Hip Pelvis.  2017 Mar;29(1):62-67. 10.5371/hp.2017.29.1.62.

The Fixation Method according to the Fracture Type of the Greater Trochanter in Unstable Intertrochanteric Fractures Undergoing Arthroplasty

• Sun D
• Park BS
• Jang GI
• Lee B

• KMID: 2371769
• DOI: http://doi.org/10.5371/hp.2017.29.1.62

Abstract

PURPOSE
We conducted a study on patients who underwent hip joint arthroplasty because of unstable femur intertrochanteric fractures with greater trochanter bony fragments. After dividing patients into three groups depending on their fracture patterns, we evaluated the clinical and radiological outcomes of different operation methods applied to each of these groups.
MATERIALS AND METHODS
Using Evan's classification, we defined an unstable intertrochanteric fracture as those characterized as stage 4 or 5. Of the 137 patients presenting with an intertrochanteric fracture with osteoporosis (bone mineral density, <−2.5) between March 2014 and October 2015, 63 met the eligibility criteria and were included in this study. Next, patients were divided into three groups based on their greater trochanter fracture patterns (discerned with three-dimensional computed tomography images); different fixation methods were applied to each group by a single orthopaedic surgeon.
RESULTS
Taken as a whole, 50 out of 63 patients experienced no reduction in walking distance in their daily lives. Harris hip score increased from 74.8 to 85.7 point and we considered this a relatively good result. Radiologically, we observed complete bone union in 62 cases (98.4%); the lone exception was in a patient who experienced osteolysis. There were also 3 cases who removed greater trochanter reattachment device due to broken implant and 1 case of dislocation.
CONCLUSION
The different fixation methods applied to three distinct groups with varying fractures patterns were successful in achieving proper reduction and fixation of greater trochanteric fractures. We also observed reduced bone union periods when arthroplasty was performed in patients with unstable intertrochanteric fractures. Lastly, we believe these approaches may also aid in achieving early ambulation and early rehabilitations.

Keyword

Intertrochanteric fracture; Hip joint arthroplasty; Greater trochanter reattatchment

MeSH Terms

Arthroplasty*
Classification
Dislocations
Early Ambulation
Femur*
Hip
Hip Fractures*
Hip Joint
Humans
Methods*
Miners
Osteolysis
Osteoporosis
Walking

Figure

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  Fig. 1 Three-dimensional computed tomography images of the greater trochanter for each group. (A) Group A, oblique or spiral shape fracture with large fragment of greater trochanter. (B) Group B, transverse shape fracture of greater trochanter. (C) Group C, comminuted fracture of greater trochanter.

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  Fig. 2 Arthroplasty with 1.0 roll wire double strand figure 8 wiring in case of oblique or spiral pattern of fracture. (A) Preoperative plane X-ray, (B) postoperative plane X-ray, (C) operation method applied to model.

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  Fig. 3 Tension band wiring with 1.8 K-wire and 1.0 roll wire in case of transverse pattern of fracture. (A) Preoperative plane X-ray, (B) postoperative plane X-ray, (C) operation method applied to model.

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  Fig. 4 Using greater trochanteric reattachment device in case of comminuted fracture. (A) Preoperative plane X-ray, (B) postoperative plane X-ray, (C) operation method applied to model.

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