UNSTABLE INTERTROCHANTERIC FRACTURES: OUR EXPERIENCE WITH INTRAMEDULLARY SLIDING HIP SCREW

Abstract

Background: Hip fractures are common among the aged population, with high mortality and morbidity rates. It ‘s annual cost in the United States is expected to double by the year 2040 to about 16 billion U.S Dollars. Of those, approximately 50% are inter-trochanteric fractures. Among them, 50 to 60% are categorized as unstable fractures. Unstable intertrochanteric fractures are defined as 1) fractures with comminution of the posteromedial buttress which exceeds a simple lesser trochanteric fragment; 2) fractures with evidence of subtrochanteric fracture lines; and 3) reverse oblique fractures of the femoral neck. Review of the literature reveals large variations in the amount of complications after surgical treatment of unstable intertrochanteric fractures, among various medial institutes. Infection rates winds from fewer than 1% and up to 15% of cases, and reports of cutout events range from % to 20%. Other complications, such as non-unioin, femoral shaft fractures, and painful hardware, are much less common.

Purpose: To investigate the rate of complications after surgical treatment of unstable inter-trochanteric fractures, in our department.

Method: Retrospective review of 61 patients who were admitted in our department due to unstable intertro-chanteric fractures, after simple falls, between May 2001 to August 2006, and were treated with intramedullary sliding hip screw. Most of the hardware (90%) were A.O nails (PFN, proximal femoral nail).

Results: There were 4 cases of infections, which are 4.9% of cases. Three of them required removal of the hardware. One admission was due to superficial surgical wound infection. There were 3 cases of mechanical cutout of the femoral head screw, which are 6.5% of the cases. No cases of non-union, femoral shaft fractures, or painful hard are noted.

Conclusions: To our experience, intramedullary sliding hip screw is a safe and effective treatment for unstable intertrochanteric fractures. Complication rates to our experience are at the lower third compared to reports from medical institutes over the world.