Hip & pelvis

The Korean Hip Society (대한고관절학회)
권호 표지

Effect of a Trochanter-stabilizing Plate in Unstable Intertrochanteric Fractures - A Clinical and Biomechanical Study -

대퇴골 전자간 불안정 골절에서 전자부 안정화 금속판의 유용성 - 임상적과 생역학적 연구 -

  • Kim, Tae-Ho (Department of Orthopedic Surgery, Mokdong Hospital, Ewha Woman’s University, School of Medicine) ;
  • Kim, Jong-Oh (Department of Orthopedic Surgery, Mokdong Hospital, Ewha Woman’s University, School of Medicine) ;
  • Seo, Jeong-Ho (Department of Orthopedic Surgery, Mokdong Hospital, Ewha Woman’s University, School of Medicine)
  • 김태호 (이화여자대학교 의학전문대학원 목동병원 정형외과) ;
  • 김종오 (이화여자대학교 의학전문대학원 목동병원 정형외과) ;
  • 서정호 (이화여자대학교 의학전문대학원 목동병원 정형외과)
  • Published : 2009.06.30

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Abstract

Purpose: To evaluate the effectiveness of a trochanter-stabilizing plate (TSP) for the treatment of unstable intertrochanteric fractures. Materials and Methods: In the clinical aspect of the study, 48 patients who were treated surgically for unstable intertrochanteric fractures were evaluated. One group of patients was treated with CHS [spell out with 1st use] only (group 1, n=23) and the other group was treated with CHS and TSP (group 2, n=25). In the biomechanical aspect of the study, an AO type A2.2 intertrochanteric fracture was reproduced in 10 proximal femur models. Five models were reduced and fixed using CHS only (group 1) and 5 models were fixed using CHS with TSP (group 2). A load of 750 N (300 cycles) was applied using Instron. Results: In the clinical aspect of the study, the extent of lag screw sliding, greater trochanter lateralization, and neck-shaft angle varus change was less in group 2 than in group 1. In the biomechanical aspect of the study, the extent of lag screw sliding was less in group 2 than in group 1, but the neck-shaft angle varus change was greater in group 2 than in group 1. Conclusion: The use of TSP is effective for the buttress effect on the proximal fragment. It decreases the excessive sliding of the lag screw, lateral displacement of the greater trochanter, and neck-shaft angle varus change. Therefore, TSP may be a useful treatment for unstable intertrochanteric fractures.

목적: 대퇴골 전자간 불안정 골절시 임상적 그리고 생역학적 연구를 통해 전자부 안정화 금속판(TSP)의 유용성을 알아보고자 한다. 대상 및 방법: 임상적 연구로 2003년 1월부터 2007년 6월까지 전자간 불안정 골절로 수술 받은 환자 중 6개월 이상 추시 가능했던 48예에 대해 CHS만으로 치료한 군(1군)과 TSP을 추가한 군(2군)으로 나누어, 이 두 군을 임상적 그리고 방사선학적으로 비교 분석하였다. 생역학적 연구로 10개의 근위 대퇴 인조골에 AO type A22 불안정 전자간 골절을 재현하여 두 군으로 나눈 뒤, 제1군에서는 CHS만으로 제 2군에서는 TSP를 추가하여 고정하였다. Instron 3366으로 750 N의 주기적 부하를 300회 가한 후 방사선학적으로 분석하였다. 결과: 임상적 연구에서 방사선학적 분석상 2군에서 지연 나사의 활강 정도, 대전자의 외측 이동과 대퇴 경간각 감소가 유의하게 적었다. 생역학적 연구에서 지연나사의 활강은 2군에서 유의하게 적었으나 대퇴 경간각의 감소는 2군에서 많았다. 결론: 대퇴골 전자간 불안정 골절에 있어서 전자부 안정화 금속판은 대전자부에 대한 지지가 가능하므로 지연 나사의 활강 정도와 대전자부의 외측 이동과 대퇴 경간각 감소를 줄일 수 있어 유용한 치료법이라 사료된다.

Keywords

References

  1. Aune AK, Ekeland A, Odegaard B, Grogaard B, Alho A. Gamma nail vs. compression screw for trochanteric femoral fractures. 15 reoperation in a prospective, randomized study of 378 patients. Acta Orthop Scand, 65: 127-130, 1994. https://doi.org/10.3109/17453679408995418
  2. Babst R, Renner N, Biedermann M, et al. Clinical results using the trochanteric stabilizing plate(TSP): The modular extension of the dynamic hip screw(DHS) for internal fixation of selected unstable intertrochanteric fractures: J Orthop Trauma, 12: 392-399, 1998. https://doi.org/10.1097/00005131-199808000-00005
  3. Broos PL, Romments PM, Deleyn PR, Green VR, Stappaerts K. Peritrochanteric fractures in the elderly: are there indication for primary prosthetic replacement- J Orthop Trauma, 5: 446-451, 1991. https://doi.org/10.1097/00005131-199112000-00010
  4. Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop Relat Res, 348: 87-94, 1998.
  5. Buciuto R, Uhlin B, Hammerby S, Hammer R. RAB-plate vs Richards CHS plate for unstable trochanteric hip fractures. Acta Orthop Scand, 69: 25-28, 1998. https://doi.org/10.3109/17453679809002350
  6. Doppelt SH. The sliding compression screw-today's best answer for stabilization of intertrochanteric hip fractures. J Orthop Trauma, 7: 348-353, 1980. https://doi.org/10.1097/00005131-199308000-00011
  7. 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, 80: 618-630, 1998.
  8. Koval KJ, Cantu RV. Intertrochanteric fractures. In: Rookwood CA Jr, Green DP, eds. Fractures in adults. 6th ed, Philadelphia, JB Lippincott: 1793-1825, 2006.
  9. Loch DA, Kyle RF, Bechtold JE, Kane M, Anderson K, Sherman RE. Forces required to initiate sliding in secondgeneration intramedullary nails. J Bone Joint Surg, 80-A: 1626-1631, 1998.
  10. Lunsjo K, Ceder L, Stigsson L, Hauggaard L. One-way compression alone the femoral shaft with the Medoff sliding plate. Acta Orthop Scand, 66: 343-346, 1995. https://doi.org/10.3109/17453679508995558
  11. Madsen JE, Naess L, Aune AK, et al. Dynamic hip screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the gamma nail and compression hip screw. J Orthop Truama, 12: 241-248, 1998. https://doi.org/10.1097/00005131-199805000-00005
  12. Muller ME, Nazarian S. Classification et documentation aoedes fractures femur. Rev Chir Orthop, 67: 297, 1981.
  13. Nakata. K, Ohzono.K, Hiroshima K, Toge K. Serial change of sliding in intertrochanteric femoral fractures treated with sliding screw system. Arch Orthop Trauma Surg, 113: 276-280, 1994. https://doi.org/10.1007/BF00443817
  14. Osnes EK, Lofthus CM, Falch JA, et al. More postoperative femoral fractures with the Gamma nail than the sliding screw plate in the treatment of trochanteric fractures. Acta Orthop Scand, 72: 252-256, 2001. https://doi.org/10.1080/00016470152846574
  15. Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures. Cochrane Database Syst Rev, 1: CD000093, 2004.
  16. Rha JD, Kim YH, Yoon SI, Park TS, Lee MH. Factors affecting sliding of the lag screw in intertrochanteric fractures. Int Orthop, 17: 320-324, 1993.
  17. Sernbo I, Johnell O, Gardsell A. Locking and compression of the lag screw in trochanteric fractures is not beneficial. Acta Orthop Scand, 65(1): 24-26, 1994. https://doi.org/10.3109/17453679408993712
  18. Steinberg GG, Desai SS, Kornwitz AA, Sullivan TJ. The intertrochanteric hip fracture: A prospective analysis. Orthopedics, 11: 265-273, 1988.
  19. Su ET, Dewal H, Kummer FJ, Koval KJ. The effect of an attachable lateral support plate on the stability of intertrochanteric fracture fixation with a sliding hip screw. J Orthop Trauma,55: 504-508, 2003.
  20. Whitelaw GP, Segal D, Sanzone CF, Ober NS, Hadley N. Unstable Intertrochanteric/Subtrochanteric Fractures of the Femur. Clin Orthop, 252: 238-245, 1990.