Taipei Medical University Institutional Repository:Item 987654321/44515
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    Please use this identifier to cite or link to this item: http://libir.tmu.edu.tw/handle/987654321/44515


    Title: Surgical treatment of unstable subtrochanteric fracture with dynamic condylar screw
    以動態髁螺釘治療不穩定股骨轉子下骨折
    Authors: 林心畬;莊太元;廖宜賢;王普光;吳柏林;何為斌
    Contributors: 生化學科
    Date: 2009
    Issue Date: 2011-10-13 19:15:48 (UTC+8)
    Abstract: 【Introduction】
    The management of unstable subtrochanteric fracture is challenging to each
    orthopaedic surgeon. There was a controversy over the choice of implants
    between intra-medullary or extra-medullary devices. This topic presented our
    prospective series with unstable subtrochanteric fractures treated with
    dynamic condylar screws (DCS).
    【Materials and Methods】
    From 2003 through 2008, 118 peritrochanteric fractures were treated
    surgically by one surgeon. Twenty of them using DCS under indication of
    Seinsheimer classification (for subtrochanteric fractures) type IIC, III, IV, and
    V . Fracture union by serial X-ray evaluation was made monthly, and change
    of neck-shaft angle and medial migration were also estimated. Functional
    tests with Harris hip score were also evaluated.
    【Results】
    Eighteen of the 20 patients were followed for an average of 35.1 months
    (range 8-58 months). Functional outcome was excellent (>90 points) in 13
    (13/18), good (80-99 points) in 2 (2/18), and fair (70-79 points) in 3(3/18).
    The primary union rate was 94% (17/18) in 12 weeks, and implants failure
    rate was 6% (1/18) which received revised surgery. Superficial wound
    infection was noted in one case.
    【Discussion】
    Unstable subtrochanteric fractures are difficult to treat due to high
    compression and tension force in the medial cortex with high failure rate of
    internal fixation. The most common devices for internal fixation include
    intra-medullar nail (IM nail), trochanteric stabilized plate (THS), and DCS.
    Dynamic hip screw had obviously higher failure rate and wasn't suggested in
    such fracture type. Although IM nail showed better then DCS in
    biomechanical studies, literature review showed great variation of results,
    and no large randomized control trial comparing available. There is some
    limitation of IM nail, including severe comminuting with intertrochanteric
    Appears in Collections:[Department of Orthopedic Surgery] Periodical Articles

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