Surgical Treatment for Stable 2-Part Intertrochanteric Femur Fracture Using Dynamic Hip Screw with 2-Hole Side Plate in Elderly Patients

Kyung-Hoon Lee; Suk Ku Han; Seung-Jae Chung; Jongho Noh; Kee-Haeng Lee

doi:10.12671/jkfs.2016.29.3.192

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Lee, Han, Chung, Noh, and Lee: Surgical Treatment for Stable 2-Part Intertrochanteric Femur Fracture Using Dynamic Hip Screw with 2-Hole Side Plate in Elderly Patients

Original Article

Journal of the Korean Fracture Society 2016; 29(3): 192-199.

Published online: 21 July 2016

DOI: https://doi.org/10.12671/jkfs.2016.29.3.192

Surgical Treatment for Stable 2-Part Intertrochanteric Femur Fracture Using Dynamic Hip Screw with 2-Hole Side Plate in Elderly Patients

Kyung-Hoon Lee, M.D., Suk Ku Han, M.D., Seung-Jae Chung, M.D., Jongho Noh, M.D., Kee-Haeng Lee, M.D.

Department of Orthopedic Surgery, School of Medicine, The Catholic University of Korea, Seoul, Korea.

Address reprint requests to: Kee-Haeng Lee, M.D. Department of Orthopedic Surgery, The Catholic University of Korea, Bucheon St. Mary's Hospital, 327 Sosa-ro, Wonmi-gu, Bucheon 14647, Korea. Tel: 82-32-340-2260, Fax: 82-32-340-2671, keeleehip@gmail.com

Received 23 March 2016 Revised 15 April 2016 Accepted 8 June 2016

(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/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to evaluate the postoperative outcomes of elderly patients with stable 2-part intertrochanteric femur fractures surgically treated using dynamic hip screw with 2-hole side plate.

Materials and Methods

From February 2008 to January 2014, 50 patients older than the age of 65 years, who had been followed-up for more than 6 months after the operation at The Catholic University of Korea, Bucheon St. Mary's Hospital were enrolled. A clinical evaluation of the skin incision length, operating time, and ambulatory status, using Clawson's Ambulation Capacity Classification, was performed, and a radiologic evaluation of Fogagnolo reduction quality, tip-apex distance (TAD), Cleveland index, sliding extent of lag screws, time duration till bony union, and complications was also done.

Results

The mean skin incision length was 9.8 cm (range, 8-13 cm), the mean operating time was 41.4 minutes (range, 30-60 minutes), and 32 patients recovered their ambulatory function. Forty-eight patients gained bony union, and the time lapsed till union was average 10.6 weeks (range, 8-16 weeks). The evaluation of postoperative radiologic images showed the following reduction statuses by the Fogagnolo classification: 46 cases of "Good", 3 cases of "Acceptable," and 1 case of "Poor." Moreover, the mean TAD was 18.9 mm (range, 9.0-24.9 mm). While 45 cases fit into the zone 5 of the Cleveland index, other 3 were within zone 8 and the other 2 were within zone 6. The mean sliding length of the lag screws were 4.9 mm (range, 0.1-19.4 mm). There were a case of nonunion and a case of periprosthetic infection with nonunion as complications.

Conclusion

Using dynamic hip screws with 2-hole side plate for stable 2-part intertrochanteric femur fractures in elderly patients showed satisfactory results with respect to the recovery of ambulatory functions and bony union.

Keywords: Femur, Intertrochanteric fractures, Dynamic hip screw, 2-hole side plate

Figures and Tables

Fig. 1

(A) Preoperative X-ray. (B) X-ray taken immediately after the operation. An excessive lag screw telescope is observed due to a reduction loss. (C) X-ray taken 6 months after the operation. Varus collapse occurred due to non-union and breakage of distal cortical screw. (D) Conversion to hip replacement arthroplasty.

Fig. 2

(A) Preoperative X-ray. (B) X-ray taken immediately after the operation. (C) X-ray taken 7 months after the operation. Breakage of the lag screw, non-union of the fracture site, and radio-lucent shadow around the hardware are observed. The patient complained of systemic femur with right hip pain. (D) Girdlestone operation with antibiotic-loaded cement insertion was done. However, the patient expired due to sepsis.

Table 1

Demographic Characteristics of Enrolled Patients

Characteristic	Value
Sex (male:female)	50 (17:33)
Age (yr)	77.8±8.6 (65-101)
Follow-up period (mo)	14.3±10.4 (6-60)
BMD (T-score)	−3.0±1.5 (−5.6 to −0.3)
Cormobidities
Diabetes mellitus	18
Hypertension	24
Cerebrovascular accident	9
COPD	2
ASA physical status classification
Class I	9
Class II	21
Class III	16
Class IV	4
AO classification of fracture
31-A1.1	41
31-A1.2	9

Values are presented as number (%), mean±standard deviation (range), or number only. BMD: Bone mineral density, COPD: Chronic obstructive pulmonary disease, ASA: American Society of Anesthesiologists.

Table 2

Clawson's Ambulation Capacity Classification11)

Class I	Wheelchair ambulation
Class II	Crutch, two cane
Class III	One cane or simple brace
Class IV	Self ambulation

Table 3

Clinical Results of Enrolled Patients

Variable	Value
Length of skin incision (cm)	9.8±1.1 (8-13)
Operation time (min)	41.4±6.6 (30-60)
Ambulation capacity recovery rate before trauma by Clawson classification
Class I	100 (2/2)
Class II	50.0 (2/4)
Class III	50.0 (5/10)
Class IV	67.6 (23/34)

Values are presented as mean±standard deviation (range) or percent (number/total number).

Table 4

Radiologic Results of Enrolled Patients

Variable	Value
Bone union rate	96.0 (48/50)
Bone union time (wk)	10.6±1.7 (8-16)
Reduction status by Fogagnolo classification
Good	46
Acceptable	3
Poor	1
Tip apex distance (mm)	18.9±4.0 (9.0-24.9)
Cleveland index
Zone 5	45
Zone 6	2
Zone 8	3
Telescope length of lag screw (mm)	4.9±5.1 (0.1-19.4)

Values are presented as percent (number/total number), mean±standard deviation (range), number only.

Notes

^{Financial support} None.

^{Conflict of interest} None.

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