The Fixation Method according to the Fracture Type of the Greater Trochanter in Unstable Intertrochanteric Fractures Undergoing Arthroplasty
1
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Purpose: We conducted a study on patients who underwent hip joint arthroplasty because of unstable femur intertrochanteric fractures with greater trochanter bony fragments. After dividing patients into three groups depending on their fracture patterns, we evaluated the clinical and radiological outcomes of different operation methods applied to each of these groups. Materials and Methods: Using Evan’s classification, we defined an unstable intertrochanteric fracture as those characterized as stage 4 or 5. Of the 137 patients presenting with an intertrochanteric fracture with osteoporosis (bone mineral density, <–2.5) between March 2014 and October 2015, 63 met the eligibility criteria and were included in this study. Next, patients were divided into three groups based on their greater trochanter fracture patterns (discerned with three-dimensional computed tomography images); different fixation methods were applied to each group by a single orthopaedic surgeon. Results: Taken as a whole, 50 out of 63 patients experienced no reduction in walking distance in their daily lives. Harris hip score increased from 74.8 to 85.7 point and we considered this a relatively good result. Radiologically, we observed complete bone union in 62 cases (98.4%); the lone exception was in a patient who experienced osteolysis. There were also 3 cases who removed greater trochanter reattachment device due to broken implant and 1 case of dislocation. Conclusion: The different fixation methods applied to three distinct groups with varying fractures patterns were successful in achieving proper reduction and fixation of greater trochanteric fractures. We also observed reduced bone union periods when arthroplasty was performed in patients with unstable intertrochanteric fractures. Lastly, we believe these approaches may also aid in achieving early ambulation and early rehabilitations.
Abstract
Purpose: We conducted a study on patients who underwent hip joint arthroplasty because of unstable femur intertrochanteric fractures with greater trochanter bony fragments. After dividing patients into three groups depending on their fracture patterns, we evaluated the clinical and radiological outcomes of different operation methods applied to each of these groups. Materials and Methods: Using Evan’s classification, we defined an unstable intertrochanteric fracture as those characterized as stage 4 or 5. Of the 137 patients presenting with an intertrochanteric fracture with osteoporosis (bone mineral density, <–2.5) between March 2014 and October 2015, 63 met the eligibility criteria and were included in this study. Next, patients were divided into three groups based on their greater trochanter fracture patterns (discerned with three-dimensional computed tomography images); different fixation methods were applied to each group by a single orthopaedic surgeon. Results: Taken as a whole, 50 out of 63 patients experienced no reduction in walking distance in their daily lives. Harris hip score increased from 74.8 to 85.7 point and we considered this a relatively good result. Radiologically, we observed complete bone union in 62 cases (98.4%); the lone exception was in a patient who experienced osteolysis. There were also 3 cases who removed greater trochanter reattachment device due to broken implant and 1 case of dislocation. Conclusion: The different fixation methods applied to three distinct groups with varying fractures patterns were successful in achieving proper reduction and fixation of greater trochanteric fractures. We also observed reduced bone union periods when arthroplasty was performed in patients with unstable intertrochanteric fractures. Lastly, we believe these approaches may also aid in achieving early ambulation and early rehabilitations.
참고문헌 (20)
- Koval KJ, "Patients with femoral neck and intertrochanteric fractures. Are they the same?", Clin Orthop Relat Res, (330), pp.166~172 (1996)
- Lorich DG, "Osteoporotic pertrochanteric hip fractures: management and current controversies", Instr Course Lect, 53, pp.441~454 (2004)
- Bonamo JJ, "Treatment of intertrochanteric fractures with a sliding nail-plate", J Trauma, 22, pp.205~215 (1982)
- Jensen JS, "Unstable trochanteric fractures. A comparative analysis of four methods of internal fixation", Acta Orthop Scand, 51, pp.949~962 (1980)
- Laros GS, "Complications of fixation in intertrochanteric fractures", Clin Orthop Relat Res, (101), pp.110~119 (1974)
- Stern MB, "Comminuted intertrochanteric fractures treated with a Leinbach prosthesis", Clin Orthop Relat Res, (218), pp.75~80 (1987)
- Stern MB, "The use of the Leinbach prosthesis in intertrochanteric fractures of the hip", Clin Orthop, (128), pp.325~331 (1977)
- 조수현, "Primary Cementless Hip Arthroplasty in Unstable Intertrochanteric Femur Fracture in Elderlys: Short-term Results", Hip and Pelvis, 26(3), pp.157~165 (2014), 대한고관절학회[DOI]
- 남호진, "불안정성 대퇴부 전자간 골절의 무시멘트 인공관절 전치환술에서 이중 강선, 이중 고리, 8자 고정술을 이용한 대전자부 골절 고정술", Hip and Pelvis, 24(4), pp.316~321 (2012), 대한고관절학회[DOI]
- 박명식, "고령 환자의 전자부 불안정성 골절에 대한 이중 강선 및 인장 대 강선 고정과 표준형 시멘트 주대를 이용한 인공 고관절 반치환술", Hip and Pelvis, 22(2), pp.159~165 (2010), 대한고관절학회
- 고덕환, "고령의 불안정성 대퇴 전자부 골절 환자에서 대퇴거 대치형 주대를 사용한 인공 고관절 반치환술", Hip and Pelvis, 25(3), pp.203~210 (2013), 대한고관절학회[DOI]
- 김원유, "대퇴 전자부 골절 환자의 양극성 인공골두 치환술시 전자 골절편의 내고정법", Hip and Pelvis, 18(1), pp.67~72 (2006), 대한고관절학회
- Hwang DS, "Recovery of walking ability after treatment of unstable intertrochanteric fractures in elderly patients: Comparison of compression hip screw to primary hemiarthroplasty", J Koean Hip Soc, 11, pp.22~29 (1999)
- Ceder L, "Prognostic indicators and early home rehabilitation in elderly patients with hip fractures", Clin Orthop Relat Res, (152), pp.173~184 (1980)
- Gill JM, "Biomechanical aspects of the repair of intertrochanteric fractures", J Biomed Eng, 11, pp.235~239 (1989)
- Chan KC, "Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures", Clin Orthop Relat Res, (371), pp.206~215 (2000)
- Haentjens P, "Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Primary bipolar arthroplasty compared with internal fixation", J Bone Joint Surg Am, 71, pp.1214~1225 (1989)
- Haentjens P, "Primary bipolar arthroplasty or total hip arthroplasty for the treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients", Acta Orthop Belg, 60(Suppl 1), pp.124~128 (1994)
- Kim YH, "Cemented Bipolar hemiarthroplasty for the femoral intertrochanteric fracture in elderly patients", J Korean Hip Soc, 10, pp.149~155 (1998)
- Hamadouche M, "Reattachment of the ununited greater trochanter following total hip arthroplasty. The use of a trochanteric claw plate", J Bone Joint Surg Am, 85-A, pp.1330~1337 (2003)