Hip Pelvis.  2019 Sep;31(3):144-149. 10.5371/hp.2019.31.3.144.

Selecting Arthroplasty Fixation Approach Based on Greater Trochanter Fracture Type in Unstable Intertrochanteric Fractures

Affiliations
  • 1Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea. wonderchung@naver.com

Abstract

PURPOSE
To evaluate the success rate of fixation approaches for greater trochanter (GT) fracture types in those with unstable intertrochnateric fractures.
MATERIALS AND METHODS
Forty-four patients who underwent arthroplasty for unstable intertrochanteric fractures between January 2015 and November 2017 and followed-up more than six months were included in this study. The fractures of GT were classified into one of four types (i.e., A, B, C, and D) and fixed using either figure-8 wiring or cerclage wiring according to fracture type. Fractures were type A (n=7), type B (n=20), type C (n=6), and type D (n=11). Type A and B, which are fractures located above the inferior border of GT were fixed using figure-8 wiring and/or adding cerclage wiring. On the other hand, all type C and D fractures, which were located below the inferior border, were fixed using cerclage wiring. Fixation failure was defined as breakage of wire and progressive migration of GT fragment greater than 5 mm on follow-up radiographs.
RESULTS
The most common GT fracture types were B and D, both of which are longitudinal fractures. The success rates of fixation were 85.7% (6 out of 7 cases) for the treatment of type A, 90.0% (18 out of 20 cases) for the treatment of type B, and 100% for the treatment of types C (6 out of 6 cases) and D (11 out of 11 cases).
CONCLUSION
We note high success rates following fixation methods were selected based on the GT fracture type.

Keyword

Intertrochanteric fracture; Hemiarthroplasty; Greater trochanter fracture; Fixation

MeSH Terms

Arthroplasty*
Femur*
Follow-Up Studies
Hand
Hemiarthroplasty
Hip Fractures*
Humans

Figure

  • Fig. 1 Greater trochanter (GT) fracture classification. (A) Type A is a fracture with transverse direction above the inferior border of the GT. (B) Type B is a fracture with oblique direction above the inferior border of the GT. (C) Type C is a fracture with transverse direction below the inferior border of the GT. (D) Type D is a fracture with oblique direction below the inferior border of the GT.

  • Fig. 2 (A) An 88-year-old female with an unstable intertrochanteric fracture of the right femur. Type A greater trochanter (GT) fracture was observed using computer tomography (B) and intraoperative findings (C). (D) The GT fragment was fixed using figure-8 wiring and non-absorbable suture.

  • Fig. 3 (A) An 83-year-old female with an unstable intetrochanteric fracture in her left hip. (B) Type D greater trochanter (GT) fracture was observed using computer tomography. (C) The GT fragment was fixed with cerclage wires.

  • Fig. 4 (A) An 85-year-old female with an intertrochanteric fracture with a type B greater trochanter (GT) fracture. (B) The GT fracture was fixed using figure-8 wiring. (C) At 2 months after operation, the wire was broken and the fragment was also migrated proximally.


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