J Korean Fract Soc.  2007 Oct;20(4):291-296. 10.12671/jkfs.2007.20.4.291.

Comparison between Results of Internal Fixation and Hemiarthroplasty in Unstable Intertrochanter Fracture of Osteoporotic Bone

• Jung HJ
• Choi JY
• Shin HK
• Kim E
• Park SJ
• Lee YT
• Kim GS
• Kim JM

• KMID: 2297508
• DOI: http://doi.org/10.12671/jkfs.2007.20.4.291

Abstract

PURPOSE
To perform comparative analysis between the results of internal fixation and hemiarthroplasty in unstable intertrochanteric fracture of osteoporotic bone.
MATERIALS AND METHODS
From February 2003 to February 2006, 36 patients treated surgically for unstable intertrochanteric fractures were evaluated. The patient's age was older than 70 year old; the T-score of preoperative bone mineral density (BMD) was lower than -3.0; they were followed up for more than 1 year. The patient were divided into two groups. One group was treated with dynamic hip screw or proximal femoral nail (Group A, 23 cases), and the other group was treated with bipolar hemiarthroplasty (Group B, 13 cases). The two groups were compared in terms of hip joint function using Clawson classification and radiologically.
RESULTS
Nonunion and fixation failure happened in 6 cases (26%) of gruop A. However, all patients in group B showed stable maintenance of implant. Recovery of hip joint function was found in 13 cases (43%) of group A, whereas 12 cases (93%) of group B recovered.
CONCLUSION
Nonunion and failure of fixation happened more frequently in internal fixation than bipolar hemiarthroplasty, and the postoperative hip joint function was better in bipolar hemiarthroplasty than internal fixation. Therefore, bipolar hemiarthroplasty might be better operative treatment for unstable intertrochanteric fracture of osteoporotic bone.

Keyword

Unstable intertrochanteric fracture; Osteoporosis; Internal fixation; Hemiarthroplasty

MeSH Terms

Bone Density
Classification
Hemiarthroplasty*
Hip
Hip Fractures
Hip Joint
Humans
Osteoporosis

Figure

• 

  Fig. 1 Evans classification of intertrochanteric fracture.

• 

  Fig. 2 (A) Preoperative radiograph of a 78-year-old female showing unstable intertrochanteric fracture according to Evans classification. (B) Postoperative after 6 month showing lag screw loosening and incarceration of proximal fragement into intramedullary cavity of the distal fragment. (C) After conversion to bipolar hemiarthroplasty.

• 

  Fig. 3 (A) Preoperative radiograph of a 72-year-old male showing unstable intertrochanteric fracture according to Evans classification. (B) Postoperative radiograph after 13 months showing good maintenance of implant.

Reference

1. Bendo JA, Weiner LS, Strauss E, Yang E. Collapse of intertrochanteric hip fractures fixed with sliding screws. Orthop Rev. 1994; Suppl. 30–37.

2. Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur. J Bone Joint Surg Br. 1991; 73:330–334.

3. Boldin C, Seibert FJ, Fankhauser F, Peicha G, Grechenig W, Szyszkowitz R. The proximal femoral nail (PFN)-a minimal invasive treatment of unstable proximal femoral fractures: A prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand. 2003; 74:53–58.

4. Clawson DK. Intertrochanteric fracture of the hip. Am J Surg. 1957; 93:580–587.

5. Engh CA, Bobyn JD. The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. Clin Orthop Relat Res. 1988; 231:7–28.

6. Evans E. The treatment of intertrochanteric fractures of the femur. J Bone Joint Surg Br. 1949; 31:190–203.

7. Gundle R, Gargan MF, Simpson AH. How to minimize failures of fixation of unstable intertrochanteric fracutures. Injury. 1995; 26:611–614.

8. Haentjens P, Casteleyn PP, De Boeck H, Handelberg F, Opdecam P. Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients: primary bipolar arthroplasty compared with internal fixation. J Bone Joint Surg Am. 1989; 71:1214–1255.

9. Hardy DC, Descamps PY, Krallis P, et al. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures: a prospective, randomized study of one hundred patients. J Bone Joint Surg Am. 1998; 80:618–630.

10. Hwang DS, Jung HT, Kim SB, Kim JS. Recovery of walking ability after treatment of unstable intertrochanteric fractures in elderly patients-comparison of compression hip screw to primary hemiarthroplasty. J Korean Soc Fract. 1998; 11:296–303.

11. Park BC, Ihn JC, Kim SY, Ahn HS. Treatment of intertrochanteric fractures using gamma nail. J Korean Soc Fract. 1994; 7:588–596.

12. Laros GS, Moore JF. Complications of fixation in intertrochanteric fractures. Clin Orthop Relat Res. 1974; 101:110–119.

13. Mariani EM, Rand JA. Nonunion of intertrochanteric fractures of the femur following open reduction and internal fixation: results of second attempt to gain union. Clin Orthop Relat Res. 1987; 218:81–89.

14. Sadowski C, Lubbeke A, Saudan M, Riand N, Stern R, Hoftmeyer P. Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degree screwplate: a prospective, randomized study. J Bone Joint Surg Am. 2002; 84:372–381.

15. Yoo MC, Ahn JW, Kum SJ, Oh CJ. Clinical analysis for prognostic factors of intertrochanteric fractures. J Korean Orthop Assoc. 1989; 24:776–785.

16. Yoon HK, Cho DY, Shin DE, Kang SH. Comparison of functional recovery between internal fixation and hemiarthroplasty in basal intertrochanteric fracture in the over eighties. J Korean Orthop Assoc. 2004; 39:115–122.

17. Zuckerman JD. Comprehensive care of orthopedic injuries in the elderly. Baltimore: Urban and Schwarzenberg;1990.