Trochanteric Femoral Fractures Research Articles

Differences in exposure to stimulatory and inhibitory components of the insulin-like growth factor (IGF) system in patients with femoral neck versus trochanteric fracture

SIR—Bone loss, the major determinant of hip fracture risk in the elderly [1], results from an increased rate of bone turnover [2] that will amplify the imbalance at the level of the individual remodelling unit. However, while the increase in bone turnover in elderly women results in part from secondary hyperparathyroidism [3], the mechanisms responsible for the age-related decline in bone formation have not yet been identified.

The Influence of Dementia on Ambulatory Ability after Trochanteric Fracture of Femur

The Influence of Dementia on Ambulatory Ability after Trochanteric Fracture of Femur

Trochanteric hip fracture in an elderly patient with leprosy during osteoporosis treatment with risedronate and alfacalcidol

There is no well-established treatment for osteoporosis in male patients with leprosy, because no clinical trials have examined the efficacy of treatment on bone mineral density (BMD) or fracture incidence in patients with leprosy. In this study, we report a case of osteoporosis in a man with leprosy, treated by oral administration of risedronate and alfacalcidol. An 82-year-old man with leprosy presented to our hospital with chronic back pain, due to osteoporosis, in July 2002. To prevent the progression of osteoporosis, oral administration of risedronate and alfacalcidol was started for this patient. An increase in forearm BMD and a decrease in the level of urinary crosslinked N-telopeptides of type I collagen (NTx) were observed in January 2003. The patient suffered a trochanteric fracture of the proximal femur at the end of March 2003. Surgical treatment with a sliding-screw plate was performed 5 days after the injury. Complete bony union of the right proximal femur was confirmed by radiography in July 2003. The above findings suggested that the treatment with risedronate and alfacalcidol contributed to the increase in BMD; however, the treatment did not prevent fracture due to osteoporosis in this male patient with leprosy.

当科における大腿骨転子部骨折の手術成績―ＣＨＳとγ‐ｎａｉｌの比較―

Between April 1999 and September 2004, 58 cases of femoral trochanteric fractures were treated with a CHS (compression hip screw), and 25 cases with a Gamma nail. We evaluated the multivariate studies and the post-operative walking ability between two groups. There were significant differences in the duration of admission, fracture types, post-operative walking ability in unstable fracture type, and complications. Because of the operative-technique, complications in the Gamma group were more than the CHS group. In the unstable fractures type, 88 percent of the patients in the Gamma group regained pre-injury walking ability, but only 40 percent in the CHS group regained the ability. In the decreased factors of walking ability, there were significant differences in unstable fractures type and dementia of the CHS group. We conclude that the Gamma nail is a more useful device than CHS in unstable fractures type and dementia.

AS hip screwを用いた大腿骨転子部骨折に対する最小侵襲骨接合術の手術手技

AS hip screwを用いた大腿骨転子部骨折に対する最小侵襲骨接合術の手術手技

高齢者（80歳以上）の大腿骨転子部骨折における待機手術と緊急手術の比較検討

高齢者（80歳以上）の大腿骨転子部骨折における待機手術と緊急手術の比較検討

Proximal Femoral Nail (PFN) for the Treatment of the Femoral Trochanteric Fracture

목 적: 최근 개발된 근위 대퇴정을 이용한 대퇴 전자부 골절의 치료 결과에 대해 보고하고자 한다. 대상 및 방법: 2001년 6월부터 2002년 8월까지 대퇴 전자부 골절에 대하여 근위 대퇴정을 이용하여 치료한 27예 중 24예를 대상으로 하였으 며, 급성신부전 및 호흡기 합병증으로 사망한 1예, 3개월 미만 추시 2예는 제외하였다. 평균 연령은 69.6세, 평균 추시 기간은 12개월이었다. 결 과: 술 후 방사선 사진상 내측 피질골의 내외측 전이는 평균 4.6 mm, 전방 피질골의 전후방 전이는 평균 4.1 mm였고, 술 후 대비 최종 추시 방사선 사진상 지연 나사의 활강 정도는 1.2 mm, 대퇴골 경간각의 변화는 술 후 평균 131.1°에서 최종 추시 127.8°로 평균 3.3° 내반 변형을 보였다. 체중 부하 시기는 평균 1주였고, 골유합 시기는 10주였고, 전 예에서 최종 추시 현재 골유합 소견을 보였고, 지연유합, 불유합은 없었다. 결 론: 고령의 대퇴 전자부 골절에 있어서 근위 대퇴정의 사용은 수술 시간의 감소 및 견고한 내고정을 통하여 조기 보행을 가능하게 하였고, 추시 관찰상 좋은 골유합과 합병증이 적어 만족스러운 치료 결과를 얻었다.

大腿骨転子部骨折と転子下骨折の治療における問題点（１０年前との比較を基に）

In this study the problems of surgical treatment for femoral trochanteric and subtrochanteric fractures were analyzed in 1993 and 2002. We treated 46 patients with CHS from January to December 1993, and 53 patients with CHS and CHS with wire and screw from January to December 2002.The average age of the patients and the number of complications before surgery have been increasing over the last 10 years.Complications after surgery were frequent in grade 4 (Evans) in 2002. It was found that patients with numerous complications after surgery had to pay high medical expenses and stay in the hospital many days.Patients with complex type fracture had to pay high medical expenses even after returning home.

大腿骨頚部外側骨折に対するDYAX-Asiatic nail の治療経験

大腿骨頚部外側骨折に対するDYAX-Asiatic nail の治療経験

A different treatment modality for trochanteric fractures of the femur in surgical high-risk patients: a clinical study of 44 patients with 21-month follow-up.

To assess the effectiveness of a modular axial fixator as an alternative method in surgically high-risk patients with trochanteric fractures of the femur. In a prospective, uncontrolled clinical study, 44 high-risk patients (ASA grade 3 or 4) with trochanteric femoral fractures were treated by a modular axial fixator. They were prospectively followed up for 21 months (range 14-30 months) and evaluated using Foster's criteria. All of the fractures healed, and mean time to union was 10.9 weeks. Three types of complications were noticed. These were infections, varus alignment and shortening. Results were anatomically excellent in 35 patients, good in 9, and functionally excellent in 36, good in 8. The modular axial fixator is a reliable alternative for treating frail patients with trochanteric fractures of the femur.

大腿骨転子部骨折に対する3cmの皮切で行うAS hip screwの治療成績

大腿骨転子部骨折に対する3cmの皮切で行うAS hip screwの治療成績

Stabilization of unstable trochanteric femoral fractures: dynamic hip screw (DHS) with trochanteric stabilization plate vs. proximal femur nail (PFN)

Stabilization of unstable trochanteric femoral fractures: dynamic hip screw (DHS) with trochanteric stabilization plate vs. proximal femur nail (PFN)

Postoperatively aggravating factors in elderly patients over 90 years old with the femoral trochanteric fractures

Postoperatively aggravating factors in elderly patients over 90 years old with the femoral trochanteric fractures

Epidemiological study of cervical and trochanteric fractures of the proximal femur in Tokushima Prefecture

Epidemiological study of cervical and trochanteric fractures of the proximal femur in Tokushima Prefecture

The results of the S-ROM hemiarthroplasty for the nonunion of the femoral trochanteric fracture in the super elderly

The results of the S-ROM hemiarthroplasty for the nonunion of the femoral trochanteric fracture in the super elderly

当院における大腿骨転子部骨折治療の検討―ＰＦＮとγ‐ｎａｉｌの比較

Between January 1997 and June 2002, 50 cases of femoral trochanteric fractures were treated with a proximal femoral nail (PFN), and 50 cases with a Gamma nail. This study evaluated the effectiveness of these fixation devices. There were no significant differences in the mean age, sex, fracture types according to Evans classification and the pre-injury walking ability between the two groups. We clinically and radiographically evaluated the two groups. More than 70 percent of the patients regained walking ability post operatively. Local complications included: three fractures the around the tip of the nail in the Gamma group and one in the PFN group, and five cases of Coxa vara deformity in the Gamma group. However, there was no incidence of cut-out in either group. These devices provide satisfactory results in the treatment of such fractures. However, we conclude that the PFN is a more useful device than the Gamma nail because femoral neck screw positioning is critical.

The incidence of cervical and trochanteric fractures of the proximal femur in 1999 in Niigata Prefecture, Japan.

The purpose of this study was to determine the incidence of cervical and trochanteric fractures of the proximal femur in 1999 in Niigata Prefecture, Japan, and to compare this incidence with those previously reported in Niigata in 1985, 1987, 1989, and 1994. The authors visited all hospitals within Niigata Prefecture having an orthopedic department and reviewed the medical records and radiographs of all patients who sustained such fractures in 1999. The population of Niigata Prefecture was determined in 1999 to be 2 486 999 (1 208 195 males and 1 278 804 females). The population over 65 years of age was 515 290 (210 564 males and 304 726 females), representing 20.7% of the total population. In 1999, there were 1697 cervical or trochanteric fractures, in 400 males and 1297 females, with a male-to-female ratio of 1 : 3.2. The incidence of these fractures in persons over 65 years of age was 308.7 fractures per 100 000 per year. This incidence increased from 1985 to 1989 and from 1989 to 1994, but after that, the rate of increase in incidence from 1994 to 1999 slowed down slightly. This suggests that the prevention of fractures in the elderly population in Niigata Prefecture influenced the lower ratio.

Classification of trochanteric fracture of the proximal femur: a study of the reliability of current systems

Five observers using the Jensen modification of the Evans classification and the AO classification (with and without subgroups) classified the radiographs of 88 trochanteric hip fractures. Each observer classified the radiographs independently on two occasions 3 months apart. Kappa statistical analysis was used for determination of intra- and inter-observer variation. For the Jensen classification, the mean kappa value was 0.52 (range: 0.44–0.60) for intra-observer variation and 0.34 (range: 0.17–0.38) for inter-observer variation. For the AO system with subgroups, the mean kappa value was 0.42 (range: 0.20–0.65) for intra-observer variation and 0.33 (range: 0.14–0.48) for inter-observer variation. For the AO classification system without subgroups, the mean kappa value was 0.71 (range: 0.60–0.81) for intra-observer variation and 0.62 (range: 0.50–0.71) for inter-observer variation. We recommend classifying trochanteric fractures into three groups as that of the AO system without the subgroups. For ease of use, these three groups may be termed stable trochanteric, unstable trochanteric and trans-trochanteric. Neither the Jensen classification nor the AO classification with subgroups is an acceptable classification system for trochanteric hip fractures.

The AO/ASIF proximal femoral nail (PFN) for the treatment of unstable trochanteric femoral fracture

The AO/ASIF proximal femoral nail (PFN) is a new device designed for the treatment of the unstable trochanteric femoral fracture. This study reports the outcome in such fractures treated using the PFN at a District General Hospital. All patients presenting to our department with unstable trochanteric femoral fractures were treated operatively using the PFN. A total of 76 patients were included in the study and were followed up to fracture union or fixation failure. A case documentation form and follow-up form were used to collect the data which included the Salvati and Wilson assessment of hip function. The majority of the procedures were reported by the operating surgeon as “easy” or “usual”. Distal locking was difficult in three patients. In one patient, the fixation failed because the screws were wrongly positioned and was revised to a THR. Mortality rate, during the first 3 months, was 27%. Of the surviving patients, screws cut through the femoral head in four patients (8%), however, fractures united in all the patients. There was one incidence of fracture around the tip of the nail. Seventy-eight percent of the patients at the final follow-up scored >20 points (out of 40 points), using the Salvati and Wilson hip function scoring system. According to the patients and/or their carers, outcome was described as good or very good in 94% of the patients and the level of function was similar to pre-injury level in 50% of the patients. We conclude that the PFN is a useful device in the treatment of the unstable trochanteric femoral fracture. It is a relatively easy procedure and a biomechanically stable construct allowing early weight bearing. Femoral neck screws positioning is critical.

大腿骨頚部外側骨折に対するＰＦＮの使用経験

We treated 10 patients who had femoral trochanteric fractures with AO small proximal femoral nail (PFN). PFN is a new intramedullary device with lag screw and hip pin. One patient showed varus deformity by more than 10 degrees, but there were nocut outs. All patients achieved bony union within 11 weeks. Eighty percent of the patients regained almost the same gait ability after operation. We conclude that this new implant PFN is suitable for the treatment of femoral trochanteric fractures.