J Korean Fract Soc.  1999 Jul;12(3):502-508.

Problems of compression Hip Screw for the Treatment of Intertrochanteric Fracture in Elderly Patients

• Roh KJ
• Kim JO
• Kim HH

Abstract

The principle in the treatment of an elderly patient with an intertrochanteric fracture has swung from traction to internal fixation due to complication such as pneumonia, skin ulcer, and thromboernbolic disease, etc. Many surgeons have used sliding compression screw for trochanteric fracture fixation which was regarded as a most effective device to manage the fracture. but, they have reported several risk factors to cause fixation failure such as screw impaction or loosening, because of osteoporosis, large defect on posteromedial aspect of neck, eccentric fixation of lag screw. The aim of the present investigation was to study the relationships between the type of fracture, the trabecular bone grading of proximal femur, reduction status, the implant position and the extent of impaction or loosening of the comression screw. We studied 47 elderly patients(age>60) who were managed using of compression hip screw as operative management and followed more than 6 months after operative treatment at Department of orthopaedic surgery, Ewha womens university Mokdong hospital from 1994 to 1998. The results were as follows 1. Screw impaction or loosening was developed in 7 cases of 47 cases after internal fixation. 2. Of 7 cases, 2 cases were stable fracture(modified Evans type I, II) and 5 cases unstable (modified Evans type III, IV, V). 3. Of 7 cases, 3 cases were high trabecula grade(grade VI, V, IV), 4 cases were low trabecula grade(grade I, II, III). 4. No siginificant diffierence of impaction or loosening development was in screw position. 5. Of 7 cases, 2 cases were anatomical reduction and 5 cases medial reduction.

Keyword

Intertrochanteric fracture; internal fixation; compression hip screw

MeSH Terms

Aged*
Female
Femur
Fracture Fixation
Hip*
Humans
Neck
Osteoporosis
Pneumonia
Risk Factors
Skin Ulcer
Surgeons
Traction