J Korean Orthop Assoc.  2011 Feb;46(1):49-53. 10.4055/jkoa.2011.46.1.49.

Changes in Patient Pattern and Operation Methods for Intertrochanteric Fractures

• Kim DH
• Lee SH
• Ha SH
• You JW

• KMID: 2106571
• DOI: http://doi.org/10.4055/jkoa.2011.46.1.49

Abstract

PURPOSE
The purpose of this study was to analyze characteristics of femur intertrochanteric fractures concerning age, fracture pattern, and change in operation method, retrospectively.
MATERIALS AND METHODS
Of the patients over 65 years of age that had been treated between June 1999 and June 2007, two hundred forty patients, who were available for follow-up for at least 1 year were selected. Patients were divided into 2 groups, A or B, based on their time of operation during a 4-year period. Age, bone marrow density (BMD), causes of fracture, fracture patterns, and treatment trends were analyzed.
RESULTS
The number of patients in group A was 108 and in group B was 132; the mean age was 75.38 years and 77.58 years, retrospectively with the mean age increased by 2.2 years. In group A, 44 cases (40%) were comminuted fractures over AO type A2-2, 77 cases (71%) were unstable fracture using Evans classification; in group B, there were 65 cases (49%) and 100 cases (76%), respectively. Based on the BMD analysis, an average -0.29 decreased in group B. In group A, 61 cases (56%) were treated with compressive hip screw, 41 cases (38%) with proximal femoral nail , 6 cases (6%) with bipolar hemiarthroplasty. In group B, 48 cases (36%) were treated with compressive hip screw, 73cases (55%) with proximal femoral nail, and 11 cases (9%) with bipolar hemiarthroplasty.
CONCLUSION
There were increases in patient age, percentages of unstable fractures, fracture comminution and decrease in bone marrow density. The use of proximal femoral nail or primary arthroplasty increased.

Keyword

femur; intertrochanteric fracture; operative treatment

MeSH Terms

Arthroplasty
Bone Marrow
Femur
Follow-Up Studies
Fractures, Comminuted
Hemiarthroplasty
Hip
Hip Fractures
Humans
Nails
Retrospective Studies

Figure

• 

  Figure 1 Changes in age of patients.

• 

  Figure 2 Changes in operation method.

Reference

1. Population profections for Korea(2000-2050). 2001. Vital statistics division of Korea national statistical office.

2. Kyle RF. Fractures of the proximal part of the femur. J Bone Joint Surg Am. 1994. 76:924–950.

3. Dávid A, von der Heyde D, Pommer A. Therapeutic possibilities in trochanteric fractures. Safe--fast--stable. Orthopade. 2000. 29:294–301.

4. Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies. Instr Course Lect. 2004. 53:441–454.

5. Yoon HK, Cho DY, Shin DE, Kang SH. Comparison of functional recovery between internal fixation and hemiarthroplasty in basal intertrochanteric fracture in the over eighties. J Korean Orthop Assoc. 2004. 39:115–122.

6. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987. 40:373–383.

7. Herrera A, Domingo LJ, Calvo A, Martínez A, Cuenca J. A comparative study of trochanteric fractures treated with the Gamma nail or the proximal femoral nail. Int Orthop. 2002. 26:365–369.

8. Saudan M, Lübbeke A, Sadowski C, Riand N, Stern R, Hoffmeyer P. Pertrochanteric fractures: is there an advantage to an intramedullary nail: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma. 2002. 16:386–393.

9. Yoo MC, Ahn JW, Kum SJ, Oh CJ. Clinical analysis for prognostic factors of intertrochanteric fractures. J Korean Orthop Assoc. 1989. 24:776–785.

10. Riggs BL, Melton LJ 3rd. Evidence for two distinct syndromes of involutional osteoporosis. Am J Med. 1983. 75:899–901.

11. Friedl W, Clausen J. Experimental examination for optimized stabilisation of trochanteric femur fractures, intra- or extramedullary implant localisation and influence of femur neck component profile on cut-out risk. Chirurg. 2001. 72:1344–1352.

12. Loch DA, Kyle RF, Bechtold JE, Kane M, Anderson K, Sherman RE. Forces required to initiate sliding in second-generation intramedullary nails. J Bone Joint Surg Am. 1998. 80:1626–1631.

13. Nuber S, Schönweiss T, Rüter A. Stabilisation of unstable trochanteric femoral fractures. Dynamic hip screw (DHS) with trochanteric stabilisation plate vs. proximal femur nail (PFN). Unfallchirurg. 2003. 106:39–47.

14. Fracture and dislocation compendium. Orthopaedic trauma association committee for coding and classification. J Orthop Trauma. 1996. 10:Suppl 1. v–ix. 1–154.

15. Hwang DS, Jung HT, Kim SB, Kim JS. Recovery of walking ability after operation for unstable intertrochanteric fractures of the femur in elderly. -Timing on weight bearing-. J Korean Soc Fract. 1998. 11:296–303.

16. Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br. 1991. 73:330–334.

17. Gundle R, Gargan MF, Simpson AH. How to minimize failures of fixation of unstable intertrochanteric fractures. Injury. 1995. 26:611–614.

18. Boldin C, Seibert FJ, Fankhauser F, Peicha G, Grechenig W, Szyszkowitz R. The proximal femoral nail (PFN)--a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand. 2003. 74:53–58.

19. Hardy DC, Descamps PY, Krallis P, et al. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg Am. 1998. 80:618–630.

20. Anglen JO, Weinstein JN. American Board of Orthopaedic Surgery Research Committee. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American board of orthopaedic surgery database. J Bone Joint Surg Am. 2008. 90:700–707.