J Korean Orthop Assoc.
1979 Dec;14(4):653-663. 10.4055/jkoa.1979.14.4.653.
The Treatment of Hip Fracture
- KMID: 2460266
- DOI: http://doi.org/10.4055/jkoa.1979.14.4.653
Abstract
- Because most of the hip fracture is endemic to an elderly population, high mortality and morbidity has been encountered due to the fatal complications such as pneumonia, thromboembolism, and decubitus ulceration. So, it is essential to achieve early ambulation with complete reduction by strong interoal fixation divices in order to reduce those complications. As early as 25 years ago McCarroll remarked that this fracture must be considered "unsolved until the incidence of aseptic necrosis and nonunion could be diminished or abolished. Since that time improved reduction method and many new strong fixation divices such as Jewett nail-plate, Massie nail, and compression hip screw have been developed to achieve more accurate reduction and rigid immobilization. The following clinical results were shown by analysis of 117 cases of hip fractures experienced in the Department of Orthopedic Surgery, Seoul National University in the past 5 years from Jan. 1974 to Dec. 1978. 1. Femoral neck fractures were 67 cases and intertrochanteric fractures were 36 cases. 2. The most common cause of hip fractures was slip or fall (70.1%). 3. Incidence of femoral neck fracture was most frequent in the 6th decade, and that of the intertrochanteric fracture was in the 7th decade that is compared with 7th and 8th decade of Caucasian respectively. 4. Old hip fracture more than 3 weeks after trauma was in the 53.6%, and especially that of neck fracture was about 57%. 5. In the classification of the hip fractures, transcervical neck fracture was most frequent (70.1%), and unstable type (79.5%) in the intertrochanteric fracture. 6. Knowles pin was usually used in the stable neck fracture, while compression hip screw used in the unstable neck fracture. 7. Jewett nail-plate was usually used after Dimon-Hughston reduction, and compression hip screw after anatomical reduction in the unstable intertrochanteric fracture. But in the stable fracture either Jewett nail-plate or compression hip screw was usually used after anatomical reduction. 8. Endoprosthesis (26 cases), and total hip replacement arthroplasty (8 cases) were usually carried out in the old femur neck fracture treated by total hip arthroplasty was better than that by endoprosthesis. 9. Avascular necrosis was 13.3%, and nonunion 20% in the femur neck fracture. Nonunion was 12.5%, and delayed union 4.2% in the intertrochanteric fracture. With the above mentioned results, the following conclusion is obtained: 1. It is recommended that open reduction or arthriplasty of the hip should be performed if the closed reduction of the fracture of femoral neck is not adequate. 2. Graden alignment index is a good criteria for adequate reduction of femoral neck fracture. 3. Malunion induces the fate of femoral head to be avascular in the femoral neck fracture. 4. Compression hip screw is a good stabilizer for unstable intertrochanteric fracture. 5. The position of femoral endoprosthesis for delayed or inadequately reduced femoral neck fracture may be replaced by total hip replacement. The clinical result of total hip replacement is far better than that of femoral endoprosthesis In the cases of arthroplasty indication.
