Hip & pelvis

The Korean Hip Society (대한고관절학회)
권호 표지

Treatment of Intertrochanteric Fractures in Patients with Severe Osteoporosis with Dynamic Compression Hip Screws

심한 골다공증 환자에서 압박 고 나사 금속판을 이용한 대퇴 전자간 골절의 치료

  • Kim, Yong-Sik (Department of Orthopedic Surgery, Kangnam St. Mary’s Hospital, The Catholic University of Korea) ;
  • Kwon, Soon-Yong (Department of Orthopedic Surgery, St. Mary’s Hospital, The Catholic University of Korea) ;
  • Lee, Yoon-Min (Department of Orthopedic Surgery, St. Paul’s Hospital, The Catholic University of Korea) ;
  • Han, Suk-Ku (Department of Orthopedic Surgery, St. Paul’s Hospital, The Catholic University of Korea)
  • 김용식 (가톨릭대학교 의과대학 강남성모병원 정형외과) ;
  • 권순용 (가톨릭대학교 의과대학 성모병원 정형외과) ;
  • 이윤민 (가톨릭대학교 의과대학 성바오로병원 정형외과) ;
  • 한석구 (가톨릭대학교 의과대학 성바오로병원 정형외과)
  • Published : 2009.03.31

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Abstract

Purpose: The purpose of this study was to compare the clinical results in the treatment of femoral intertrochanteric fractures with dynamic compression hip screws (DHS) in patients with or without osteoporosis. Materials and Methods: Between March 2003 and February 2006, the clinical results in the treatment of intertrochanteric fractures of the femur with DHS in patients with severe osteoporosis (T score<-4.0 at the femoral neck by DXA; 56 patients [group 1]) and in non-osteoporotic patients (T score>-2.5; 46 patients [group 2]) were reviewed. We retrospectively compared the mortality rate, the incidence of postoperative complications or fixation failures, and the patterns between the two groups. Results: The mortality rate in group 1 was 30.4% at postoperative 1 year and 21.4% at 6 months. The mortality rate at 1 year was 21.8% in group 2 (p<0.05). There were no differences in fracture patterns according to the AO/OTA classification between the two groups. However, the incidence of fixation failures were 19.6% in group 1 vs. 13.0% in group 2 (p<0.05). Conclusion: There was a higher postoperative mortality rate at 1 year (30.4% vs. 21.4%), and the incidence of fixation failures (19.6% vs. 13.0%) in the treatment of osteoporotic intertrochanteric fractures by DHS in osteoporotic compared to non-osteoporotic fractures.

목적: 골다공증이 심한 대퇴 전자간 골절환자를 압박 고 나사 금속판으로 치료 후 임상적 결과를 관찰하고자 한다. 대상 및 방법: 2003년 3월부터 2006년 2월까지 압박 고 나사 금속판으로 수술한 대퇴 전자간 골절환자 중 건측 대퇴 경부의 골밀도 검사에서 T score가 -4.0 이상인 환자 56명과 T score가 -2.5 미만인 46명의 대조군과 임상적 결과를 비교하였다. 두 군간의 사망율, 술 후 전신적 합병증 및 고정실패 빈도와 유형을 후향적으로 비교하였다. 결과: 술 후 1년이내 사망한 환자는 제 1군이 17명(30.4%)이었으며 이 중 12명(21.4%)이 술 후 6개월이내 사망하였고, 제 2군은 10명(21.8%)이 술 후 1년이내 사망하였다(p<0.05). 방사선적으로 골절형태는 두 군간 AO/OTA 분류상 차이가 없었고, 고정실패는 제 1군에서 11예(19.6%)가 발생하였으며, 제 2군은 6예(13.0%)가 발생하였다(p<0.05). 결론: 골다공증이 심한 대퇴 전자간 골절환자에서 압박 고 나사 금속판의 치료결과 대조군에 비해 술 후 의미있게 높은 사망률(30.4%:21.4%)과 고정실패(19.6%:13.0%)가 발생하였다.

Keywords

References

  1. Aharonoff GB, Koval KJ, Skovron ML, Zuckerman JD: Hip fractures in the elderly: predictors of one year mortality. J Orthop Trauma, 11: 162-165, 1997. https://doi.org/10.1097/00005131-199704000-00004
  2. Barrios C, Brostrom LA, Stark A, Walheim G: Healing complications after internal fixation of trochanteric hip fractures: the progrnostic value of osteoporosis. J Orthop Trauma, 7: 438-442, 1993. https://doi.org/10.1097/00005131-199310000-00006
  3. Bartucci EJ, Gonzalez MH, Cooperman DR, et al.: The effect of adjunctive methylmethacrylate on failures of fixation and function in patients with intertrochanteric fractures and osteoporosis. J Bone Joint Surg, 67-A: 1094-1107, 1985.
  4. Baumgartner MR, Curtin SL, Lindskog DM, Keggi JM: The value of tip-apex distance in predicting failure of fixation of pertrochanteric fractures of the hip. J Bone Joint Surg, 77-A: 1058-1064, 1995.
  5. Bonnare F, Zenker H, Lill C, Weber AT, Linke B: Treatment stratigies for proximal femur fractures in osteoporotic patients. Osteoporosis Int, 16: S93-S102, 2005. https://doi.org/10.1007/s00198-004-1746-7
  6. Bonnare F, Weber A, Bosl O, Eckhardt C, Schwieqer K, Linke B: "Cutting out"in pertrochanteric fractures-problem of osteoporosis? Unfallchirurg, 110: 425-432, 2007. https://doi.org/10.1007/s00113-007-1248-0
  7. Bramlet DG: Use of the talon hip compression screw in intertrochanteric fractures of the hip. Clin Orthop Relat Res, 425: 93-100, 2004. https://doi.org/10.1097/01.blo.0000132628.90667.e6
  8. Broos PL, Rommens PM, Deleyn PR, Greens VR, Stappaerts KH: Pertrochanteric fractures in the elderly: are there indications for primary prosthetic replacement ? J Orthop Trauma, 5: 446-451, 1991. https://doi.org/10.1097/00005131-199112000-00010
  9. Choueka J, Koval KJ, Kummer FJ, Zuckerman JD: Cement augmentation of intertrochanteric fracture fixation. Acta Orthop Scand, 67: 153-157, 1996. https://doi.org/10.3109/17453679608994661
  10. Cornwall R, Gilbert MS, Koval KJ, Strauss E, Siu AL: Functional outcomes and mortality vary among different types of hip fractures. Clin Orthop Relat Res, 425: 64-71, 2004. https://doi.org/10.1097/01.blo.0000132406.37763.b3
  11. Cranney A, Jamal SA, Tsang JF, Josse RG, Leslie WD: Low bone mineral density and fracture burden in postmenopausal women. CMAJ, 177: 575-580, 2007. https://doi.org/10.1503/cmaj.070234
  12. Gardner MJ, Flik KR, Mooar P, Lane JM: Improvement in the undertreatment of ostoeporosis following hip fractures. J Bone Joint Surg, 84-A: 1342-1348, 2002.
  13. Godfried Y: The lateral trochanteric wall. Clin Orthop Relat Res, 425: 82-86, 2004. https://doi.org/10.1097/01.blo.0000132264.14046.c2
  14. Ha YC, Kim SR, Koo KH, et al.: An epidemiological study of hip fracture in Jeju island, Korea. J Korean Orthop Assoc, 39: 131-136, 2004.
  15. Ishida Y, Kawai S, Taguchi T: Factors affecting ambulatory status and survival of patients 90 years and older with hip fractures. Clin Orthop Relat Res, 436: 208-215, 2005.
  16. Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E: FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int, 19: 385-397, 2008. https://doi.org/10.1007/s00198-007-0543-5
  17. Kim WY, Han CH, Park JI, Kim JY: Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop, 25: 360-362, 2001. https://doi.org/10.1007/s002640100287
  18. Kim YS, Kwon SY, Han SK, Sung BY, Choi NY: Factors affecting fixation failure in treatment of intertrochanteric fracture of the femur by dynamic compression hip screw. J Korean Hip Soc, 20: 19-26, 2008.
  19. Koval KJ, Aharonoff GB, Rokito AS, Lyon T, Zuckerman JD: Patients with femoral neck and intertrochanteric fractures. Are they same? Clin Orthop Relat Res, 330: 166-172, 1996. https://doi.org/10.1097/00003086-199609000-00020
  20. Koval KJ, Sala DA, Kummer FJ, Zuckerman JD: Postoperative weight-bearing after a fracture of the femoral neck or an intertrochanteric fracture. J Bone Joint Surg, 80-A: 352-356, 1998.
  21. Koval KJ, Skovron ML, Aharonoff GB, Meadows SE, Zuckerman JD: Ambulatory ability after hip fracture. A prospective study in geriatric patients. Clin Orthop Relat Res, 310: 150-159, 1995.
  22. Laros GS, Moore JF: Complications of fixation intertrochanteric fractures. Clin Orthop Relat Res, 110-119, 1974.
  23. Lorich DG, Geller DS, Nielson JH: Osteoporotic pertrochanteric hip fractures. Management and current controversies. Instr Course Lect, 53: 441-454, 2004.
  24. Morin S, Rahme E, Behlouli H, Tenenhouse A, Goltzman D, Pilote L: Effectiveness of antiresorptive agents in the prevention of recurrent hip fractures. Osteoporos Int, 18: 1625-1632, 2007. https://doi.org/10.1007/s00198-007-0421-1
  25. Moroni A, Faldini C, Pegreffi F, Giannini S: HA-coated screws decrease the incidence of fixation failure in osteoporotic trochanteric fractures. Clin Orthop Relat Res, 425: 87-92, 2004. https://doi.org/10.1097/01.blo.0000132405.30139.bb
  26. Moroni A, Faldini C, Hoang-Kim A, Pegreffi F, Giannini S: Alendronate improves screw fixation in osteoporotic bone. J Bone Joint Surg, 89-A: 96-101, 2007.
  27. Schott AM, Dargent-Molina P, Meunier PJ: The effect of risedronate on the risk of hip fracture in elderly women. N Engl J Med, 344: 1721, 2001. https://doi.org/10.1056/NEJM200105313442215
  28. Stern R: Are there advances in the treatment of extracapsular hip fractures in the elderly? Injury, 38S3: S77-S87, 2007. https://doi.org/10.1016/S0020-1383(07)80012-X