Fax: 82-2-2001-2176, kim@samsung.com

Abstract

Purpose

To perform comparative analysis between the results of internal fixation and hemiarthroplasty in unstable intertrochanteric fracture of osteoporotic bone.

Materials and Methods

From February 2003 to February 2006, 36 patients treated surgically for unstable intertrochanteric fractures were evaluated. The patient's age was older than 70 year old; the T-score of preoperative bone mineral density (BMD) was lower than -3.0; they were followed up for more than 1 year. The patient were divided into two groups. One group was treated with dynamic hip screw or proximal femoral nail (Group A, 23 cases), and the other group was treated with bipolar hemiarthroplasty (Group B, 13 cases). The two groups were compared in terms of hip joint function using Clawson classification and radiologically.

Results

Nonunion and fixation failure happened in 6 cases (26%) of gruop A. However, all patients in group B showed stable maintenance of implant. Recovery of hip joint function was found in 13 cases (43%) of group A, whereas 12 cases (93%) of group B recovered.

Conclusion

Nonunion and failure of fixation happened more frequently in internal fixation than bipolar hemiarthroplasty, and the postoperative hip joint function was better in bipolar hemiarthroplasty than internal fixation. Therefore, bipolar hemiarthroplasty might be better operative treatment for unstable intertrochanteric fracture of osteoporotic bone.

Keywords: Unstable intertrochanteric fracture, Osteoporosis, Internal fixation, Hemiarthroplasty

Figures and Tables

Fig. 1

Evans classification of intertrochanteric fracture.

Fig. 2

(A) Preoperative radiograph of a 78-year-old female showing unstable intertrochanteric fracture according to Evans classification. (B) Postoperative after 6 month showing lag screw loosening and incarceration of proximal fragement into intramedullary cavity of the distal fragment. (C) After conversion to bipolar hemiarthroplasty.

Fig. 3

(A) Preoperative radiograph of a 72-year-old male showing unstable intertrochanteric fracture according to Evans classification. (B) Postoperative radiograph after 13 months showing good maintenance of implant.

Table 1

Clawson classification

Table 2

Data of premorbid and postop hip joint function of group A and B

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