Hip Pelvis.  2017 Mar;29(1):44-53. 10.5371/hp.2017.29.1.44.

Wiring Techniques for the Fixation of Trochanteric Fragments during Bipolar Hemiarthroplasty for Femoral Intertrochanteric Fracture: Clinical Study and Technical Note

• Lee JM
• Cho Y
• Kim J
• Kim DW

• KMID: 2371767
• DOI: http://doi.org/10.5371/hp.2017.29.1.44

Abstract

PURPOSE
Femoral intertrochanteric fractures are common in the elderly. Appropriate surgical fixation of trochanteric fracture fragments can restore normal anatomical structure and ambulation, and can aid in the recovery of biomechanical function of the hip. We evaluated clinical outcomes of bipolar hemiarthroplasty using a wiring technique for trochanteric fracture fragment fixation.
MATERIALS AND METHODS
From September 2006 to February 2015, a total of 260 cases underwent simultaneous bipolar hemiarthroplasty and wire fixation. A total of 65 patients (69 hips) with an average age of 78 years and more than one year of follow-up was included in the study. Using pre-, postoperative and follow-up radiograms, we evaluated wire fixation failure and also assessed changes in walking ability.
RESULTS
Loosening or osteolysis around the stem was not observed; however, we did observe bone growth around the stem (54 cases), cortical hypertrophy (6 cases), a wide range of sclerotic lines but no stem subsidence (1 case), wire breakage (9 cases), and fracture fragment migration with no significant functional deficiency (2 cases).
CONCLUSION
Our study showed that additional wiring for trochanteric fracture fragment fixation following bipolar hemiarthroplasty can help restore normal anatomy. The added stability results in faster rehabilitation, and good clinical and radiographic outcomes. We recommend this procedure in this type of fracture.

Keyword

Hip fractures; Hemiarthroplasty; Bone wires; Fracture fixation

MeSH Terms

Aged
Bone Development
Bone Wires
Clinical Study*
Femur*
Follow-Up Studies
Fracture Fixation
Hemiarthroplasty*
Hip
Hip Fractures
Humans
Hypertrophy
Osteolysis
Rehabilitation
Walking

Figure

• 

  Fig. 1 (A) This wiring is performed before insertion of prosthesis components. Each wire is inserted into the superior and inferior aspects of the displaced lesser trochanter and wire knots are placed at the posterior aspect of the bone fragment. (B) Hip prosthesis insertion is conducted after making bone fragments movable with the wires by fixing them using knots anteriorly. (C) After inserting all hip prostheses, lesser trochanteric fragments are reduced using wires and fixed by making knots laterally. (D) A schematic diagram representing the relationship of lesser trochanteric fragments and the iliopsoas, and candy package wiring (named because wiring shape resembles a candy package).

• 

  Fig. 2 (A) To enhance rigidity of fixation, a 1.5-mm wire was tied two or three times transversely over the greater trochanter and knots are made laterally. Tying the wire using holes drilled into the anterior portion of greater trochanter can add the additional stability. (B) After making the primary knot, the wire is tightened to the inferior to the lesser trochanter. (C) After tying the wire below the lesser trochanter, the secondary knot is made at the lateral aspect.

• 

  Fig. 3 (A) A double-strand wire is tied to the greater and lesser trochanters using a figure-8 wiring. (B) A wire knot is made rigidly at the lateral aspect. Using this wiring method, fixation can be accomplished by adjusting the position of wires depending on the pattern and location of fracture lines.

• 

  Fig. 4 (A) A 72-year old female patient visited our hospital due to intertrochanteric fracture of left femur after fall down from a height of 1 m. (Preoperative Clawson's Ambulation Capacity: Class 4). (B) Images after performing bipolar hemiarthroplasty and wiring fixation (transverse wiring with distal pulling wire ×2, candy-package wiring). (C) Postoperative 1-year follow-up; no limping gait, restoration of pre-injury ambulatory ability (Clawson's Classification: Class 4) and radiological signs of bone union.

• 

  Fig. 5 (A) An 88-year old male patient visited our hospital due to intertrochanteric fracture of right femur after slip down on the way to the toilet. (Preoperative Clawson's Ambulation Capacity: Class 3). (B) Images after performing bipolar hemiarthroplasty and wiring fixation (transverse wiring with distal pulling wire, figure-8 wiring, candy package wiring). (C) Postoperative 1-year follow-up; restoration of pre-injury ambulatory ability (Clawson's Classification: Class 3) and radiological signs of bone union despite slight displacement.

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