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KMID : 0361620050400070935
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Journal of the Korean Orthopaedic Association
2005 Volume.40 No. 7 p.935 ~ p.941
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The Role of Lateral Buttress in Treatment of Jensen type 4 Intertrochanteric Fractures of the Femur using Dynamic Compression Hip Screw in the Elderly
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Kim Yong-Sik
Kwon Soon-Yong
Han Suk-Ku
Choi Woo-Hyuk
Choi Nam-Yong
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Abstract
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Purpose: To investigate the effect of lateral buttress on the fracture healing of Jensen type 4 intertrochanteric fracture of the femur treated by dynamic compression hip screw (DCS) in elderly patients, retrospectively.
Materials and Methods: From March 1999 to February 2003, 54 patients, older than 65 years, of Jensen type 4 intertrochanteric fractures of the femur treated by DCS were included. The relationship between the structual integrity of lateral buttress measured by proximal-medial fragment angle (PMFA) and postoperative neck-shaft angle, penetrating length of lag screw, the sliding length and incidence of fixation loss were evaluated.
Results: Among 38 patients of group II (PMFA above 50 degree), 6 cases (15.8%) including 4 cases of cutting out of lag screw from femoral head, 1 case of nonunion and 1 case of excessive extrusion of lag screw failed radiologically. But there was no fixation loss case in 16 cases of group I (PMFA 50 and below 50). The neck-shaft angle in last follow-up was 138.1 degree in group I and 132.1 in group II. The sliding length of lag screw was 7.0 mm in group I and 12. 5 mm in group II (p<0.05).
Conclusion: Preoperative evaluation of intactness of lateral buttress measured by proximal-medial fragmentary angle is an useful method in treatment of Jensen type 4 intertrochanteric fractures treated by DCS in elderly patients.
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KEYWORD
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Femur, Intertrochanteric fracture, Jensen type 4, Dynamic compression screw, Lateral buttress, Proximal-medial fragmentary angle
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