In old age, trochanteric fracture occurs easily by trivial external force due to osteoporosis and many kinds of treatment has been performed. But the aims of surgery focused on obtaining rigid fixation that will permit the patients to be mobile
and
ambulatory within a short period to obviate the harzard of recumbency. A retrospective study was performed on 57 trochanteric fracture patients who were treated by closed reduction and internal fixation and followed more than one year from
January
1986
to May 1991.
The result of this retrospective study were analyzed. According to Tronzo and AO classification, Tronzo type 3(47%) and A2(40%) was most common and 18 cases were stable fracture, and 39 cases were unstable ones by Evans classification.
As the fixation devices, compression hip screw was used in 45 cases, condylar plate in 4, reconstruction nail in 3, primary bipolar arthroplasty in 4 and Judet plate in 1. Primary bipolar arthroplasty was done in four patient who had unstable
comminuted
intertrochanteric fracture with poor bone quality, and Methymetacrylate augmentation was performed in seven patients whom rigid fixation was not possible.
Of the reduction states, anatomical reduction were carried out in 34 cases, valgus in 9cases, varus in 5 cases, medialization in 6 cases. The bone quality were evaluated by the femoral trabecular pattern accord to the method of the method of
Singh
et.
al. and cortical shaft index. Fifty percent of patients had poor bone quality below grade III of Singh index (Mean value of Singh index was grade IV and mean value of cortical shaft index was 0.38). There were complication of pin penetration of
neck in
6 patients(Knowles pin in 5) and screw loosening in 3 cases, coxa valga in 1, coxa vara in 2, gross leg length discrepancy in 1 case, overall complication rate was 23 percent. Reoperation was done in 2 cases of lag screw penetration of neck and
fixation
due to screw loosening.
The patients who were treated by Methymetacrylate supplementation as a adjunct for internal fixation showed the satisfactory results without any complication and early weight bearing and rapid rehabilitation was possible.
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