Classification and Treatment of Unstable Intertrochanteric Fracture according to the Existence of Posterior Fragment: Preliminary Report

Lih Wang; Sung Keun Shon; Kyu Yeol Lee; Chul Hong Kim; Myung Jin Lee; Chul Won Lee; Sung Soo Kim

doi:10.12671/jkfs.2008.21.2.110

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Wang, Shon, Lee, Kim, Lee, Lee, and Kim: Classification and Treatment of Unstable Intertrochanteric Fracture according to the Existence of Posterior Fragment: Preliminary Report

Original Article

Journal of the Korean Fracture Society 2008; 21(2): 110-116.

Published online: 30 April 2008

DOI: https://doi.org/10.12671/jkfs.2008.21.2.110

Classification and Treatment of Unstable Intertrochanteric Fracture according to the Existence of Posterior Fragment: Preliminary Report

Lih Wang, M.D., Sung Keun Shon, M.D., Kyu Yeol Lee, M.D., Chul Hong Kim, M.D., Myung Jin Lee, M.D., Chul Won Lee, M.D., Sung Soo Kim, M.D.

Department of Orthopaedic Surgery, College of Medicine, Dong-A University, Busan, Korea.

Address reprint requests to: Sung Soo Kim, M.D. Department of Orthopaedic Surgery, College of Medicine, Dong-A University, 1, Dongdaesin-dong 3-ga, Seo-gu, Busan 602-715, Korea. Tel: 82-51-240-2953, Fax: 82-51-254-6757, sskim2@dau.ac.kr

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To predict the feature and stability of intertrochanteric fractures with posterior fragment using preoperative 3D computed tomography and to investigate the importance of the posterior fragment in treatment of unstable intertrochanteric fracture.

Materials and Methods

15 cases of unstable fractures with posterior fragment which were treated with nail only between October 2006 to August 2007 were classified into 2 groups: study group (5 cases with cannulated screw fixation of posterior fragment) and control group (10 cases without cannulated screw fixation). The average difference of neck-shaft angle, neck screw sliding distance and the complications in the two groups were compared retrospectively after a follow up of at least 3 months.

Results

The average difference of neck-shaft angle in study and control group was 3.8 and 7.5 degree (p>0.05), respectively. The average difference of neck screw sliding distance was 1.6 and 6.6 mm (p<0.05), respectively. Complication which required reoperation was not noted in study group and complications of 3 cases about neck screw lateral protrusion, proximal migration and Z-effect phenomenon were noted in control group.

Conclusion

The recognition and fixation of the posterior wall was found to be an important predictive factor in unstable intertrochanteric fracture treatment.

Keywords: Intertrochanteric fracture, 3D computed tomography, Proximal femoral nail, Gamma nail

Figures and Tables

Fig. 1

Modified classification of unstable intertrochanteric fracture.

Fig. 2

Photograph shows measurements of neck-shaft angle (∂) and neck screw sliding distance (D).

Fig. 3

(A) Preoperative AP radiograph of a 86-year-old male with intertrochanteric fracture.

(B) Fracture pattern of B1 unstable reverse oblique fracture by 3D computed tomography.

(C) Postoperative AP radiograph of Gamma nail insertion with percutaneous 2 cannulated screws fixation.

(D) AP radiograph showed satisfactory reduction at 3 months post-operation.

Fig. 4

(A) Preoperative AP radiograph of a 80-year-old male with intertrochanteric fracture.

(B) Fracture pattern of B2 unstable fracture by 3D computed tomography.

(C) Postoperative AP radiograph of Gamma nail insertion with percutaneous 2 cannulated screws fixation.

(D) AP radiograph showed 1 cannulated screw pull-out at 6 months post-operation.

(E) AP radiograph showed bone union with satisfactory reduction at 12 months post-operation.

Fig. 5

(A) Preoperative AP radiograph of a 80-year-old female with intertrochanteric fracture.

(B) Fracture pattern of B1 unstable fracture by 3D computed tomography.

(C) Postoperative AP radiograph of proximal femoral nail insertion with satisfactory reduction.

(D) AP radiograph showed neck screw back out and varus angulation at 2 months post-operation.

(E) Z-effect phenomenon was shown at 3 months postoperation.

(F) Bipolar hip arthroplasty was performed.

Table 1

Distribution of modified classification between study group and control group

Table 2

Data according to operative method between study group and control group

Table 3

Average values of neck shaft angle between study group and control group

Table 4

Summary of complications

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