A Clinical Study of Intertrochanteric Fractures

Kang, Chang Soo; Sohn, Syng Won; Pyun, Young Sik; Lee, Jong Youl

Abstract

The prime objective in treating the intertrochanteric fracture is to achieve bony stability at the fracture site using an appropriate fixation nail plate to maintain a stabilized position. Since the introduction of the Smith-Petersen nail, numerous internal fixation devices have been developed. Complications after surgical treatment of intertrochanteric fractures of the femur though rarely resulting in non-unions or aseptic necrosis of the femoral head, varus deformities or delayed unions are frequent. Recently a compression hip screw is popular because it can provide more secure internal fixation. The authors treated 41 cases of intertrochanteric fractures of the femur during a 5. 5 year period from January, 1975 to June, 1980. 1. Of 41 cases of intertrochanteric fractures, 9 cases were stable fractures, and 32 cases were unstable. 2. Of 4I cases of intertrochanteric fractures, 9 were treated conservatively, and 32 were treated with open reduction and internal fixation. Of the fixation devices, compression hip screws were used in 17 cases, Jewett nail plates in 12 cases, Mclaughlin plate in 2 cases, and a Judet plate in a case. 3. Of the 32 cases treated by open reduction, reduction with medial displacement by the Dimoe- Hughston method was used in 10 cases, 3 of which were fixed with compression hip screws and 7 with Jewett nails. The remaining 22 were anatomically reduced. 4. The average time until weight bearing in conservatively treated patients began was 17. 7 weeks but in the surgically treated patients weight bearing started after 5. 5 weeks, and in patients treated with a compression hip screw patient conld bear weight 3. 7 weeks after surgery. 5. The average fracture union time was 16. 6 weeks in conservatively treated patienta, 16. 3 weeks in operatively treated patients (14. 6 weeks in compression hip screw fixation group, 18 weeks in Jewett nail, 21 weeks in Mclaughlin plate,16 weeks in Judet plate). 6. There were complications in 8 cases; 3 in the conservatively treatment group, and 5 in the internal fixation group. Of 5 internal fixation cases, 2 complications were caused by technical error. 7, After comparison of the result of treatment obtained by 4 different types of iaternal fixation devices, our conclusion is that compression hip screw is the device of choice for treatment of intertrochanteric fractures.