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以動態髁螺釘治療不穩定股骨轉子下骨折
Other Title
Surgical treatment of unstable subtrochanteric fracture with dynamic condylar screw
Type
article
Date Issued
2009
Author(s)
Subjects
萬芳醫院
科部：骨科
類別：期刊論文
Abstract
【Introduction】
The management of unstable subtrochanteric fracture is challenging to each
orthopaedic surgeon. There was a controversy over the choice of implants
between intra-medullary or extra-medullary devices. This topic presented our
prospective series with unstable subtrochanteric fractures treated with
dynamic condylar screws (DCS).
【Materials and Methods】
From 2003 through 2008, 118 peritrochanteric fractures were treated
surgically by one surgeon. Twenty of them using DCS under indication of
Seinsheimer classification (for subtrochanteric fractures) type IIC, III, IV, and
V . Fracture union by serial X-ray evaluation was made monthly, and change
of neck-shaft angle and medial migration were also estimated. Functional
tests with Harris hip score were also evaluated.
【Results】
Eighteen of the 20 patients were followed for an average of 35.1 months
(range 8-58 months). Functional outcome was excellent (>90 points) in 13
(13/18), good (80-99 points) in 2 (2/18), and fair (70-79 points) in 3(3/18).
The primary union rate was 94% (17/18) in 12 weeks, and implants failure
rate was 6% (1/18) which received revised surgery. Superficial wound
infection was noted in one case.
【Discussion】
Unstable subtrochanteric fractures are difficult to treat due to high
compression and tension force in the medial cortex with high failure rate of
internal fixation. The most common devices for internal fixation include
intra-medullar nail (IM nail), trochanteric stabilized plate (THS), and DCS.
Dynamic hip screw had obviously higher failure rate and wasn't suggested in
such fracture type. Although IM nail showed better then DCS in
biomechanical studies, literature review showed great variation of results,
and no large randomized control trial comparing available. There is some
limitation of IM nail, including severe comminuting with intertrochanteric
The management of unstable subtrochanteric fracture is challenging to each
orthopaedic surgeon. There was a controversy over the choice of implants
between intra-medullary or extra-medullary devices. This topic presented our
prospective series with unstable subtrochanteric fractures treated with
dynamic condylar screws (DCS).
【Materials and Methods】
From 2003 through 2008, 118 peritrochanteric fractures were treated
surgically by one surgeon. Twenty of them using DCS under indication of
Seinsheimer classification (for subtrochanteric fractures) type IIC, III, IV, and
V . Fracture union by serial X-ray evaluation was made monthly, and change
of neck-shaft angle and medial migration were also estimated. Functional
tests with Harris hip score were also evaluated.
【Results】
Eighteen of the 20 patients were followed for an average of 35.1 months
(range 8-58 months). Functional outcome was excellent (>90 points) in 13
(13/18), good (80-99 points) in 2 (2/18), and fair (70-79 points) in 3(3/18).
The primary union rate was 94% (17/18) in 12 weeks, and implants failure
rate was 6% (1/18) which received revised surgery. Superficial wound
infection was noted in one case.
【Discussion】
Unstable subtrochanteric fractures are difficult to treat due to high
compression and tension force in the medial cortex with high failure rate of
internal fixation. The most common devices for internal fixation include
intra-medullar nail (IM nail), trochanteric stabilized plate (THS), and DCS.
Dynamic hip screw had obviously higher failure rate and wasn't suggested in
such fracture type. Although IM nail showed better then DCS in
biomechanical studies, literature review showed great variation of results,
and no large randomized control trial comparing available. There is some
limitation of IM nail, including severe comminuting with intertrochanteric