대퇴골 전자간 골절시 압박고 나사의 고정실패

Abstract

Failure of fixation is a major complication of the treatment of proximal femoral fractures including trochanteric fracture. In a retrospective study we assessed the causes of failure in a series of 136 proximal femoral fractures which had been internally fixed with a compression hip screw. All patients were followed from 1 year to 6.6 years(average 2.5 years). The overall rate of fixation failure was 13.2%; excessive sliding of the lag screw(7.4%), cutting-out of lag screw before union(3.7%), varus malunion(1.5%), and pulling-out of the side plate(0.7%). Fixation failure was commoner in unstable fractures (p=0.0001) and osteoporotic patients(p=0.031). Fixation failure was also associated with superior placement of the lag screw within head(p<0.0001) and anteromedial displacement of the distal fragment(p<0.0001). These results indicate that these fractures should be reduced as accurate as possible and care must be taken to avoid the placement of the lag screw in the superior half of the head. Dynamic hip screw with a laterally mounted trochanteric stabilizing plate(DHS/TSP) or Gamma nail may be an aid in the treatment of these difficult fractures because the problem with the medialization or anterior displacement of the distal fragment frequently associated with the compression hip screw is prevented.