J Korean Fract Soc.  2008 Apr;21(2):110-116. 10.12671/jkfs.2008.21.2.110.

Classification and Treatment of Unstable Intertrochanteric Fracture according to the Existence of Posterior Fragment : Preliminary Report

• Wang L
• Shon SK
• Lee KY
• Kim CH
• Lee MJ
• Lee CW
• Kim SS

• KMID: 2183905
• DOI: http://doi.org/10.12671/jkfs.2008.21.2.110

Abstract

PURPOSE: To predict the feature and stability of intertrochanteric fractures with posterior fragment using preoperative 3D computed tomography and to investigate the importance of the posterior fragment in treatment of unstable intertrochanteric fracture.
MATERIALS AND METHODS
15 cases of unstable fractures with posterior fragment which were treated with nail only between October 2006 to August 2007 were classified into 2 groups: study group (5 cases with cannulated screw fixation of posterior fragment) and control group (10 cases without cannulated screw fixation). The average difference of neck-shaft angle, neck screw sliding distance and the complications in the two groups were compared retrospectively after a follow up of at least 3 months.
RESULTS
The average difference of neck-shaft angle in study and control group was 3.8 and 7.5 degree (p>0.05), respectively. The average difference of neck screw sliding distance was 1.6 and 6.6 mm (p<0.05), respectively. Complication which required reoperation was not noted in study group and complications of 3 cases about neck screw lateral protrusion, proximal migration and Z-effect phenomenon were noted in control group.
CONCLUSION
The recognition and fixation of the posterior wall was found to be an important predictive factor in unstable intertrochanteric fracture treatment.

Keyword

Intertrochanteric fracture; 3D computed tomography; Proximal femoral nail; Gamma nail

MeSH Terms

Follow-Up Studies
Hip Fractures
Nails
Neck
Reoperation
Retrospective Studies

Figure

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  Fig. 1 Modified classification of unstable intertrochanteric fracture.

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  Fig. 2 Photograph shows measurements of neck-shaft angle (∂) and neck screw sliding distance (D).

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  Fig. 3 (A) Preoperative AP radiograph of a 86-year-old male with intertrochanteric fracture. (B) Fracture pattern of B1 unstable reverse oblique fracture by 3D computed tomography. (C) Postoperative AP radiograph of Gamma nail insertion with percutaneous 2 cannulated screws fixation. (D) AP radiograph showed satisfactory reduction at 3 months post-operation.

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  Fig. 4 (A) Preoperative AP radiograph of a 80-year-old male with intertrochanteric fracture. (B) Fracture pattern of B2 unstable fracture by 3D computed tomography. (C) Postoperative AP radiograph of Gamma nail insertion with percutaneous 2 cannulated screws fixation. (D) AP radiograph showed 1 cannulated screw pull-out at 6 months post-operation. (E) AP radiograph showed bone union with satisfactory reduction at 12 months post-operation.

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  Fig. 5 (A) Preoperative AP radiograph of a 80-year-old female with intertrochanteric fracture. (B) Fracture pattern of B1 unstable fracture by 3D computed tomography. (C) Postoperative AP radiograph of proximal femoral nail insertion with satisfactory reduction. (D) AP radiograph showed neck screw back out and varus angulation at 2 months post-operation. (E) Z-effect phenomenon was shown at 3 months postoperation. (F) Bipolar hip arthroplasty was performed.

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