Kyung-Hoon Lee; Suk Ku Han; Seung-Jae Chung; Jongho Noh; Kee-Haeng Lee

doi:10.12671/jkfs.2016.29.3.192

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Original Article
Surgical Treatment for Stable 2-Part Intertrochanteric Femur Fracture Using Dynamic Hip Screw with 2-Hole Side Plate in Elderly Patients: Kyung-Hoon Lee, M.D., Suk Ku Han, M.D., Seung-Jae Chung, M.D., Jongho Noh, M.D., Kee-Haeng Lee, M.D.; Journal of the Korean Fracture Society 2016;29(3):192-199.
DOI: https://doi.org/10.12671/jkfs.2016.29.3.192
Published online: July 21, 2016

Department of Orthopedic Surgery, School of Medicine, The Catholic University of Korea, Seoul, Korea.

Address reprint requests to: Kee-Haeng Lee, M.D. Department of Orthopedic Surgery, The Catholic University of Korea, Bucheon St. Mary's Hospital, 327 Sosa-ro, Wonmi-gu, Bucheon 14647, Korea. Tel: 82-32-340-2260, Fax: 82-32-340-2671, keeleehip@gmail.com

• Received: March 23, 2016 • Revised: April 15, 2016 • Accepted: June 8, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
NOTES
REFERENCES

Abstract

Purpose
The purpose of this study is to evaluate the postoperative outcomes of elderly patients with stable 2-part intertrochanteric femur fractures surgically treated using dynamic hip screw with 2-hole side plate.
Materials and Methods
From February 2008 to January 2014, 50 patients older than the age of 65 years, who had been followed-up for more than 6 months after the operation at The Catholic University of Korea, Bucheon St. Mary's Hospital were enrolled. A clinical evaluation of the skin incision length, operating time, and ambulatory status, using Clawson's Ambulation Capacity Classification, was performed, and a radiologic evaluation of Fogagnolo reduction quality, tip-apex distance (TAD), Cleveland index, sliding extent of lag screws, time duration till bony union, and complications was also done.
Results
The mean skin incision length was 9.8 cm (range, 8-13 cm), the mean operating time was 41.4 minutes (range, 30-60 minutes), and 32 patients recovered their ambulatory function. Forty-eight patients gained bony union, and the time lapsed till union was average 10.6 weeks (range, 8-16 weeks). The evaluation of postoperative radiologic images showed the following reduction statuses by the Fogagnolo classification: 46 cases of "Good", 3 cases of "Acceptable," and 1 case of "Poor." Moreover, the mean TAD was 18.9 mm (range, 9.0-24.9 mm). While 45 cases fit into the zone 5 of the Cleveland index, other 3 were within zone 8 and the other 2 were within zone 6. The mean sliding length of the lag screws were 4.9 mm (range, 0.1-19.4 mm). There were a case of nonunion and a case of periprosthetic infection with nonunion as complications.
Conclusion
Using dynamic hip screws with 2-hole side plate for stable 2-part intertrochanteric femur fractures in elderly patients showed satisfactory results with respect to the recovery of ambulatory functions and bony union.
Key words: Femur, Intertrochanteric fractures, Dynamic hip screw, 2-hole side plate

None.

REFERENCES

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Fig. 1

(A) Preoperative X-ray. (B) X-ray taken immediately after the operation. An excessive lag screw telescope is observed due to a reduction loss. (C) X-ray taken 6 months after the operation. Varus collapse occurred due to non-union and breakage of distal cortical screw. (D) Conversion to hip replacement arthroplasty.

Fig. 2

(A) Preoperative X-ray. (B) X-ray taken immediately after the operation. (C) X-ray taken 7 months after the operation. Breakage of the lag screw, non-union of the fracture site, and radio-lucent shadow around the hardware are observed. The patient complained of systemic femur with right hip pain. (D) Girdlestone operation with antibiotic-loaded cement insertion was done. However, the patient expired due to sepsis.

Table 1

Demographic Characteristics of Enrolled Patients

Characteristic	Value
Sex (male:female)	50 (17:33)
Age (yr)	77.8±8.6 (65-101)
Follow-up period (mo)	14.3±10.4 (6-60)
BMD (T-score)	−3.0±1.5 (−5.6 to −0.3)
Cormobidities
Diabetes mellitus	18
Hypertension	24
Cerebrovascular accident	9
COPD	2
ASA physical status classification
Class I	9
Class II	21
Class III	16
Class IV	4
AO classification of fracture
31-A1.1	41
31-A1.2	9

Values are presented as number (%), mean±standard deviation (range), or number only. BMD: Bone mineral density, COPD: Chronic obstructive pulmonary disease, ASA: American Society of Anesthesiologists.

Table 2

Clawson's Ambulation Capacity Classification11)

Class I	Wheelchair ambulation
Class II	Crutch, two cane
Class III	One cane or simple brace
Class IV	Self ambulation

Table 3

Clinical Results of Enrolled Patients

Variable	Value
Length of skin incision (cm)	9.8±1.1 (8-13)
Operation time (min)	41.4±6.6 (30-60)
Ambulation capacity recovery rate before trauma by Clawson classification
Class I	100 (2/2)
Class II	50.0 (2/4)
Class III	50.0 (5/10)
Class IV	67.6 (23/34)

Values are presented as mean±standard deviation (range) or percent (number/total number).

Table 4

Radiologic Results of Enrolled Patients

Variable	Value
Bone union rate	96.0 (48/50)
Bone union time (wk)	10.6±1.7 (8-16)
Reduction status by Fogagnolo classification
Good	46
Acceptable	3
Poor	1
Tip apex distance (mm)	18.9±4.0 (9.0-24.9)
Cleveland index
Zone 5	45
Zone 6	2
Zone 8	3
Telescope length of lag screw (mm)	4.9±5.1 (0.1-19.4)

Values are presented as percent (number/total number), mean±standard deviation (range), number only.

Figure & Data

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Surgical Treatment for Stable 2-Part Intertrochanteric Femur Fracture Using Dynamic Hip Screw with 2-Hole Side Plate in Elderly Patients

J Korean Fract Soc. 2016;29(3):192-199. Published online July 31, 2016

DOI: https://doi.org/10.12671/jkfs.2016.29.3.192

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Surgical Treatment for Stable 2-Part Intertrochanteric Femur Fracture Using Dynamic Hip Screw with 2-Hole Side Plate in Elderly Patients

Fig. 1 (A) Preoperative X-ray. (B) X-ray taken immediately after the operation. An excessive lag screw telescope is observed due to a reduction loss. (C) X-ray taken 6 months after the operation. Varus collapse occurred due to non-union and breakage of distal cortical screw. (D) Conversion to hip replacement arthroplasty.

Fig. 2 (A) Preoperative X-ray. (B) X-ray taken immediately after the operation. (C) X-ray taken 7 months after the operation. Breakage of the lag screw, non-union of the fracture site, and radio-lucent shadow around the hardware are observed. The patient complained of systemic femur with right hip pain. (D) Girdlestone operation with antibiotic-loaded cement insertion was done. However, the patient expired due to sepsis.

Fig. 1

Fig. 2

Surgical Treatment for Stable 2-Part Intertrochanteric Femur Fracture Using Dynamic Hip Screw with 2-Hole Side Plate in Elderly Patients

Table 1

Demographic Characteristics of Enrolled Patients

Characteristic	Value
Sex (male:female)	50 (17:33)
Age (yr)	77.8±8.6 (65-101)
Follow-up period (mo)	14.3±10.4 (6-60)
BMD (T-score)	−3.0±1.5 (−5.6 to −0.3)
Cormobidities
Diabetes mellitus	18
Hypertension	24
Cerebrovascular accident	9
COPD	2
ASA physical status classification
Class I	9
Class II	21
Class III	16
Class IV	4
AO classification of fracture
31-A1.1	41
31-A1.2	9

Table 2

Clawson's Ambulation Capacity Classification11)

Class I	Wheelchair ambulation
Class II	Crutch, two cane
Class III	One cane or simple brace
Class IV	Self ambulation

Table 3

Clinical Results of Enrolled Patients

Variable	Value
Length of skin incision (cm)	9.8±1.1 (8-13)
Operation time (min)	41.4±6.6 (30-60)
Ambulation capacity recovery rate before trauma by Clawson classification
Class I	100 (2/2)
Class II	50.0 (2/4)
Class III	50.0 (5/10)
Class IV	67.6 (23/34)

Values are presented as mean±standard deviation (range) or percent (number/total number).

Table 4

Radiologic Results of Enrolled Patients

Variable	Value
Bone union rate	96.0 (48/50)
Bone union time (wk)	10.6±1.7 (8-16)
Reduction status by Fogagnolo classification
Good	46
Acceptable	3
Poor	1
Tip apex distance (mm)	18.9±4.0 (9.0-24.9)
Cleveland index
Zone 5	45
Zone 6	2
Zone 8	3
Telescope length of lag screw (mm)	4.9±5.1 (0.1-19.4)

Values are presented as percent (number/total number), mean±standard deviation (range), number only.

Table 1 Demographic Characteristics of Enrolled Patients

Table 2 Clawson's Ambulation Capacity Classification11)

Table 3 Clinical Results of Enrolled Patients

Values are presented as mean±standard deviation (range) or percent (number/total number).

Table 4 Radiologic Results of Enrolled Patients

Values are presented as percent (number/total number), mean±standard deviation (range), number only.