The Effect of Positive Medial Cortical Support in Reduction of Pertrochanteric Fractures with Posteromedial Wall Defect Using a Dynamic Hip Screw

• Published in: Clinics in orthopedic surgery Vol. 10; no. 3; pp. 292 - 298
• Main Authors: Cho, Myung Rae, Lee, Jae Hyuk, Kwon, Jai Bum, Do, Jung Suk, Chae, Seung Bum, Choi, Won-Kee
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Orthopaedic Association 01.09.2018; 대한정형외과학회
• Subjects: Aged; Aged, 80 and over; Bone Screws; Female; Femoral Neck Fractures - diagnostic imaging; Femoral Neck Fractures - surgery; Femur Neck - diagnostic imaging; Femur Neck - surgery; Humans; Male; Original; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - instrumentation; Reconstructive Surgical Procedures - methods; Reconstructive Surgical Procedures - statistics & numerical data; Retrospective Studies; Treatment Outcome; Walking - physiology; 정형외과학; Medial cortical support; Dynamic hip screw; AO/OTA 31-A2
• ISSN: 2005-291X; 2005-4408
• DOI: 10.4055/cios.2018.10.3.292

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. 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. 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 ( = 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. In the treatment of pertrochanteric fractures accompanied by posteromedial wall defect using a dynamic hip screw, reduction with negative cortical support should be avoided.