The Effects of Bone Graft in the Treatment of Osteoporotic Unstable Intertrochanteric Fracture of the Femur

Jahng, Jun Seop; Kim, Hyun Woo; Park, Young Joon; Kim, Dong Soo

Abstract

There are many problems in the treatment of intertrochanteric fracture of the femur in elderly patients due to poor bone quality and unstable pattern of the fracture. In the internal fixation of intertrochanteric fracture, it is known that the important prognostic factors include the accuracy of anatomic reduction, the stability of reduction, and the proper positioning if the lag screw. However, in elderly patients, the loss of reduction frequently occur as a postoperative complication in spite of the adequate anatomic reduction. In general, the bone graft increases initial stability of the fracture and promotes bone healing. So authors tried a prospective study using plain films to determine the effects of bone graft in the treatment of osteoporotic unstable intertrochanteric fracture of the femur with large bone defect in the posteromedial cortex. The study population included 35 patients who had been treated at the Department of Orthopaedic Surgery, Yonsei University College of Medicine from Mar. 1990 and to Feb. 1994. The results were as follows. 1. Among 35 patients, there are 22 cases of anatomically reduced (6 cases of bone graft group and 16 cases of non-bone graft group) and 13 cases of nonanatomically reduced (5 cases of bone graft group and 8 cases of non-bone graft group). 2. The average sliding length was 5.7mm in antomically reduced (5.0mm in bone graft group and 6.1mm in non-bone graft group) and 7.9mm in nonanatomically reduced (6.0mm in bone graft group and 9.6mm in non-bone graft group). 3. The loss of reduction during follow-up period was found in 6 cases in anatomically reduced (27.3%), 1 case in bone graft group (16.7%) and 5 cases in non-bone graft group (31.2%), and 6 cases (75%) in nonanatomically reduced without bone graft. In conclusion, additional bone graft in the treatment of osteoporotic unstable intertrochanteric fracture of the femur decreased postoperative complications such as the varus and posterior angular deformity. Therefore, we recommend selective bone graft in the treatment of osteoporotic unstable intertrochanteric fracture of the femur with large bone defect in the posteromedial cortex.