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고관절 골절 금속내고정의 실패에 관한 방사선적 분석 Failed Hip Nailing in Hip Fractures

대한정형외과학회지 1976년 11권 3호 p.531 ~ 541
조두영, 정문상, 홍강의,
소속 상세정보
조두영 (  ) 
서울대학교 의과대학 정형외과학교실

정문상 (  ) 
서울대학교 의과대학 정형외과학교실
홍강의 (  ) 
서울대학교 의과대학 정형외과학교실

Abstract


The fracture of the upper end of the femur is unique in orthopedics because it is endemic to an elderly population with special problem.
In trochanteric fractures open reduction and internal fixation, with a hip nail used to maintain reduction, have become the standard treatment protocol for the elderly. Unlike fractures of the femoral neck, nonunion and avascular necrosis is rare but more frequently complicated by fatal sequele, such´as pneumonia, thromboembolic disease, and decubitus ulceration. In order to achieve early ambulation of a patient with a trochanteric hip fracture, two conditions must be met: The implant used for fixation must be strong enough to withstand loadings exerted upon it during fracture healing, and the fracture itself must be rendered stable in a suitably reduced position.
The treatment of the fracture of the femoral neck has a long and frustrating history. As recently as 20 years ago McCarroll remarked that this fracture must be considered "unsolved until the incidence of aseptic necrosis and nonunion could be diminished or abolished. But now with adequate reduction, impaction, accurate internal fixation with newer devices, and carefully supervised postoperative care the fracture of the femoral neck can be expected to heal at least 90 per cent of the patients. A lower incidence of recognizable aseptic necrosis has been reported under these circumstances.
X-ray films of 94 cases of hip nailing for hip fractures were collected in the Department of Orthopedic Surgery of Seoul National University Hospital. Twenty seven cases considered to be failed in hip nailing were analysed radiologically, and following results were obtained.
1. The incidence of failed hip nailing was most frequent in the fifties with average age of 54.6 years, which seemed somewhat younger than that of the hip fracture. There was no sexual difference.
2. Hip nailings were failed in 23 cases of-the femoral neck fractures and in 4 cases of the 1 trochanteric fractures, which revealed respectively 52:3% and 8.2% of failure. Amohg these the technical failure was 22.7% in femoral neck fractures and 6.1 % in trochanteric fractures.
3. Among the various fixation devices, Smith-Petersen nail or hip scre~r-s which has no side plate to fix the shaft rigidly showed high failure rates.
4. In all cases the etiology of the failed hip nailing was functional, such as failure of reduction, failure of fixation, penetration of the head, avascular necrosis, infection, and inadequate postoperative management.
5. Most cases of femoral neck fractures which was not achieved near anatomical reduction was failed in fixation.
6. Too long or short nails showe$ high failure rates. In view point of this, hip nail should fix the lateral cortex, calcar femorale and center of subchondral bone, even in the trochanteric fracure. So devices such as heavy !lbmpression sliding nail or multiple pinning were more desirable to achieve complete fixation.
7. When, in the fresh fractures of the femur neck cannot be reduced to an anatomical or slightly overcorrected position, endoprosthesis should be considered seriously. When the joint is abnormal, the total hip arthroplasty cad.reduce morbidity and mortality, and also shorten the hospitalization

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