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The Clinical Resuts of Bipolar Hemiarthroplasty in Old Age-Femoral Neck Fracture vs. Intertrochanteric Fracture-
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Dong Heon Kim, Kyu Cheol Shin, Byeong Chun Chang, Dae Sul Kang
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J Korean Soc Fract 1999;12(3):509-515. Published online July 31, 1999
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DOI: https://doi.org/10.12671/jksf.1999.12.3.509
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 Abstract
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- The peritrochanteric fracture remains one of the most common and potentially devastating injuries in the geriatric population. The goal of treatment is early ambulation to prevent the complications such as pressure sore, pneumonia, deep vein thrombosis, pulmonary embolism and long time hospitalization by open reduction and internal fixation or closed reduction and internal rotation. In femoral neck fracture, many surgeons agree on the bipolar hemiarthroplasty but there is controversy about that treatment in intertrochanteric fracture. We have tried to assess the clinical outcome of bipolar hemiarthroplasty for the intertrochanteric fracture as compared with femoral neck fracture in old age. Ninty-five bipolar hemiarthroplasties were performed at our hospital, between January 1991 and February 1996. We selected 65 patients who had been followed for at least one year. Forty of sixty-five patients had femoral neck fractures and twenty-five of them intertrochanteric fractures.
The results were as follows: 1. Regardless of using the cement, the partial weight bearing ambulation time after operation was 10.3 days in femoral neck fracture, 19.5 days in intertrichanteric fracture.
2. At one year follow-up the average Modified Harris Hip Score was 88.9 in femoral neck fracture, and 87.5 in intertrochanteric fracture.
3. Postoperative complications in case of femoral neck fracture included thigh pain in 4 patients, heterotopic ossification in 1, intraoperative fractures of the femoral shaft in 2, leg length inequality in 1 and dislocations after bipolar hemiarthroplasties in 3. And those in case of intertrochanteric fractures were thigh pain in 2 patients, heterotopic ossifications in 2, intraoperative fractures of the femoral shaft in 2 and dislocation after bipolar hemiarthroplasty in 1.
4. There were no statistically significant differences in the clinical functional score and complications between intertrochanteric and femoral neck fracture groups, therefore bipolar hemiarthroplasty can be recommended as one of the treatment of intertrochanteric fracture as well as femoral neck fracture in the elderly patient.
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The Treatment of the Proximal Tibia Fracture -Comparison of the Variable Method of Fixation-
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Dong Heon Kim, Kyu cheol Shin, Kyeong Soon Kim, Byeong Chun Chang, Dae Sul Kang
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J Korean Soc Fract 1998;11(2):442-448. Published online April 30, 1998
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DOI: https://doi.org/10.12671/jksf.1998.11.2.442
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Abstract
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- The treatment of proximal tibial fracture is an area of great controversy. Because open and comminuted fractures are common, selection of fixation method of the proximal tibial fracture is more difficult than any other fractures. Many authors reported high rate of malunion and loss of reduction. The purpose of this study is to compare the results of the proximal tibial fractures depending on the fixation method. We evaluated the records of 35 patients (36 fractures) who had been treated with intramedullary nailing, plate and screws and external fixation from January 1989 to January 1996. The mean period of follow-up was 12months. Of the 36 fractures, 8 fractures were with intramedullary nailing, 12 fractures with plate and screws, 16 fractures with external fixator. In intramedullary nailing groupp, the average time of bony union was nineteen weeks (16-27), in plate and screws fixation group twenty three weeks (18-31) and in external fixation group 22 weeks (19-29). The complications of intramedullary nailing group were 3 nonunions, 1 delayed union, 1 varus deformity, 2 anterior angulations and 2 cases of deep wound infection. The complications of plate and screws group were 1 nonunion, 3 delayed union, 1 deep wound infection, 2 superficial infections and in most fractures partial stiffiness of knee joint. The complications of external fixator group were 1 nonunion, 1 delayed union, 1 deep wound infection, 6 pin tract infections and 3 cases of knee joint stiffness. In our cases, if there is open wound higher than Gustilo grade III-B and severe comminuted fracture initially, the external fixation is more preferred for wound management and also more advantageous method for the patients who got a multiple trauma in abdomen, chest and head injuries. In closed fractures and Gustilo grade I, II open fractures, intramedullary nailing is considered to be more preferable method. But the anatomy of proximal tibia made nailing these fractures technically difficult. In conclusion, we consider each method of fixation is useful fixation method of the proximal tibial fractures, but each method should be selected advertently depending on the severity of soft tissue injury and the degree of comminution of the fractures.
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