The Importance of Position of the Distal Fragment in Intertrochanteric Fracture of the Femur using Compression Hip Screw

Rha, Jong Deuk; Park, Hyun Soo; Park, Young Bong; Lim, Chang Suk; Kim, Seung Woo

Abstract

PURPOSE: We reviewed the amount of impaction and the change of neck shaft angle of intertrochanteric fracture of the femur which were treated with compression hip screw according to the fracture type and the displaced state of the distal fragment.
MATERIALS AND METHODS
There were 50 patients who had at least six months follow up, 13 men, and 37 women who were treated from January 1995 to December 2000. We have analysed the amount of impaction (measurement of the ratio between screw length and screw outside barrel length) and the change of neck shaft angle according to the fracture type and the displaced state of the distal fragment. The results were assessed statistically.
RESULTS
The fracture healing was achieved in about 13 weeks. There were 36 stable fracture types and 14 unstable fracture types by Evans classification. The most common osteoporotic singh index was grade II. The mean impaction amount of the fracture site was 5.4 mm and the mean neck shaft angle change was 1.5degrees of varus angulation. The mean tip apex distance was 32 mm. There was no case of lag screw penetration into the joint. There was significant difference in result according to the displaced state of the distal fragment. The amount of impaction was less in cases that anatomically reduced or got the posterolateralization of the distal fragment.
CONCLUSION
The results of our study indicate that the anatomical reduction and posterolateralization of the distal fragment could reduce the amount of impaction and the change of neck shaft angle. We advise that the position of the distal fragment in intertrochanteric fracture of the femur is very important to reduce the failure.