Outcomes of Wedge Wing in the Lag Screw for Unstable Intertrochanteric Fractures in Elderly Patients
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: To evaluate clinical-functional and radiologic outcomes of elderly patients with an unstable intertrochanteric femur fracture treated with a wedge wing in the lag screw. Materials and Methods: Forty-eight patients treated with the Dyna Locking Trochanteric nail (DLT nail) to resolve an unstable intertrochanteric femur fracture were reviewed retrospectively. Based on AO/OTA classification, Fracture 31-A2 (34 cases) and 31-A3 (14 cases) were included in the analysis. We measured the femoral neck-shaft angle, tip-apex distance (TAD), Cleveland index, sliding distance of the lag screw, and time to the fracture union. The Harris Hip Score and Paker and Palmer’s mobility score for clinical evaluation were used. Results: The mean follow-up period was 21.4 months (range, 12-34 months). The postoperative state of reduction was good in 28 cases and acceptable in 20 cases. The mean TAD was 20.5 mm. The position of the lag screw was center-center in 30 cases and center-inferior in 18 cases. The mean sliding distance of the lag screw was 3.4 mm at the last follow-up. The mean union time was 4.5 months. Two cases had complications which included a cut-out (1 case) and non-union (1 case). The mean Harris Hip Score was 86.5±8.3 (range, 76-90). Walking ability in 34 of the cases (70.8%) at last follow-up was similar to that prior to fracture. Conclusion: Functional and radiological outcomes are satisfactory using the DLT nail in the treatment of elderly patients with unstable intertrochanteric fractures; however, wedge wing in the lag screw does not prevent implant-related complications.
Abstract
Purpose: To evaluate clinical-functional and radiologic outcomes of elderly patients with an unstable intertrochanteric femur fracture treated with a wedge wing in the lag screw. Materials and Methods: Forty-eight patients treated with the Dyna Locking Trochanteric nail (DLT nail) to resolve an unstable intertrochanteric femur fracture were reviewed retrospectively. Based on AO/OTA classification, Fracture 31-A2 (34 cases) and 31-A3 (14 cases) were included in the analysis. We measured the femoral neck-shaft angle, tip-apex distance (TAD), Cleveland index, sliding distance of the lag screw, and time to the fracture union. The Harris Hip Score and Paker and Palmer’s mobility score for clinical evaluation were used. Results: The mean follow-up period was 21.4 months (range, 12-34 months). The postoperative state of reduction was good in 28 cases and acceptable in 20 cases. The mean TAD was 20.5 mm. The position of the lag screw was center-center in 30 cases and center-inferior in 18 cases. The mean sliding distance of the lag screw was 3.4 mm at the last follow-up. The mean union time was 4.5 months. Two cases had complications which included a cut-out (1 case) and non-union (1 case). The mean Harris Hip Score was 86.5±8.3 (range, 76-90). Walking ability in 34 of the cases (70.8%) at last follow-up was similar to that prior to fracture. Conclusion: Functional and radiological outcomes are satisfactory using the DLT nail in the treatment of elderly patients with unstable intertrochanteric fractures; however, wedge wing in the lag screw does not prevent implant-related complications.
참고문헌 (25)
- Jayaram Redd P, "A comparative study of surgical management of intertrochanteric fractures using dynamic hip screw(DHS)and proximal femoral nail(PFN)", Int J Orthopaedics Sci, 6, pp.480~484 (2020)
- 김용식, "Dyna Locking Trochanter (DLT) 금속정을 이용한 대퇴 전자간 골절의 치료", Hip and Pelvis, 22(3), pp.216~221 (2010), 대한고관절학회
- 김성수, "대퇴 전자간 골절에 있어 고정형 전자부 금속정, 항회전 근위 대퇴 금속정 및 3세대 감마정의 치료 비교", Hip and Pelvis, 25(3), pp.211~219 (2013), 대한고관절학회[DOI]
- Ross AF, "Principles and practice of anesthesiology", pp.2~36 (1993), Mosby
- Fogagnolo F, "Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail", Arch Orthop Trauma Surg, 124, pp.31~37 (2004)
- Cleveland M, "A ten-year analysis of intertrochanteric fractures of the femur", J Bone Joint Surg Am, 41-A, pp.1399~1408 (1959)
- Baumgaertner MR, "The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip", J Bone Joint Surg Am, 77, pp.1058~1064 (1995)
- Hoffer MM, "Functional ambulation in patients with myelomeningocele", J Bone Joint Surg Am, 55, pp.137~148 (1973)
- Koval KJ, "Functional recovery after fracture of the hip", J Bone Joint Surg Am, 76, pp.751~758 (1994)
- Holt G, "Outcome after short intramedullary nail fixation of unstable proximal femoral fractures", Acta Orthop Belg, 76, pp.347~355 (2010)
- Uzun M, "Long-term radiographic complications following treatment of unstable intertrochanteric femoral fractures with the proximal femoral nail and effects on functional results", Acta Orthop Traumatol Turc, 43, pp.457~463 (2009)
- Lobo-Escolar A, "Predictive factors for cutting-out in femoral intramedullary nailing", Injury, 41, pp.1312~1316 (2010)
- Ruecker AH, "The treatment of intertrochanteric fractures : results using an intramedullary nail with integrated cephalocervical screws and linear compression", J Orthop Trauma, 23, pp.22~30 (2009)
- Elmorsy A, "Primary bipolar arthroplasty in unstable intertrochanteric fractures in elderly", OJO, 2, pp.13~17 (2012)
- Baumgaertner MR, "Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures", Clin Orthop Relat Res, (348), pp.87~94 (1998)
- Mahomed N, "Biomechanical analysis of the gamma nail and sliding hip screw", Clin Orthop Relat Res, (304), pp.280~288 (1994)
- Bjørgul K, "Outcome after treatment of complications of gamma nailing : a prospective study of 554 trochanteric fractures", Acta Orthop, 78, pp.231~235 (2007)
- Bridle SH, "Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw", J Bone Joint Surg Br, 73, pp.330~334 (1991)
- Kawaguchi S, "Cutting-out of the lag screw after internal fixation with the Asiatic gamma nail", Injury, 29, pp.47~53 (1998)
- Gadegone WM, "Proximal femoral nail-an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year", Int Orthop, 31, pp.403~408 (2007)
- Sommers MB, "A laboratory model to evaluate cutout resistance of implants for pertrochanteric fracture fixation", J Orthop Trauma, 18, pp.361~368 (2004)
- Kuzyk PR, "A biomechanical comparison of static versus dynamic lag screw modes for cephalomedullary nails used to fix unstable peritrochanteric fractures", J Trauma Acute Care Surg, 72, pp.E65~E70 (2012)
- Temiz A, "Unstable intertrochanteric femur fractures in geriatric patients treated with the DLT trochanteric nail", Injury, 46(Suppl 2), pp.S41~S46 (2015)
- Gunay C, "Does the wedge wing in the neck screw prevent cut-out failure in Ota", AO 31-A2 trochanteric fractures in elderly patients, 2014, pp.80, 26~33
- Andruszkow H, "Tip apex distance, hip screw placement, and neck shaft angle as potential risk factors for cut-out failure of hip screws after surgical treatment of intertrochanteric fractures", Int Orthop, 36, pp.2347~2354 (2012)