Chinese Journal of Tissue Engineering Research ›› 2010, Vol. 14 ›› Issue (39): 7291-7294.doi: 10.3969/j.issn.1673-8225.2010.39.017

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Dynamic hip screw fixation for intertrochanteric fracture in 110 osteoporotic patients

Meng Yong1, Xin Xiao-tang1, Jiang Peng2, Lan Hai1, Yu Yong-lin1   

  1. 1 Department of Orthopedics, 2 Department of Respiration, Weihai Municipal Hospital, Weihai  264200, Shandong Province, China
  • Online:2010-09-24 Published:2010-09-24
  • Contact: Xin Xiao-tang, Associate professor, Department of Orthopedics, Weihai Municipal Hospital, Weihai 264200, Shandong Province, China linfeng2194@yahoo.com.cn
  • About author:Meng Yong★, Studying for master’s degree, Attending physician, Department of Orthopedics, Weihai Municipal Hospital, Weihai 264200, Shandong Province, China masonmed@yahoo.cn

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Abstract:

BACKGROUND: Dynamic hip screw is the most widely used device for intertrochanteric fractures but in the patients with osteoporosis there are high risks of lag screw cut-out from the femoral head, resulting operation failure.
OBJECTIVE: To evaluate the risk factors leading to the failure of dynamic hip screw fixation for senile intertrochanteric fracture with various osteoporosis. 
METHODS: A total of 127 osteoporotic patients with an intertrochanteric fracture were treated with a 135° sliding compression hip screw. 110 patients with complete data were retrospectively analyzed. The fractures were classified on preoperative radiographs according to the Evens classification system. The bone quality was classified by Singh rating system. Tip-apix distance (TAD) was used to assess the position of placement of lag screw. Five possible factors (age, Singh's index, reduction states, type of fractures, implant placement) were analyzed using t-test and Chi-square test.
RESULTS AND CONCLUSION: All cases were followed up for 3 to 24 months, and 16 cases got fixation failure. The average age of failed cases were 77.5 years (63-88 years, 8.5 older than the cured group (P=0.03). The difference between the degree of osteoporosis and the magnitude of TAD was significant (P=0.01) Stable fracture was of significance for operation success (P < 0.05). There was no significance between the two groups in anatomical reduction or functional reduction (P=0.31). Results showed that age, Singh's index, reduction states, type of fractures, implant placement had statistical relations to the failure of dynamic hip screw fixation. Functional reduction did not increase the risk of internal fixation. Dynamic hip screw is not the first choice for the elder cases of unstable fractures combined with severe osteoporosis. As for the application of dynamic hip screw fixation, the TAD value should be not higher than 25 mm for the general patients. It might be inadvisable to overemphasize anatomical reduction, but an anatomical reduction with posteromedial apposition is necessary.

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