Soon-Yong Kwon; Hyun-Woo Park; Sang-Uk Lee; Soo-Hwan Kang; Jae-Young Kwon; Jung-Hoon Do; Seung-Koo Rhee

doi:10.12671/jkfs.2008.21.4.267

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Original Article
Treatment of Failed Intertrochanteric Fractures to Maintain the Reduction in Elderly Patients: Soon-Yong Kwon, M.D., Hyun-Woo Park, M.D., Sang-Uk Lee, M.D., Soo-Hwan Kang, M.D., Jae-Young Kwon, M.D., Jung-Hoon Do, M.D., Seung-Koo Rhee, M.D.; Journal of the Korean Fracture Society 2008;21(4):267-273.
DOI: https://doi.org/10.12671/jkfs.2008.21.4.267
Published online: October 31, 2008

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

^*Department of Orthopedic Surgery, Dankook University College of Medicine, Seoul, Korea.

Address reprint requests to: Seung-Koo Rhee, M.D. Department of Orthopedic Surgery, St. Mary's Hospital, The Catholic University of Korea, 62, Yeouido-dong, Yeongdeungpo-gu, Seoul 150-713, Korea. Tel: 82-2-3779-1192, Fax: 82-2-783-0252, skrhee@catholic.ac.kr

• Received: July 26, 2008 • Revised: August 19, 2008 • Accepted: September 22, 2008

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
The aim of this study was to evaluate and report the new method with a cement augmented screw fixation again to treat the failed intertrochanteric fracture in elderly which were treated with ordinary compression hip screw initially.
Materials and Methods
From Mar. 1988 to May 2007, 10 patients (mean age 69 years) with the failed intertrochanteric fracture which were treated with initial hip screw, were treated with a cement augmented compression hip screw again. The mean follow-up after surgery was over 18 months. The cause of failure, the period upto the reoperation, the neck-shaft angle after the reoperation, the position of lag screw in the femoral head, and the degree of union at last follow-up were analyzed. The change in the functional hip capacity were evaluated by the classification of Clawson.
Results
Causes of failure were superior cutting-out in 6 cases, cortical anchorage failure in 3, and nonunion in one case. The period upto the reoperation was average 7.8 months. Valgus reduction of average 5.7° was achieved, and the positions of lag screw were postero-inferior in 6 cases, center in 3, infero-center in one case. We obtained complete union in 9 cases. The functional outcome showed moderate in 6 cases, good in 3 and poor degree in one case.
Conclusion
Cement augmented compression hip screw treatment will possibly reduce cutting-out of screw and bring more stability in fixation for intertrochanteric fractures in old osteoporotic patients, as well, even in failed cases treated with initial compression hip screw, but proper selection of patients is important.
Key words: Failed intertrochanteric fracture, Cement augmented compression hip screw, Fracture fixation

REFERENCES

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Fig. 1

The position of lag screw on femoral head at premetallic failure.

Fig. 2

Finite Element Method (FEM) model.

Fig. 3

The position of lag screw on femoral head after reoperation.

Fig. 4

(A) Initial radiograph of 55 years old man shows the unstable femur intertrochanteric comminuted fracture (Evans type II).

(B) Immediate postoperative radiograph shows a good compression hip screw fixation.

(C) Cortical anchorage failure and reduction loss in varus position after 11 months later.

(D) 2nd postoperative state with cement augmented fixation again.

(E) Complete union was achieved 2 years 7 months later.

Fig. 5

AP & lateral radiographs of 63 year old male patient show (A) unstable intertrochanteric fracture, (B) postoperative state with compression hip screw, (C) nonunion state at 1 year, (D) 2nd postoperative state with cement augmented fixation, and (E) achievement of complete union at 2 years and 6 months later.

Fig. 6

AP & lateral radiographs of 74 year old male patient show (A) unstable intertrochanteric fracture, (B) postoperative X-ray with compression hip screw, (C) superior cut-out at 3 months, (D) 2nd postoperative X-rays with cement augmented fixation again, (E) screw penetration at 1 year 7 months later, and (F) 3rd postoperative X-ray with total hip replacement arthroplasty.

Table 1

Comparison of PVMS^* for non-cemented and cement-augmented cases

^*PVMS (MPa): peak-Von Mises stress (Mega Pascal).

Figure & Data

REFERENCES

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Safety and Effectiveness of the Anchor Augmentation with Bone Cement on Osteoporotic Femoral Fracture: A Systematic Reviews
So Young Kim
Journal of the Korean Fracture Society.2019; 32(2): 89. CrossRef

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Treatment of Failed Intertrochanteric Fractures to Maintain the Reduction in Elderly Patients

J Korean Fract Soc. 2008;21(4):267-273. Published online October 31, 2008

DOI: https://doi.org/10.12671/jkfs.2008.21.4.267

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Figure

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Treatment of Failed Intertrochanteric Fractures to Maintain the Reduction in Elderly Patients

Fig. 1 The position of lag screw on femoral head at premetallic failure.

Fig. 2 Finite Element Method (FEM) model.

Fig. 3 The position of lag screw on femoral head after reoperation.

Fig. 4 (A) Initial radiograph of 55 years old man shows the unstable femur intertrochanteric comminuted fracture (Evans type II). (B) Immediate postoperative radiograph shows a good compression hip screw fixation. (C) Cortical anchorage failure and reduction loss in varus position after 11 months later. (D) 2nd postoperative state with cement augmented fixation again. (E) Complete union was achieved 2 years 7 months later.

Fig. 5 AP & lateral radiographs of 63 year old male patient show (A) unstable intertrochanteric fracture, (B) postoperative state with compression hip screw, (C) nonunion state at 1 year, (D) 2nd postoperative state with cement augmented fixation, and (E) achievement of complete union at 2 years and 6 months later.

Fig. 6 AP & lateral radiographs of 74 year old male patient show (A) unstable intertrochanteric fracture, (B) postoperative X-ray with compression hip screw, (C) superior cut-out at 3 months, (D) 2nd postoperative X-rays with cement augmented fixation again, (E) screw penetration at 1 year 7 months later, and (F) 3rd postoperative X-ray with total hip replacement arthroplasty.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Treatment of Failed Intertrochanteric Fractures to Maintain the Reduction in Elderly Patients

Table 1

Comparison of PVMS^* for non-cemented and cement-augmented cases

^*PVMS (MPa): peak-Von Mises stress (Mega Pascal).

Table 1 Comparison of PVMS* for non-cemented and cement-augmented cases

^*PVMS (MPa): peak-Von Mises stress (Mega Pascal).