Journal List > J Korean Orthop Assoc > v.26(6) > 1114677

Moon, Woo, and Kim: A Clinical Study of Trochanteric Fractures of the Femur: Outcome of Treatment in Regard to Osteoporosis and Type of Treatment

Abstract

The frequency and severity of the malunion or nonunion of the intertrochanteric fracture are directly related to the mechanical effectiveness of internal fixation which is determined by five independent variables:quality of bone, geometry of fragment, reduction of fragments, type of implant and its placement. A retrospective study was performed on 95 trochanteric fracture patients who were operatively treated and followed more than one year at the Department of Orthopaedics, Catholic University Medical College Kang-Nam St. Mary's Hospital between 1982 and 1989. The influence of osteoporosis (Singh index and femoral score), type of fracture and fixative implant on fracture healing or fragment reduction failure were studied. The results were as follows:l. Of fixation devices, Knowles pins were used in 28 cases, Ender nails in 25 cases, compression sliding screw plates in 12, combination of Ender nail and Knowles pin in 7, Rowe plates in 16, I-beam nails in 4, cannulated hip screws in 2, and Judet plate in 1 case. 2. Of 95 cases of trochanteric fractures, 27 cases were stable fractures, and 68 cases were unstable ones by the Evans' classification. 3. Of illumination of reductions state, anatomical reduction were carried out in 62 cases, medialization in 9 cases, valgus position in 15 csses, and varus position in 9 cases. 4. For all patients, radiographic morphometry using the Singh index and the cortical shaft index (femoral score) were performed; 70.4% of these patients had poor bone quality ; below grade IV and below 0.34 of cortical shaft index (mean value of Singh index was grade IV and mean value of femoral score was 0.37). 5. Unstable fractures were identified in patients having osteoporosis below grade IV of Singh index and its incidence was 75%, while the incidence in patients having above grade V of Singh index was 25%. Overall incidence of unstable fracture was 71.6% (68 cases). 6. Fixation loss was ensued in 25 out of 95 cases during the follow-up. 23 out of 25 cases had grade IV or more psteoporosis. 7. Complications were encountered in 70(73.7%) cases;coxa vara deformity in 20 cases (21.1%), screw loosening in 10(10.5%), nail or pin penetration of neck in 8(8.2%), coxa valga deformity in 6(6.4%), external rotation deformity in 5(5.3%), nonunion in 1(1%), gross leg length discrepance in 1(1%), death in 2(2.1%), decubitus ulcer in 3(3.2%) and urinary tract infection in 2(2.1%). Of these 68 patients 2 cases (2.1%) were reoperated. 8. Patients who had Ender nail with multiple pins showed best result without any significant complication even in the presence of severe osteoporosis.

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