Clin Orthop Surg.  2011 Jun;3(2):107-113. 10.4055/cios.2011.3.2.107.

Additional Fixations for Sliding Hip Screws in Treating Unstable Pertrochanteric Femoral Fractures (AO Type 31-A2): Short-Term Clinical Results

• Cho SH
• Lee SH
• Cho HL
• Ku JH
• Choi JH
• Lee AJ

• KMID: 1719306
• DOI: http://doi.org/10.4055/cios.2011.3.2.107

Abstract

BACKGROUND
To evaluate the utility of additional fixation methods and to suggest a method of reduction in the treatment of unstable pertrochanteric femur fractures with a sliding hip screw (SHS).
METHODS
A retrospective study was performed on thirty patients with unstable pertrochanteric femur fractures, who were operated on with a SHS between September 2004 and September 2009 and were followed up for at least 6 months. The additional fixation devices were as follows; antirotation screw (21 cases), fixation of displaced fractures of the posteromedial bone fragment (cerclage wiring, 21 cases and screw, 2 cases) and trochanter stabilizing plate (27 cases). Clinically, the Palmer's mobility score and Jensen's social function group were used. Radiologically, alignment and displacement were observed. The tip-apex distance (TAD) and sliding of the lag screw were measured, and the position of the lag screw within the femoral head was also examined.
RESULTS
The mean age at the time of surgery was 76 years (range, 56 to 89 years) and the average follow-up period was 25 months (range, 6 to 48 months). At the last follow-up, the average mobility and social function score was 6.2 (+/- 3.5) and 2.3 (+/- 1.5). Postoperatively, the alignment and displacement indices were adequate in almost all the cases. The mean amount of lag screw sliding and the mean TAD was 5.1 mm (range, 2 to 16 mm) and 6 mm (range, 3 to 11 mm) respectively. The lag screws were located in the center-center zone in 21 cases. The average period to union was 18.7 weeks without any cases of nonunion or malunion. Mechanical failure was noted in one case with breakage of the lag screw and clinical failure was noted in another case with persistent hip pain related to excessive sliding (16 mm).
CONCLUSIONS
With additional fixations, the unstable pertrochanteric femur fractures could be well stabilized by SHS until bone union.

Keyword

Pertrochanteric femur fracture; Sliding hip screw; Trochanter stabilizing plate

MeSH Terms

Aged
Aged, 80 and over
Bone Plates
*Bone Screws
Bone Wires
Female
Fracture Fixation, Intramedullary/*methods
Hip Fractures/radiography/*surgery
Humans
Male
Retrospective Studies
Treatment Outcome

Figure

• 

  Fig. 1 Steps in the surgical procedure. (A) Achievement and maintenance of anteromedial cortical continuity with a K-wire. (B) Wiring of the posteromedial bone fragment to obtain anatomical alignment. (C) A second K-wire to prevent toggling of the femoral head while inserting the lag screw. (D) Anatomical reduction and fixation of type A2 pertrochanteric femur fracture using both the sliding hip screw and three additional fixation devices.

• 

  Fig. 2 Group I. (A) Preoperative radiograph of a 65-year-old male showing AO type 31-A2, pertrochanteric femur fracture with a small posteromedial bone fragment with comminution. (B) Immediate postoperative radiograph showing anatomical alignment. (C) Eight months postoperative radiograph showing callus formation.

• 

  Fig. 3 Group II. (A) Preoperative radiograph of an 80-year-old male showing AO type 31-A2, pertrochanteric femur fracture with a large posteromedial bone fragment. (B) Immediate postoperative radiograph showing anatomical reduction. (C) Six months postoperative radiograph showing union.

• 

  Fig. 4 Group III. (A) Preoperative radiograph of a 74-year-old female showing AO type 31-A2, pertrochanteric femur fracture with a large posteromedial bone fragment. (B) Immediate postoperative radiograph showing anatomical alignment. (C) Fifteen months postoperative radiograph showing union.

• 

  Fig. 5 Group IV. (A) Preoperative radiograph of a 70-year-old female showing AO type 31-A2, pertrochanteric femur fracture. The large posteromedial bone fragment has a linear fracture bisecting it horizontally. (B) Immediate postoperative radiograph shows anatomical alignment with the large posteromedial bone fragment well reduced and fixed with cerclage wiring. (C) Seven months postoperative radiograph shows uneventful bone union despite the upper part of posteromedial fragment displaced upwardly. The anteromedial cortex was reformed without a visible step-off and the wired inferior cortical beak was well maintained anatomically. These two factors contributed to the stability until union.

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