Fixation of Greater Trochanter Using an AO Trochanteric Reattachment Device (AO TRD) in Arthroplasty for Intertrochanteric Femur Fracture of Elderly Patients

Weon-Yoo Kim; Young-Yul Kim; Jae-Jung Jeong; Do-Joon Kang

doi:10.5371/hp.2013.25.4.274

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Kim, Kim, Jeong, and Kang: Fixation of Greater Trochanter Using an AO Trochanteric Reattachment Device (AO TRD) in Arthroplasty for Intertrochanteric Femur Fracture of Elderly Patients

Original Article

Hip & Pelvis 2013; 25(4): 274-279.

Published online: 31 December 2013

DOI: https://doi.org/10.5371/hp.2013.25.4.274

Fixation of Greater Trochanter Using an AO Trochanteric Reattachment Device (AO TRD) in Arthroplasty for Intertrochanteric Femur Fracture of Elderly Patients

Weon-Yoo Kim, MD, Young-Yul Kim, MD, Jae-Jung Jeong, MD, Do-Joon Kang, MD

Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Daejeon, Korea.

Address reprint request to Weon-Yoo Kim, MD. Department of Orthopaedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 520-2 Daehung-dong, Jung-gu, Daejeon 301-723, Korea. TEL: +82-42-220-9530, FAX: +82-42-221-0429, weonkim@hotmail.com

Received 20 August 2013 Revised 20 November 2013 Accepted 12 December 2013

(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

The purpose of this study is to evaluate the efficacy of the trochanter reattachment device (TRD) as a firm internal fixation method for bipolar hemiarthroplasty in unstable intertrochanteric femur fracture for elderly patients over 65 years old.

Materials and Methods

From September 2010 to April 2011, 19 patients (M/F: 1/18) over 65 years old were treated with bipolar hemiarthroplasty using the TRD as a fixation method for intertrochanteric femur fracture with above Evans-Jensen classification 2nd (above AO/OTA A1.3). They were followed up for more than 12 months(12-29 months).

Results

Out of 19 patients, only one had loosening of the TRD plate and reoperation was performed. There was no dislocation after surgery. Complete fracture union was observed in 19 patients with follow up of more than 12 months.

Conclusion

In bipolar hemiarthroplasty for intertrochanteric femur fracture, TRD produced easy and firm fixation. Additional fixation with TRD restoring abduction force by union of greater trochanter can be a good choice of surgery for avoidance of dislocation and chronic pain due to trochanteric nonunion after arthroplasty.

Keywords: Femur, Intertrochanteric fracture, Trochanteric reattachment device, Hip dislocation, Hemiarthroplasty

Figures and Tables

Fig. 1

(A) AO TRD (AO Trochanteric reattachment device). It is very important to plan the direction from which the cables will be tensioned. (B) The TRD is also available in a large version. The large TRD is indicated when an additional femur shaft fracture occurred. (C) Applied small TRD at greater trochanter. (The source of image is Synthe® The Cable system for orthopedic trauma surgery).

Fig. 2

Schematic procedure sequence. Schematic figure for fixation technique of trochanter with TRD. 1st cable should be placed at neck of stem for firm fixation while tightening. And then, place 2nd cable under the lesser trochanter. 3rd cable should be placed inferior portion of gluteus medius, use tensioner and cable crimper to tighten the TRD at greater trochanter.

Fig. 3

(A) Bipolar hemiarthroplasty was performed in left hip joint of the patient 2 years ago. On simple x-ray, minimal comminuted intertrochanteric fracture was found at right femur. Large size bone loss of left greater trochaneric area was found. (B) Comminuted fractures and displacement were found on computed tomography. Cemented bipolar hemiarthroplasty was performed in right femur intertrochanteric fracture, and additional fixation using AO TRD was done to comminuted and displaced fracture of greater trochanter and lesser trochanter. (C) Radiograph at 1 year shows bony union of right femur greater trochanter. (D) Compared to left trochanteric bone loss, most bone density is remained at right trochanter.

Table 1

Clinical Results

References

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