The Role of Beta-Tricalcium Phosphate Graft in the Dynamic Hip Screw Fixation of Unstable Intertrochanter Fracture

Chul-Ho Kim; Ji Wan Kim; Eic Ju Lim; Jae Suk Chang

doi:10.12671/jkfs.2016.29.4.250

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Kim, Kim, Lim, and Chang: The Role of Beta-Tricalcium Phosphate Graft in the Dynamic Hip Screw Fixation of Unstable Intertrochanter Fracture

Original Article

Journal of the Korean Fracture Society 2016; 29(4): 250-257.

Published online: 20 October 2016

DOI: https://doi.org/10.12671/jkfs.2016.29.4.250

The Role of Beta-Tricalcium Phosphate Graft in the Dynamic Hip Screw Fixation of Unstable Intertrochanter Fracture

Chul-Ho Kim, M.D., Ji Wan Kim, M.D., Ph.D.^*, Eic Ju Lim, M.D., Jae Suk Chang, M.D., Ph.D.

Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Inje University College of Medicine, Busan, Korea.

^*Department of Orthopedic Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Address reprint requests to: Jae Suk Chang, M.D., Ph.D. Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: 82-2-3010-3525·Fax: 82-2-488-7877, jschang@amc.seoul.kr

Received 18 July 2016 Revised 12 August 2016 Accepted 21 September 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 was to introduce our method of stabilizing unstable intertrochanteric fractures by using the dynamic hip screw (DHS) with a beta-tricalcium phosphate (β-TCP) graft and to compare the outcomes of this procedure with those of the conventional DHS without β-TCP.

Materials and Methods

Patients who underwent surgery by using DHS between March 2002 and January 2016 were retrospectively reviewed for analysis of the outcomes. The inclusion criteria were: 1) age of 60 years and older; 2) low-energy fracture resulting from a fall from no greater than the standing height; 3) multifragmentary pertrochanteric fracture (AO classification 31-A2.2, 2.3); and 4) follow-up of over 3 months. We compared 29 patients (29 hips) who underwent surgery, using DHS without β-TCP, with 29 age-sex matched patients (29 hips) who underwent surgery using DHS with grafted β-TCP granules to empty the trochanter area after reaming. We investigated the fracture union rate, union time, and length of lag screw sliding.

Results

Bone union was achieved in all cases. The mean union time was 7.0 weeks in the β-TCP group and 8 .8 weeks in the non-β-TCP group. The length of lag screw sliding was 3.6 mm in the β-TCP group and 5 .5 mm in the non-β-TCP group. There were no implant failure cases in both groups.

Conclusion

The β-TCP graft for reinforcement DHS acquired satisfactory clinical outcomes for treating unstable intertrochanteric fractures.

Keywords: Femur, Intertrochanter fractures, Dynamic hip screw, Beta-tricalcium phosphate

Figures and Tables

Fig. 1

Beta-tricalcium phosphate graft through the lag screw reaming window.

Fig. 2

A 79-year-old female patient. (A) Intraoperative C-arm image shows reaming lag screw. (B) Impaction beta-tricalcium phosphate (β-TCP) granule to lessor trochanter area. (C) Impaction β-TCP granule to greater trochanter area. (D) Post-fixation status.

Fig. 3

The Doppelt's method. To measure the extent of sliding, a correction factor was applied. Correction factor=B/b, the extent of sliding=A−a×B/b.

Fig. 4

Serial follow-up x-ray of the 70-year-old female patient. (A) Preoperative radiograph shows 31-A2.2 type trochanteric fracture. (B) Immediate postoperative radiograph after surgery using beta-tricalcium phosphate. (C) Postoperative radiograph at the 3-month follow-up. (D) Postoperative radiograph at the 12-month follow-up.

Table 1

Patients Demographics of the Cohort

Variable	β-TCP group	Non-β-TCP group	p-value
Age (yr)	74.6±14.2	74.6±14.2
Gender
Male	10 (34.5)	10 (34.5)
Female	19 (65.5)	19 (65.5)
BMI (kg/m²)	21.4±3.4	22.6±3.6	0.325
BMD (T-score)	−3.6±0.9	−3.0±1.3	0.067
Fracture type			0.374
AO 31–A2.2	19	15
AO 31–A2.3	10	14

Values are presented as mean±standard deviation, number (%), or number only. β-TCP: Beta-tricalcium phosphate, BMI: Body mass index, BMD: Bone mineral densitometry.

Table 2

Comparison between Two Groups of Blade Screw Slippage and Bone Union

Variable	β-TCP group	Non-β-TCP group	p-value
Blade screw slippage (mm)	3.62±3.46	5.50±7.47	0.943
Bone union rate	100	100
Period of bone union (wk)	7.02±2.14	8.80±2.75	0.654

Values are presented as mean±standard deviation or percent only.

β-TCP: Beta-tricalcium phosphate.

Notes

^{Financial support} None.

^{Conflict of interest} None.

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