Recovery of Walking Ability After Operation for Unstable Intertrochanteric fractures of the Femur in Elderly. -Timing on weight Bearing-

Hwang, Deuk Soo; Jung, Hyun Tae; Kim, Sang Beom; Kim, Jin soo

Abstract

Intertrochanteric fracture of the femur frequently occurs in elderly patients with osteoporosis, represent as unstable and comminuted fracture, is the major cause of the morbidity and mortality in old ages. In the past, the goal of treatment of a fracture was to obtain union with little regard early ambulation is thought to be the best treatment modality. Fifty-three patients with unstable intertrochanteric fracture of the femur treated by possible anatomic reduction and internal fixation with compression hip screw were divided two groups and reviewed. In group A, 25 patients were began to bearing partial weight during six to eight weeks after operation. In group B, 28 patients were began to bearing partial weight as soon as possible(during first to third week after operation). The results were as follows; 1. According to Koval's classification, 6 cases(24.0%) in group A and 12 cases(42.9%) in group B maintained their prefracture ambulatory ability at more than 1 year postoperatively. 12 cases(48.0%) in group A, 8 cases(28.6%) in group B lost more than two grade of ambulatory ability. 2. Average loss of neck-shaft angle was 5.87degree in group A and 9.41degree in group B. Also average shortening was 5.2mm in group A and 12.7mm in group B at more than 1 year postoperatively. 3. The complications were two cases of nonunion in group A, two cases of femur fracture around compression hip screw in group B. There was no evidence of nail penetration or metal failure in both group. We concluded that better results are obtained in the respect of recovery of walking ability when partial weight bearing was started in early, even if more malunion was occurred, which is not seemed to be a severe problem for ordinary daily living in elderly.