J Korean Fract Soc.  2016 Jul;29(3):192-199. 10.12671/jkfs.2016.29.3.192.

Surgical Treatment for Stable 2-Part Intertrochanteric Femur Fracture Using Dynamic Hip Screw with 2-Hole Side Plate in Elderly Patients

• Lee KH
• Han SK
• Chung SJ
• Noh J
• Lee KH

• KMID: 2344092
• DOI: http://doi.org/10.12671/jkfs.2016.29.3.192

Abstract

PURPOSE
The purpose of this study is to evaluate the postoperative outcomes of elderly patients with stable 2-part intertrochanteric femur fractures surgically treated using dynamic hip screw with 2-hole side plate.
MATERIALS AND METHODS
From February 2008 to January 2014, 50 patients older than the age of 65 years, who had been followed-up for more than 6 months after the operation at The Catholic University of Korea, Bucheon St. Mary's Hospital were enrolled. A clinical evaluation of the skin incision length, operating time, and ambulatory status, using Clawson's Ambulation Capacity Classification, was performed, and a radiologic evaluation of Fogagnolo reduction quality, tip-apex distance (TAD), Cleveland index, sliding extent of lag screws, time duration till bony union, and complications was also done.
RESULTS
The mean skin incision length was 9.8 cm (range, 8-13 cm), the mean operating time was 41.4 minutes (range, 30-60 minutes), and 32 patients recovered their ambulatory function. Forty-eight patients gained bony union, and the time lapsed till union was average 10.6 weeks (range, 8-16 weeks). The evaluation of postoperative radiologic images showed the following reduction statuses by the Fogagnolo classification: 46 cases of "Good", 3 cases of "Acceptable," and 1 case of "Poor." Moreover, the mean TAD was 18.9 mm (range, 9.0-24.9 mm). While 45 cases fit into the zone 5 of the Cleveland index, other 3 were within zone 8 and the other 2 were within zone 6. The mean sliding length of the lag screws were 4.9 mm (range, 0.1-19.4 mm). There were a case of nonunion and a case of periprosthetic infection with nonunion as complications.
CONCLUSION
Using dynamic hip screws with 2-hole side plate for stable 2-part intertrochanteric femur fractures in elderly patients showed satisfactory results with respect to the recovery of ambulatory functions and bony union.

Keyword

Femur; Intertrochanteric fractures; Dynamic hip screw; 2-hole side plate

MeSH Terms

Aged*
Classification
Femur*
Gyeonggi-do
Hip Fractures
Hip*
Humans
Korea
Skin
Walking

Figure

• 

  Fig. 1 (A) Preoperative X-ray. (B) X-ray taken immediately after the operation. An excessive lag screw telescope is observed due to a reduction loss. (C) X-ray taken 6 months after the operation. Varus collapse occurred due to non-union and breakage of distal cortical screw. (D) Conversion to hip replacement arthroplasty.

• 

  Fig. 2 (A) Preoperative X-ray. (B) X-ray taken immediately after the operation. (C) X-ray taken 7 months after the operation. Breakage of the lag screw, non-union of the fracture site, and radio-lucent shadow around the hardware are observed. The patient complained of systemic femur with right hip pain. (D) Girdlestone operation with antibiotic-loaded cement insertion was done. However, the patient expired due to sepsis.

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