J Korean Hip Soc.  2011 Dec;23(4):290-296. 10.5371/jkhs.2011.23.4.290.

The Clinical Results of Pressurized Cement-Augmented Richard Compression Hip Screw with Trochanteric Stabilizing Plate for Intertrochanteric Fracture Compared with Pressurized Cement-Augmented Richard Compression Hip Screw Only

Affiliations
  • 1Department of Orthopaedic Surgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. sykwon@catholic.ac.kr
  • 2Department of Orthopaedic Surgery, Daelim St. Mary's Hospital, Seoul, Korea.

Abstract

PURPOSE
We analyzed the radiologic and clinical outcomes of osteosynthesis using a Richard compression hip screw (RCHS) alone or RCHS with a trochanteric stabilizing plate (TSP) in patients with an intertrochanteric fracture.
MATERIALS AND METHODS
From January 2006 to December 2008, 23 patients (23 cases) underwent osteosynthesis using only RCHS and 24 patients (25 cases) underwent osteosynthesis using RCHS and TSP. We evaluated the classification of fractures, the amount of collapse and shortening, and the duration of fracture union. We used a Koval classification for the evaluation of clinical outcomes.
RESULTS
The amount of collapse and shortening in the RCHS-only group was statistically greater than the amount in the RCHS-with-TSP group. The union duration of fracture was 5.3 months in the RCHS-only group and 6.6 months in the RCHS-with-TSP group. The clinical outcomes in the RCHS-with TSP-group were better than the RCHS-only group. We had one case of fixation failure in the RCHS-only group and none in the RCHS-with-TSP group. There were no perioperative systemic complications or death.
CONCLUSION
In patients with unstable intertrochanteric fractures, we can prevent the cut out of the lag screw or screw loosening with the use of pressurized PMMA-augmented RCHS. However, we cannot prevent excessive collapse and shortening, especially in patients with severe osteoporosis, a small diameter of the femur neck, or concealed fractures. In the case of these patients, we recommend you to use RCHS with TSP for the prevention of excessive collapse and shortening.

Keyword

Intertrochanteric fracture; PMMA augemented RCHS; Trochanteric stabilizing plate

MeSH Terms

Femur
Femur Neck
Hip
Hip Fractures
Humans
Osteoporosis

Figure

  • Fig. 1 Doppelt's method was used to calculate shortening of leg length and collapse of fracture site. b2=2a2, d2=2c2, Collapse: b-d, LLD: a-c

  • Fig. 2 (A) Radiographs of the minimal displaced intertrochanteric fracture (AO/OTA A1.1 type). (B) 81 year-old male patient was treated by RCHS with cement augmentation. 7 months later, excessive collapse and shortening of fracture site was developed.

  • Fig. 3 (A) Radiographs of the unstable intetrochanteric fracture (AO/OTA A3.3 type). (B) 68 year-old female patient was treated by RCHS with cement augmentation and TSP, and 7 months later, Radiographs showed well union state without collapse and shortening of fracture site.


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