Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Clinical Results of Femoral Subtrochanteric Fractures

대퇴 전자하 골절의 임상적 결과

  • Kim, Ji-Wan (Department of Orthopedic Surgery, Haeundae Paik Hospital, College of Medicine, Inje University) ;
  • Chang, Jae-Suk (Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Lee, Hee-Sang (Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Bae, Joo-Yul (Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Kim, Jung-Jae (Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan)
  • 김지완 (인제대학교 의과대학 해운대백병원 정형외과학교실) ;
  • 장재석 (울산대학교 의과대학 서울아산병원 정형외과학교실) ;
  • 이희상 (울산대학교 의과대학 서울아산병원 정형외과학교실) ;
  • 배주열 (울산대학교 의과대학 서울아산병원 정형외과학교실) ;
  • 김정재 (울산대학교 의과대학 서울아산병원 정형외과학교실)
  • Published : 2010.09.30
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Abstract

Purpose: This study examined the clinical course of subtrochanteric fractures of the femur as well as the risk factors of complications. Materials and Methods: A retrospective study was performed on 56 patients with femoral subtrochanteric fractures who were treated at our hospital from 2004 to 2008. Risk factors, such as the type of fracture, type of implant, soft tissue dissection at the fracture site, communition of the medial cortex and degree of fracture displacement after the reduction, were compared to determine their effect on the rate of complications, such as nonunion and implant failure. Open reduction with a soft tissue dissection at the fracture site was performed in 34 cases, and a closed reduction was performed in 22 cases. Thirty five cases had medial cortex communition and 21 cases did not. Results: There were 8 cases of nonunion(14.3%). There was a positive correlation between the degree of fracture displacement after the reduction and the union time (P=0.017). The union time was longer when there was communition of the medial cortex. A subtrochanteric fracture using an open reduction tended to have a long union time but this was not statistically significant. There was no correlation between the type of implant and union time. Conclusion: The union time is longer in subtrochanteric fractures with communition of the medial cortex. Therefore, it is important to preserve the blood supply at the fracture site using a closed reduction and restore the fracture reduction accurately.

목적: 대퇴 전자하 골절 환자의 임상 결과를 알아보고, 불유합, 고정 실패 등의 합병증에 영향을 미치는 요인을 찾아보고자 한다. 대상 및 방법: 2004년부터 2008년까지 내원한 대퇴 전자하 골절 56예를 대상으로 불유합, 고정 실패 등의 합병증 발생 빈도를 골절의 분류, 수술 기구, 골절 정복 시 관혈적 정복 여부, 내측 피질골의 분쇄 여부, 수술 후 골절의 전위 정도 등의 요인과 비교하여 결과에 영향을 미치는 요인을 찾아 보았다. 관혈적 정복은 34예, 도수 정복은 22예였다. 내측 피질골의 분쇄가 없었던 경우는 35예, 있었던 경우는 21예였다. 결과: 56예의 환자 중 불유합 8예(14.3%)가 있었다. 수술 후 골절 전위 정도와 골유합 기간은 유의한 상관 관계를 가져(P=0.017), 수술 후 골절 전위가 클수록 골유합 기간이 길어지는 것으로 나타났고, 내측 피질골의 분쇄가 있는 경우 골유합 기간이 길어졌다. 관혈적 정복 시 불유합의 빈도가 커지는 경향이 있었으나 통계학적으로 차이를 보이지는 않았다(P=0.094). 수술 기법에 따른 골유합 기간 및 불유합 빈도의 차이는 없었다. 결론: 대퇴 전자하 골절의 치료 시 내측 피질골의 분쇄가 있는 경우 골유합 기간이 길어질 수 있으므로 도수 정복을 통해 골절 부위 혈행을 보존하며 골절 정복을 잘 하는 것이 바람직하다.

Keywords

References

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  2. Treatment of Femur Subtrochanteric Fracture Using the Intramedullary Long Nail; Comparison of Closed Reduction and Minimal Open Reduction vol.50, pp.1, 2010, https://doi.org/10.4055/jkoa.2015.50.1.18