The principle of treatment of intertrochanteric fractures in elderly patient is to return the patient to his activity at prefracture state as soon as possible because early mobilization helps to prevent skin ulceration, pneumonia, thrombo-embolic disease and other complications which develop in confinement to bed in the elderly people.
For these reasons, it is generally accepted that trochanteric fractures are best treated by internal fixation allowing early mobilization.
There are various methods of internal fixation, Jewett nail and compression hip screw etc.
Condylocephalic nail was introduced and used widely, esp. in elderly patient to decrease postoperative mortality and morbidity because of it´s shorter operation time, minor blood loss and minimal operation trauma.
43 cases of intertrochanteric fractrres of the femur were treated at department of orthopaedic surgery in Chungnam National University Hospital from January 1980 to April 1985 and were analysed clinically. The results were as follows:
1. Of 43 cases, 26 cases were males and 17 cases were females. The average age was 61-years old. 26 cases were sixth decade.
2. The most common causes of the fracture were slipping ana falling down.
3. In the classification of the fracture, Boyd and Griffin Type Ⅱ and Tronzo Type Ⅲ were most common.
4. The average operation times were 90 minutes in Jewett nail, 104 minutes in Compression hip screw, 60 minutes in Multiple pinning and 50 minutes in Ender nail and the average blood loss was 210 ml.
5. The mean duration of bony union were 16 weeks in conservative treatment, 13.4 weeks in Jewett nail without medial displacement, 15 weeks if Jewett nail with(medial displacement, 13.2 weeks in Compression. hip screw without medial displacement, 14 weeks in Compression hip screw with medial displacement, 15.3 weeks in Multiple pinning and 15.8 weeks in 3 cases of Ender nail which had been followed up. In Ender nail, results are following up now.
6. In the view of complications, there were 1 case of urinary tract infection and 2 cases of bed sore in the conservative treatment group, 1 case of wound infection and 1 case of metal failure in Jewett nail and 1 case of wound infection, 1 case of femoral head Penetration by the nail and 2 cases of knee joint pain and stiffness in Ender nail.
The Ender nails seems to be a excellent and promising method of treatment in elderly patients, especially with high surgical risk because of its shorter operation time, minor blood loss and minimal surgical trauma.
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