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HOME > J Korean Soc Traumatol > Volume 4(2); 1991 > Article
Treatment of Intertrochanteric Fracture with Compression Hip Screw - A clinical analysis of causative factors in loss of fixation-
Journal of Trauma and Injury 1991;4(2):57-124
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Among the many devices available for internal fixation of intertrochanteric fractures of the femur, the compression hip screw (CHS) has gained considerable acceptance. But some reports indicated that the loss of fixation was not infrequent in cases using the compression hip screw. A clinical analysis of causative factors in loss of fixation was performed. Of ninety four intertrochanteric fracture patients treated with CHS from 1985 to 1990, forty four patients (14 males and 30 females) were reviewed, whose follow-up period was more than three months. The average age at surgery was 72 years (range, 25 years to 92 years). As the index of loss of fixation, sliding of lag screw, migration toward acetabulum (including penetration), varus tilting of proximal fragment, metal failure and separation of plate from femur shaft were considered. Osteoporosis, fracture stability, initial reduction state and location of lag screw in head were considered as causative factors. Of 44 cases, sliding (max. 5.6 pitch, average 1.41 pitch) in 33 cases, migration toward acetabulum (max. 4.3 pitch, average 0.23 pitch) in 12 cases and varus tilting in 4 cases were noted. Neither metal failure nor separation case was observed. In causative factors, osteoporosis, fracture stability and Dimon-Hughston tendency reduction and nonanatomic reduction at initial reduction were significant factors in loss of fixation. Placement of lag screw more than 1cm from subchondral bone is considered to be safe. Using a short barrel plate is recommended for the cases in which large amount of sliding is expected.

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