Treatment of Osteoporotic Unstable Intertrochanteric Fractures: Comparative Study between using Dynamic Hip Screw and Additional Trochanter Stabilizing Plate

Kim, Young Chang; An, Ki Chan; Kim, Key Yong; Choi, Jang Suk; Chung, Kyung Chil; Na, Chae Oh; Ha, Dong Joon; Kim, Chang Wan

Abstract

PURPOSE
To compare the effectiveness of a trochanter stabilizing plate with a dynamic hip screw, with using a dynamic hip screw only in the treatment of an unstable intertrochanteric fracture of elderly patients. MATERIALS AND METHODS: From January 2000 to December 2004, 70 patients, who were treated surgically for unstable intertrochanteric fractures, were evaluated. The patient s age were above 65 years and the T-score <-3.0 and they were followed up for more than 6 months. The patient were divided into two groups. One group was treated with DHS only (Group 1, 38 cases), and the other was treated with DHS and TSP (Group 2, 32 cases). The two groups were compared clinically and radiologically. RESULTS: There was no difference in the prevalence of lag screw sliding. However, there were significant differences in the extent of sliding between the two groups, (an average of 8.8 mm p<0.05). There was a significant difference between two groups in the extent of lateralization of the great trochanter, (An average of 6.0 mm p<0.05). However, there was no difference in the leg length between two groups (p>0.05), but the postoperative functional loss of the hip joint was significantly lower in the group 2 (p<0.05), who required additional surgery due to reduction loss or metal failure. CONCLUSION: Although it is a relatively simple technique, the use of DHS with TSP is more effective for the buttress effect on proximal fragment and additional fixation of great trochanter than just DHS only. It decreases the excessive slippage of the lag screw, lateral displacement of the greater trochanter and postoperative functional loss of the hip joint. Therefore, it may be a useful treatment for unstable or comminuted intertrochanteric fractures in elderly patients with osteoporosis.