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KMID : 1207720180100030292
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Clinics in Orthopedic Surgery
2018 Volume.10 No. 3 p.292 ~ p.298
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The Effect of Positive Medial Cortical Support in Reduction of Pertrochanteric Fractures with Posteromedial Wall Defect Using a Dynamic Hip Screw
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Cho Myung-Rae
Lee Jae-Hyuk
Kwon Jai-Bum
Do Jung-Suk
Chae Seung-Bum
Choi Won-Kee
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Abstract
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Background: We evaluated the radiological and clinical results of reduction using a dynamic hip screw according to the grade of medial cortical support in patients with AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification type 31-A2 pertrochanteric fractures.
Methods: We enrolled 100 patients with AO/OTA type 31-A2 fractures with displaced lesser trochanter fragments (length of the cortical area longer than 20 mm on the pelvis anteroposterior view). Patients with positive medial cortical support were assigned to group 1 (n = 28); neutral medial cortical support, group 2 (n = 42); and negative medial cortical support, group 3 (n = 30). Radiological evaluation was done by measuring the change in the femoral neck-shaft angle and sliding distance of the lag screw. Clinical outcomes of each group were compared by means of the walking ability score proposed by Ceder.
Results: Group 1 showed significantly less changes in the femoral neck-shaft angle and shorter sliding distance than groups 2 and 3. Group 2 showed significantly less changes in the femoral neck-shaft angle and shorter sliding distance than group 3. Group 1 showed significantly higher walking ability scores than group 3 (p = 0.00). The use of trochanter stabilizing plates or fixation using wires for posteromedial wall defect resulted in no significant changes in terms of the femoral neck-shaft angle or sliding distance.
Conclusions: In the treatment of pertrochanteric fractures accompanied by posteromedial wall defect using a dynamic hip screw, reduction with negative cortical support should be avoided.
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KEYWORD
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AO/OTA 31-A2, Dynamic hip screw, Medial cortical support
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