Journal of Musculoskeletal Trauma

Original Articles

Treatment of Unstable Intertrochanteric Fractures in Elderly Patients: Comparison between DHS and Additional TSP: Sang Won Park, Jong Ryoon Baek, In Seok Moon; J Korean Soc Fract 2003;16(1):9-14. Published online January 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.1.9

PURPOSE
The purpose of this study was to compare the results by only Dynamic HIP Screw(DHS) with those by DHS and additional Trochanter Stabilizing Plate(TSP) in the operative treatments of unstable intertrochanteric fractures.
MATERIALS AND METHODS
From January 1998 to December 2000, twenty-five cases of unstable intertrochanteric fractures in the patient over 70 years old were reviewed with minimal follow up of one year. Ten cases(group I) were treated with DHS and additional TSP. Fifteen cases(group II) were treated with only DHS. The cases were analyzed according to the type of fracture by AO classification, the cause of trauma, the age of patient. We evaluated the sliding of lag screw, the change of neck-shaft angle and lateral displacement of greater trochanter by comparison of last follow up radiographs with immediate postoperative radiographs.
RESULTS
The degree of sliding of lag screws was average 8.57 mm in group I and average 14.75 mm in group II(P=0.04). The change of neck-shaft angle was average 3.81 degree in group I and average 3.93 degree in group II(P>0.05). There was a significant difference between group I(0 case) and group II(14 cases) in lateral displacements of greater trochanter. In group II, the degree of lateral displacement of greater trochanter was average 6.41 mm.
CONCLUSION
We consider that additional TSP is more effective method for reducing excessive sliding of lag screw and lateral displacement of greater trochanter than only using dynamic hip screw in the treatment of unstable intertrochanteric fracture.

Citations

Citations to this article as recorded by

A Comparison of Clinical Results between Compression Hip Screw and Proximal Femoral Nail as the Treatment of AO/OTA 31-A2.2 Intertrochanteric Femoral Fractures
Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, In Hwa Back, Kyeong Soo Eom
Journal of the Korean Orthopaedic Association.2016; 51(6): 493. CrossRef
The Comparison between ITST™ (Intertrochanteric/Subtrochanteric) & DHS (Dynamic Hip Screw) in Unstable Femur Intertrochanteric Fracture
Ho-Seung Jeon, Byung-Mun Park, Kyung-Sub Song, Hyung-Gyu Kim, Jong-Ju Yun
Journal of the Korean Fracture Society.2009; 22(3): 131. CrossRef

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Effect of Unreduced Lesser Trochanteric Fracture on Stability in Intertrochanteric Fracture of Femur: Seung Woo Suh, Jeong Ho Park, Jong Kun Oh, Kyung Wook Nah, Tae Hyeon Kim, Woo Nam Moon; J Korean Soc Fract 1997;10(3):529-533. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.529

Abstract PDF: Unstable intertrochanteric hip fractures are characterized by comminution of the posteromedial cortex, resulting in a fragment of variable size containing the lesser trochanter. Stability can be provided by transfixion of the lesser trochanteric fracture fragment with a screw. However, fixation of lesser trochanteric fragment is difficult, time-consuming, and often unsuccessful. Controversy exists as to whether it is necessary to perform reduction and fixation of this fragment. A radiological review of 61 intertrochanteric fractures treated with compression screw was made to study the effect of unreduced lesser trochanteric fracture on fracture healing and stability in unstable intertrochanteric fractures accompanied by lessor trochanteric fracture. Analysis were made on terms of rate of bone union, maintenance of reduction by comparing between anatomically reduced group with/without lesser trochanteric fracture and malreduced group with lesser trochanteric fracture. Anatomically reduced groups with/without lessel trochanteric fracture showed similar rates of bone union(88.3% in average) and degree of sliding of lag screw(3.74mm in average) regardless of fixation of lesser trochanter. On the other hand, unreduced group had 33.3% of bone union rates and 9.80mm of sliding of lag screw representing importance of anatomical reduction rather than fixation of lesser trochanteric fracture. In conclusion, it is suggested that unstable intertrochanteric fractures accompanied by large lesser trochanteric fracture fragment can be treated without fixation of lesser trochanteric fragment avoiding major complicatioins such as loosening of implant or collapse of fracture fragment.

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