The Fixation Method according to the Fracture Type of the Greater Trochanter in Unstable Intertrochanteric Fractures Undergoing Arthroplasty

Abstract

PurposeWe conducted a study on patients who underwent hip joint arthroplasty because of unstable femur intertrochanteric fractures with greater trochanter bony fragments. After dividing patients into three groups depending on their fracture patterns, we evaluated the clinical and radiological outcomes of different operation methods applied to each of these groups.Materials and MethodsUsing Evan's classification, we defined an unstable intertrochanteric fracture as those characterized as stage 4 or 5. Of the 137 patients presenting with an intertrochanteric fracture with osteoporosis (bone mineral density, <−2.5) between March 2014 and October 2015, 63 met the eligibility criteria and were included in this study. Next, patients were divided into three groups based on their greater trochanter fracture patterns (discerned with three-dimensional computed tomography images); different fixation methods were applied to each group by a single orthopaedic surgeon.ResultsTaken as a whole, 50 out of 63 patients experienced no reduction in walking distance in their daily lives. Harris hip score increased from 74.8 to 85.7 point and we considered this a relatively good result. Radiologically, we observed complete bone union in 62 cases (98.4%); the lone exception was in a patient who experienced osteolysis. There were also 3 cases who removed greater trochanter reattachment device due to broken implant and 1 case of dislocation.ConclusionThe different fixation methods applied to three distinct groups with varying fractures patterns were successful in achieving proper reduction and fixation of greater trochanteric fractures. We also observed reduced bone union periods when arthroplasty was performed in patients with unstable intertrochanteric fractures. Lastly, we believe these approaches may also aid in achieving early ambulation and early rehabilitations.

Primary Arthroplasty for Unstable and Failed Intertrochanteric Fractures: Role of Multi-Planar Trochanteric Wiring Technique

“…Their report did not mention union of the trochanteric fragment. In 2017, Sun et al 26) , who reported on a study evaluating the efficacy of different methods for fixation of the greater trochanter fracture fragment in patients with unstable intertrochanteric fractures undergoing hip arthroplasty, observed improvements in HHS from 74.8 to 85.7 points at the latest follow-up. Our study using HHS showed a better functional outcome ( Table 4 ).…”

Selecting Arthroplasty Fixation Approach Based on Greater Trochanter Fracture Type in Unstable Intertrochanteric Fractures

“…Intertrochanteric fractures in the elderly are mostly osteoporotic fractures in a form of a comminuted fracture in which the bone has broken into 3–4 fragments in 30–40% and unstable intertrochanteric fractures that affect to the posteromedial cortex34). Hemiarthroplasty is one surgical treatment option for the management of unstable intertrochanteric fractures in older adults by allowing early ambulation after surgery, preventing several complications caused by prolonged bed rest, and having a positive effect on gait restoration567). Since fixation failure of the greater trochanteric fragment, the attachment site for the abductor muscles, may cause pain, limping and dislocation of the hip, a variety of fixation methods have been introduced to obtain solid fixation of bone fragments89101112).…”

Artroplastía Parcial de Cadera con Banda de Tensión en Fracturas de Fémur Proximal en Pacientes Ancianos

“…La artroplastía aguda, en fracturas de fémur proximal, se encuentra recomendada en pacientes osteoporóticos y con artritis preexistente severa. Además, si se toma en cuenta que la fractura intertrocantérica inestable se presenta en el 45 % a 52 % de todas las fracturas de cadera de personas de edad avanzada, y que en la actualidad se encuentra recomendada la fijación interna y la artroplastía aguda, se debe evaluar adecuadamente el mejor tratamiento y manejo óptimo de estas fracturas femorales (Subramanian et al, 2012;Sun et al, 2017).…”

“…Con la asociación de una banda de tensión, con cerclaje a la artroplastía, la cual debe insertarse de forma endomedular, se garantiza una mejor estabilidad protésica y mejora la propiocepcion del paciente, beneficiándose el postoperatorio para realizar ejercicios funcionales tempranos con cojinete de peso parcial (Sun et al;Zhang et al, 2017).…”