Hip & pelvis

The Korean Hip Society (대한고관절학회)
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The Result of Osteosynthesis for Femur Neck Fracture in Old Age Patients

고령의 대퇴골 경부 골절에서 내고정술의 치료 결과

  • Choo, Suk-Kyu (Department of Orthopedic Surgery, Ilsan Paik Hospital, College of Medicine, Inje University) ;
  • Oh, Hyoung-Keun (Department of Orthopedic Surgery, Ilsan Paik Hospital, College of Medicine, Inje University) ;
  • Kim, Jong-In (Department of Orthopedic Surgery, Ilsan Paik Hospital, College of Medicine, Inje University) ;
  • Lee, Hee-Du (Department of Orthopedic Surgery, Ilsan Paik Hospital, College of Medicine, Inje University) ;
  • Jang, Goo-Rak (Department of Orthopedic Surgery, Jung Ang Janglim Hospital)
  • 주석규 (인제대학교 의과대학 일산백병원 정형외과학교실) ;
  • 오형근 (인제대학교 의과대학 일산백병원 정형외과학교실) ;
  • 김종인 (인제대학교 의과대학 일산백병원 정형외과학교실) ;
  • 이희두 (인제대학교 의과대학 일산백병원 정형외과학교실) ;
  • 장구락 (중앙장림병원 정형외과)
  • Published : 2011.03.31
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Abstract

Purpose: We wanted to investigate the radiographic and clinical results of internal fixation with cannulated screws in elderly patients with femoral neck fracture. Materials and methods: We reviewed the results of 47 cases of elderly patients with femoral neck fractures that were treated by osteosynthesis from May 2000 and March 2009 and these patients could be followed up for more than one year. There were 11 males and 36 females with a median age of 72 years (65~85 years). They were classified by the Garden stage. The number of stage I and II fractures was 34 and 16, respectively. The postoperative follow up period was 24 months (12~84 months). The union time, horizontal shortening and complications were investigated. Walking ability was evaluated by Koval's scoring system and the quality of life was measured by the Korean EQ-5D. Results: The average union time was 4.4 months. The complications were one case of nonunion, 6 cases of avascular necrosis and one case of subtrochanteric fracture. The average of the horizontal shortening was 6.815 mm (0~20 mm) in the fracture site. The walking ability was on average 1 step down and it was possible to walk independently using a walker for 69% of the patients. The Korean EQ-5D quality of life was reduced from 0.856 to 0.561 (P <0.01). Conclusion: In elderly patients with femur neck fracture, the decreased abductor moment arm may reduce the quality of life and walking ability after cannulated screw fixation.

목적: 고령의 대퇴 경부 골절에 유관 나사를 이용한 내고정술 후 방사선적, 임상적 결과를 알아보고자 하였다. 대상 및 방법: 2000년 5월부터 2009년 3월까지 65세 이상 대퇴 경부 골절 환자 중 내고정술 후 1년 이상 방사선적 추시 관찰이 가능했던 47명을 대상으로 하였다. 남자 11명, 여자 36명이었고 평균 연령은 72세(65~85세)였다. Garden 분류법 상 1형 34예, 2형 16예였고 방사선 추시로 골유합 시기와 합병증 발생 유무를 확인했으며 압박에 의한 수평 단축을 계측했다. 임상적으로 Koval walking ability로 보행 능력을 조사하고 한국형 EQ-5D로 삶의 질을 평가했다. 결과: 평균 골유합 시기는 4.4개월이었고 7명에서 불유합 및 무혈성 괴사로 관절 치환술로 전환하였고 1명에서 대퇴전자하 골절로 내고정술을 시행하였다. 수평 단축은 평균 6.815 mm(0~20 mm)였다. 보행 능력은 1단계 하락했고 69%에서 보행기를 이용한 독립적 보행이 가능했다. 한국형 EQ-5D상 삶의 질은 0.856에서 0.561으로 감소했다(P<0.01). 결론: 고령의 대퇴 경부 골절에서 내고정술 후 83%의 골유합으로 비교적 만족할 만한 방사선적 결과를 얻었으며 대퇴 경부의 수평 단축으로 인한 외전 모멘트 암의 감소가 수술 후 삶의 질 및 보행 능력의 감소에 영향을 미칠 수 있을 것으로 사료된다.

Keywords

References

  1. Rogmark C, Flensburg L, Fredin H. Undisplaced femoral neck fractures-no problems--A consecutive study of 224 patients treated with internal fixation. Injury. 2009;40:274-6. https://doi.org/10.1016/j.injury.2008.05.023
  2. Hui AC, Anderson GH, Choudhry R, Boyle J, Gregg PJ. Internal fixation or hemiarthroplasty for undisplaced fractures of the femoral neck in octogenarians. J Bone Joint Surg Br. 1994;76:891-4.
  3. Leighton RK, Schmidt AH, Collier P, Trask K. Advances in the treatment of intracapsular hip fractures in the elderly. Injury. 2007;38 Suppl:S24-34.
  4. Eisler J, Cornwall R, Strauss E, Koval K, Siu A, Gilbert M. Outcomes of elderly patients with nondisplaced femoral neck fractures. Clin Orthop Relat Res. 2002;399:52-8.
  5. McGrory BJ, Morrey BF, Cahalan TD, An KN, Cabanela ME. Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty. J Bone Joint Surg Br. 1995;77:865-9.
  6. Benedetti MG, Catani F, Benedetti E, Berti L, Gioia A, Giannini S. To what extent does leg length discrepancy impair motor activity in patients after total hip arthroplasty? Int Orthop. 2010; 34: 1115-21. https://doi.org/10.1007/s00264-009-0855-5
  7. Zlowodzki M, Ayieni O, Petrisor BA, Bhandari M. Femoral neck shortening after fracture fixation with multiple cancellous screws: incidence and effect on function. J Trauma. 2008;64:163-9. https://doi.org/10.1097/01.ta.0000241143.71274.63
  8. Zlowodzki M, Brink O, Switzer J, et al. The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study. J Bone Joint Surg Br. 2008;90:1487-94. https://doi.org/10.2106/JBJS.F.00991
  9. Tidermark J, Zethraeus N, Svensson O, Tornkvist H, Ponzer S. Quality of life related to fracture displacement among elderly patients with femoral neck fractures treated with internal fixation. J Orthop Trauma. 2002;16:34-8. https://doi.org/10.1097/00005131-200201000-00008
  10. Min BW, Bae KC, Kang CH, Song KS, Kim SY, Won YY. Valgus intertrochanteric osteotomy for non-union of femoral neck fracture. Injury. 2006;37:786-90. https://doi.org/10.1016/j.injury.2006.02.045
  11. Kang EJ, Shin HS, Park HJ, Jo MW, Kim NY. A valuation of health status using EQ-5D. Korean Journal of Health Economics and Policy. 2006;12:19-43.
  12. Haidukewych GJ, Rothwell WS, Jacofsky DJ, Torchia ME, Berry DJ. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg Am. 2004;86-A:1711-6.
  13. Swiontkowski MF, Winquist RA, Hansen ST Jr. Fractures of the femoral neck in patients between the ages of twelve and forty-nine years. J Bone Joint Surg Am. 1984;66:837-46.
  14. Sendtner E, Renkawitz T, Kramny P, Wenzl M, Grifka J. Fractured neck of femur--internal fixation versus arthroplasty. Dtsch Arztebl Int. 2010;107:401-7.
  15. Crossman PT, Khan RJ, MacDowell A, Gardner AC, Reddy NS, Keene GS. A survey of the treatment of displaced intracapsular femoral neck fractures in the UK. Injury. 2002;33:383-6. https://doi.org/10.1016/S0020-1383(02)00002-5
  16. Bhandari M, Devereaux PJ, Swiontkowski MF, et al. Interal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis. J Bone Joint Surg Am. 2003;85-A:1673-81.
  17. Bryant DM, Sanders DW, Coles CP, Petrisor BA, Jeray KJ, Laflamme GY. Selection of outcome measures for patients with hip fracture. J Orthop Trauma. 2009;23:434-41. https://doi.org/10.1097/BOT.0b013e318162aaf9

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  1. The Result of Total Hip Arthroplasty after Failure of Multiple Screw Fixation for Femoral Neck Fracture vol.50, pp.4, 2011, https://doi.org/10.4055/jkoa.2015.50.4.280