Dong-Hyeok Choi; Ju-Yeong Heo; Young-Jae Jang; Young-Yool Chung

doi:10.12671/jkfs.2014.27.1.58

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Original Article
Fixation of the Greater Trochanter in Arthroplasty for Unstable Intertrochnateric Fracture: Dong-Hyeok Choi, M.D., Ju-Yeong Heo, M.D., Young-Jae Jang, M.D., Young-Yool Chung, M.D.; Journal of the Korean Fracture Society 2014;27(1):58-64.
DOI: https://doi.org/10.12671/jkfs.2014.27.1.58
Published online: January 17, 2014

Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea.

Address reprint requests to: Young-Yool Chung, M.D. Department of Orthopaedic Surgery, Kwangju Christian Hospital, 37 Yangrim-ro, Nam-gu, Gwangju 503-715, Korea. Tel: 82-62-650-5064, Fax: 82-62-650-5066, paedic@chol.com

• Received: September 28, 2013 • Revised: November 4, 2013 • Accepted: December 18, 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
We classified fractures of the greater trochanter (GT) and evaluated fracture fragment stability according to GT type.
Materials and Methods
A total of 43 patients with an unstable intertrochanteric fracture treated between January 2007 and July 2009 with bipolar hemiarthroplasty were included in this study. GT fractures were classified as type A, B, C, or D and fixed using either cerclage wiring alone, cerclage wiring and non-absorbable suture or a greater trochanteric reattachment (GTR) plate.
Results
Type A fractures were fixed using cerclage wiring with non-absorbable suture in two cases, cerclage wiring in six cases and GTR plate in seven cases. Failure occurred in three cases of type A fractures treated with cerclage wiring alone. A total of 11 type B fractures were fixed with cerclage wiring (7), cerclage wiring and non-absorbable suture (3) and GTR plate (1). There was no failure of type B fractures. Type C fractures were fixed using cerclage wiring with non-absorbable suture in one case and GTR plate in three. There was no fixation in three cases. Of 10 type D fractures, six were treated with cerclage wiring and one with GTR plate. Fixation was not performed in three patients. There was no failure in type C and D type fractures.
Conclusion
Fracture fragment stability differed according to fracture types. Cerclage wiring alone was insufficient to fix type A fractures, so type A fracture required a stronger fixation method.
Key words: Femur, Unstable intertrochanteric fracture, Classification and fixation of fractured greater trochanter

REFERENCES

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Fig. 1

Classification of greater trochanteric fracture. (A) Type A is a transverse fracture above the inferior border of greater trochanter (GT). The fracture fragment was displaced superiorly by the pulling force of the hip abductors. (B) Type B is a vertical fracture that is not extended to the inferior border of GT. Type B was similar in stability of fracture fragment to type A. (C) Type C is the transverse fracture below the inferior border of GT. Type B fracture was more stable than type A because of the balanced pulling forces of abductors proximally and vastus lateralis distally. (D) Type D is a vertical fracture that extended to below to inferior border of GT. Type D was similar in stability of fracture fragment to type C. The muscles were attached to the fracture fragment proximally and distally, which stabilized the fracture.

Fig. 2

(A) Preoperative radiograph of type A greater trochater (GT) fracture in a 78-year-old male. (B) Postoperative radiograph of a type A GT fracture fixed with a greater trochanteric reattachment plate.

Fig. 3

(A) Preoperative radiograph of a type D greater trochater (GT) fracture in an 85-year-old woman. (B) The displaced GT fragment was reduced and fixed with cerclage wiring and non-absorbable suture. (C) Postoperative radiograph after bipolar hip arthroplasty and fixation of GT fracture with cerclage wiring and non-absorbable suture.

Figure & Data

REFERENCES

Citations

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Fixation of the Greater Trochanter in Arthroplasty for Unstable Intertrochnateric Fracture

J Korean Fract Soc. 2014;27(1):58-64. Published online January 31, 2014

DOI: https://doi.org/10.12671/jkfs.2014.27.1.58

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Fixation of the Greater Trochanter in Arthroplasty for Unstable Intertrochnateric Fracture

Fig. 1 Classification of greater trochanteric fracture. (A) Type A is a transverse fracture above the inferior border of greater trochanter (GT). The fracture fragment was displaced superiorly by the pulling force of the hip abductors. (B) Type B is a vertical fracture that is not extended to the inferior border of GT. Type B was similar in stability of fracture fragment to type A. (C) Type C is the transverse fracture below the inferior border of GT. Type B fracture was more stable than type A because of the balanced pulling forces of abductors proximally and vastus lateralis distally. (D) Type D is a vertical fracture that extended to below to inferior border of GT. Type D was similar in stability of fracture fragment to type C. The muscles were attached to the fracture fragment proximally and distally, which stabilized the fracture.

Fig. 2 (A) Preoperative radiograph of type A greater trochater (GT) fracture in a 78-year-old male. (B) Postoperative radiograph of a type A GT fracture fixed with a greater trochanteric reattachment plate.

Fig. 3 (A) Preoperative radiograph of a type D greater trochater (GT) fracture in an 85-year-old woman. (B) The displaced GT fragment was reduced and fixed with cerclage wiring and non-absorbable suture. (C) Postoperative radiograph after bipolar hip arthroplasty and fixation of GT fracture with cerclage wiring and non-absorbable suture.

Fig. 1

Fig. 2

Fig. 3

Fixation of the Greater Trochanter in Arthroplasty for Unstable Intertrochnateric Fracture