J Korean Fract Soc.  2007 Jul;20(3):215-221. 10.12671/jkfs.2007.20.3.215.

Treatment of Senile Osteoporotic Intertrochanteric Fracture using Proximal Femoral Nail

• Kim DH
• Lee SH
• Moon YL
• Lee JY
• Song KS

• KMID: 2296820
• DOI: http://doi.org/10.12671/jkfs.2007.20.3.215

Abstract

PURPOSE
Clinical and radiologic results of femur intertrochanteric fractures treated with ITST nail in elderly patients with osteoporosis were analysized to evaluate the efficacy and complication of ITST nailing.
MATERIALS AND METHODS
32 patients who were treated with ITST nail due to femur intertrochanteric fracture and were followed up for more than 1 year were analysed. According to Evans classification, 11 cases were stable fractures and 21 cases were unstable fractures. Clinically, ambulatory function was compared and radiologically, BMD of healthy leg was checked with analysis of postoperative bone union and complication.
RESULTS
In ambulatory function comparison before and after the operation, there were 9 cases of good, 17 cases of moderate and 6 cases of poor. Considering social activity after the operation, 7 cases showed normal ambulation, 9 cases showed ambulatory with one cane, 5 cases showed two cane ambulation and 11 cases showed dependent ambulation. In radiologic evaluation, T-score of ward triangle in healthy femoral neck showed BMD of -3.12. In 20 cases, bone union was observed within 3 months. The patients with low BMD result had poor outcome. There were 2 cases of intraoperative proximal femur fracture, 3 cases of nonunion and 4 cases of death within 1 year.
CONCLUSION
In elderly patients with intertrochanteric fracture, ITST nailing is relatively efficient treatment. However, in pateint with severe osteoporosis (T-score<-3.0) and unstable fracture pattern, arthroplasty should be considered due to relatively high complicaton rate.

Keyword

Femur; Intertrochanteric fracture; Osteoporosis; ITST nail

MeSH Terms

Aged
Arthroplasty
Canes
Classification
Dependent Ambulation
Femur
Femur Neck
Hip Fractures
Humans
Leg
Osteoporosis
Walking

Figure

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  Fig. 1 Distribution data of patient's BMD. Most of patients had osteoporosis with less than -2.5 of T-score in results of DEXA.

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  Fig. 2 Clinical results by Clawson's walking ability score. In comparison test of ambulatory function before and after the operation, there were 9 cases of good, 17 cases of moderate and 6 cases of poor postoperatively.

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  Fig. 3 (A) Initial radiographs show a unstable intertrochanteric fracture from a slip down injury of a 71-year-old female patient. The T-score of BMD in this patient was -3.82. (B) Postoperative radiographs show the fracture fixed with ITST nail. (C) Follow-up radiographs 4 months after operation show bony union without any complications.

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  Fig. 4 (A) Initial radiographs show a stable intertrochanteric fracture from a slip down injury of a 84-year-old male patient. The T-score of BMD in this patient was -3.68. (B) Postoperative radiographs show proximal femur fracture during insertion of nail. (C) Follow-up radiographs 6 months after operation show bony union without any complications.

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  Fig. 5 (A) Initial radiographs show an unstable intertrochanteric fracture from a slip down injury of a 83-year-old female patient. The T-score of BMD in this patient was -4.82. (B) Postoperative radiographs show the fracture fixed with ITST nail. (C) Follow-up radiographs 2 months after operation show cutting out of lag screw into femoral head with loss of reduction due to fracture nonunion.

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