Bipolar Hemiarthroplasty Using the Greater Trochanter Reattachment Device (GTRD) for Comminuted Intertrochanteric Femur Fracture in Elderly Patients

Jin-Wan Kim; Young-Chul Ko; Chul-Young Jung; Il-Soo Eun; Hyeon-Soo Choi; Ok-Gul Kim; Young-June Kim

doi:10.12671/jkfs.2009.22.4.232

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Kim, Ko, Jung, Eun, Choi, Kim, and Kim: Bipolar Hemiarthroplasty Using the Greater Trochanter Reattachment Device (GTRD) for Comminuted Intertrochanteric Femur Fracture in Elderly Patients

Original Article

Journal of the Korean Fracture Society 2009; 22(4): 232-238.

Published online: 30 October 2009

DOI: https://doi.org/10.12671/jkfs.2009.22.4.232

Bipolar Hemiarthroplasty Using the Greater Trochanter Reattachment Device (GTRD) for Comminuted Intertrochanteric Femur Fracture in Elderly Patients

Jin-Wan Kim, M.D., Young-Chul Ko, M.D., Chul-Young Jung, M.D., Il-Soo Eun, M.D., Hyeon-Soo Choi, M.D., Ok-Gul Kim, M.D., Young-June Kim, M.D.

Department of Orthopedic Surgery, Busan Medical Center, Busan, Korea.

Address reprint requests to: Young-Chul Ko, M.D. Department of Orthopedic Surgery, Busan Medical Center, 1330, Geoje 2-dong, Yeonje-gu, Busan 611-706, Korea. Tel: 82-51-607-2862, Fax: 82-51-607-3001, drgo1973@nate.com

Received 26 May 2009 Revised 21 July 2009 Accepted 27 August 2009

(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 evaluate the clinical and radiological outcome of the greater trochanter reattachment device (GTRD) as firm fixation method for displaced greater trochanter fragment in bipolar hemiarthroplasty for comminuted intertrochanteric femur fracture in elderly patients.

Materials and Methods

From January 2006 to January 2008, 32 patients above 70 years old treated with bipolar hemiarthroplasty using the GTRD as fixation method for comminuted intertrochanteric femur fracture with greater trochanter bone fragment displaced above 1 cm. They were followed up for more than one year. Clinically, the postoperative Harris hip score (HHS) and daily activities of life of Johnston et al were evaluated, and radiological, any displacement of greater trocharter bone fragments and/or GTRD.

Results

The mean postoperative HHS was 71.6 (range, 53~82) points. In rating the daily activity of life, twenty seven (84.4%) patients' postoperative results were above fair. Two patients (6.3%) had displacement of the greater trochanter bone fragment above 1 cm. One patient had a deep infection, so we removed the bipolar head and inserted antibiotics-loaded cement block instead, and after the infection was controlled, conversion to total hip arthroplasty was done.

Conclusion

In bipolar hemiarthroplasty for comminuted intertrochanteric femur fracture with displaced greater trochanter bone fragment, GTRD produced satisfactory results and early rehabilitation.

Keywords: Femur, Intertrochanteric fracture, Greater trochanter reattachment device, Bipolar hemiarthroplasty

Figures and Tables

Fig. 1

Example of the GTRD: Apis grip plate® (Tradimedics).

Fig. 2

(A) Preoperative radiograph of a 80 year-old woman shows a comminuted intertrochanteric fracture (Body-Graffin type III).

(B) Follow-up radiograph 4 months after cemented bipolar hemiarthroplasty using GTRD.

Fig. 3

(A) Preoperative radiograph and 3-dimensional computed tomography of a 75 year-old man shows a comminuted intertrochanteric fracture (Body-Graffin type II).

(B) Postoperative radiograph shows cemented bipolar hemiarthroplasty using GTRD.

(C) After 7 weeks, bipolar head was removed and antibiotics-loaded cement block was inserted because deep infection occurred. After infection was controlled, cement block was removed and conversion to total hip arthroplasty was done.

(D) Follow-up radiograph 5 months after conversion to total hip arthroplasty.

Fig. 4

(A) Preoperative radiograph of a 80 year-old woman shows a comminuted intertrochanteric fracture (Body-Graffin type II).

(B) Postoperative radiograph shows cemented bipolar hemiarthroplasty using GTRD.

(C) Follow-up radiograph after 5 months shows superior migration about 1 cm of greater trochanter fragment.

Table 1

Summary of cases

^*Fx. Type: Boyd-Graffin type, ^†DAL: Daily activity of life, ^‡HHS: Harris hip score, ^§Postop. Cx.: Postoperative complications, ^∥DM: Diabetes mellitus, ^¶HTN: Hypertension, ^**CVA: Cerebrovascular accident.

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