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

Affiliations
  • 1Department of Orthopaedic Surgery, Good Samsun Hospital, Busan, Korea. suhyun1123@naver.com
  • 2Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 3Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand.

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.


Cited by  3 articles

Primary Cementless Hip Arthroplasty in Unstable Intertrochanteric Femur Fracture in Elderlys: Short-term Results
Su-Hyun Cho, Hyung Lae Cho, Hong Cho
Hip Pelvis. 2014;26(3):157-165.    doi: 10.5371/hp.2014.26.3.157.

Comments on the Article “The Effect of Positive Medial Cortical Support in Reduction of Pertrochanteric Fractures with Posteromedial Wall Defect Using a Dynamic Hip Screw”: To the Editor
Su-Hyun Cho
Clin Orthop Surg. 2019;11(4):497-498.    doi: 10.4055/cios.2019.11.4.497.

The Effect of Positive Medial Cortical Support in Reduction of Pertrochanteric Fractures with Posteromedial Wall Defect Using a Dynamic Hip Screw
Myung Rae Cho, Jae Hyuk Lee, Jai Bum Kwon, Jung Suk Do, Seung Bum Chae, Won-Kee Choi
Clin Orthop Surg. 2018;10(3):292-298.    doi: 10.4055/cios.2018.10.3.292.


Reference

1. Pervez H, Parker MJ, Pryor GA, Lutchman L, Chirodian N. Classification of trochanteric fracture of the proximal femur: a study of the reliability of current systems. Injury. 2002. 33(8):713–715.
Article
2. Doppelt SH. The sliding compression screw: today's best answer for stabilization of intertrochanteric hip fractures. Orthop Clin North Am. 1980. 11(3):507–523.
Article
3. Jensen JS. Classification of trochanteric fractures. Acta Orthop Scand. 1980. 51(5):803–810.
Article
4. Jensen JS, Michaelsen M. Trochanteric femoral fractures treated with McLaughlin osteosynthesis. Acta Orthop Scand. 1975. 46(5):795–803.
Article
5. Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br. 1993. 75(5):797–798.
Article
6. Jensen JS. Determining factors for the mortality following hip fractures. Injury. 1984. 15(6):411–414.
Article
7. Fogagnolo F, Kfuri M Jr, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg. 2004. 124(1):31–37.
Article
8. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995. 77(7):1058–1064.
Article
9. Cleveland M, Bosworth DM, Thompson FR, Wilson HJ Jr, Ishizuka T. A ten-year analysis of intertrochanteric fractures of the femur. J Bone Joint Surg Am. 1959. 41(8):1399–1408.
Article
10. Carr JB. The anterior and medial reduction of intertrochanteric fractures: a simple method to obtain a stable reduction. J Orthop Trauma. 2007. 21(7):485–489.
Article
11. Apel DM, Patwardhan A, Pinzur MS, Dobozi WR. Axial loading studies of unstable intertrochanteric fractures of the femur. Clin Orthop Relat Res. 1989. (246):156–164.
Article
12. Lee JM, Kim KY. Treatment of unstable trochanteric fracture using sliding hip screw with wiring of lesser trochanter. J Korean Orthop Assoc. 2000. 35(6):861–866.
Article
13. Kang JS, Moon KH, Kim RS, Bae JH, Lee BC. Fixaton of lesser trochanteric fragments on an unstable intertrochanteric fracture of the femur. J Korean Hip Soc. 2009. 21(3):245–251.
Article
14. Jones JB. Screw fixation of the lesser trochanteric fragment. Clin Orthop Relat Res. 1977. (123):107.
Article
15. Kim JH, Park JH, Kim HS, et al. Methods to increase the effectiveness of trochanteric stabilizing plate for unstable femoral intertrochanteric fractures with greater trochanteric fracture: fixation of greater trochanter with wire and screw. J Korean Hip Soc. 2007. 19(1):58–63.
Article
16. Im GI, Shin YW, Song YJ. Potentially unstable intertrochanteric fractures. J Orthop Trauma. 2005. 19(1):5–9.
Article
17. Kim DO, Jung JH, Yoon KS. Treatment of unstable intertrochanteric fracture using short barrel compression hip screws and a trochanteric stabilizing plate. J Korean Orthop Assoc. 2010. 45(2):101–106.
Article
18. Babst R, Renner N, Biedermann M, et al. Clinical results using the trochanter stabilizing plate (TSP): the modular extension of the dynamic hip screw (DHS) for internal fixation of selected unstable intertrochanteric fractures. J Orthop Trauma. 1998. 12(6):392–399.
Article
19. Kim YS, Kwon SY, Han SK, Choi WH, Choi NY. The role of lateral buttress in treatment of Jensen type 4 intertrochanteric fractures of the femur using dynamic compression hip screw in the elderly. J Korean Orthop Assoc. 2005. 40(7):935–941.
Article
20. Palm H, Jacobsen S, Sonne-Holm S, Gebuhr P. Hip Fracture Study Group. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg Am. 2007. 89(3):470–475.
Article
21. Wang L, Shon SK, Lee KY, et al. Classification and treatment of unstable intertrochanteric fracture according to the existence of posterior fragment: preliminary report. J Korean Fract Soc. 2008. 21(2):110–116.
Article
22. Karunakar M, McLaurin TM, Morgan SJ, Egol KA. Improving outcomes after pertrochanteric hip fractures. Instr Course Lect. 2009. 58:91–104.
23. Brunner A, Jockel JA, Babst R. The PFNA proximal femur nail in treatment of unstable proximal femur fractures: 3 cases of postoperative perforation of the helical blade into the hip joint. J Orthop Trauma. 2008. 22(10):731–736.
Article
24. Hwang JH, Oh JK, Han SH, Shon WY, Oh CW. Mismatch between PFNa and medullary canal causing difficulty in nailing of the pertrochanteric fractures. Arch Orthop Trauma Surg. 2008. 128(12):1443–1446.
Article
25. Weil YA, Gardner MJ, Mikhail G, Pierson G, Helfet DL, Lorich DG. Medial migration of intramedullary hip fixation devices: a biomechanical analysis. Arch Orthop Trauma Surg. 2008. 128(2):227–234.
Article
Full Text Links
  • CIOS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr