Functional Outcomes of Wedge Plate Versus Dynamic Hip Screw Applications in Adult Femoral Trochanteric Fractures: A Retrospective Review

Öz

Objective: To retrospectively compare the clinical and functional outcomes of wedge plate and dynamic hip screw (DHS) fixation in adult patients with trochanteric femoral fractures. Methods: This retrospective comparative analysis included 64 hips in 63 patients aged 18-60 years who underwent primary fixation of a trochanteric femoral fracture with either a wedge plate (n=38) or a dynamic hip screw (DHS; n=26) between 2005 and 2010. Eligible hips had clinical and radiographic records sufficient for final functional assessment at least 6 months after surgery. Of 149 potentially eligible patients, 66 could not be contacted. Patients who died before final assessment, hips converted to partial arthroplasty after fixation failure, and hips treated with fixation devices other than a wedge plate or DHS were excluded from this comparison. One DHS-treated hip that was converted to partial arthroplasty after implant failure and loss of reduction was excluded during cohort construction. Demographic characteristics, fracture patterns, perioperative findings, postoperative complications, and Harris Hip Score (HHS) outcomes were compared. Results: The mean patient age was 47.89±14.66 years, and 92.2% of the patients were male. Unstable fractures accounted for 73.4% of all fractures and were more frequent in the wedge plate group than in the DHS group (84.2% vs 57.7%; P=.018). The overall mean HHS was 89.85±12.47, with excellent or good functional outcomes in 86.0% of hips. No statistically significant between-group differences were detected in HHS, the overall distribution of functional outcome categories, or the individual recorded postoperative complication categories. Within the retained comparison cohort, revision surgery was required in five wedge plate cases because of mechanical failure involving plate bending and/or breakage and in none of the 26 DHS cases (Fisher exact P=.074). Conclusion: In this selected, retrospective, and relatively small cohort, no statistically significant difference in HHS-based functional outcomes was detected between wedge plate and DHS fixation. The significant imbalance in fracture stability, the five mechanical failures in the wedge plate group, and exclusion of a DHS-treated hip converted to arthroplasty limit comparative inference. These findings should not be interpreted as evidence of equivalence.

Anahtar Kelimeler

• Trochanteric fractures
• dynamic hip screw
• internal fixation
• Harris Hip Score
• functional outcome

Proje Numarası

B.30.2.ATA.0.01.00/18

Etik Beyan

Ethics committee approval was obtained from Atatürk University Local Ethics Committee (Date: July 9, 2010, Number: B.30.2.ATA.01.000/18)

Erişkin Femur Trokanterik Kırıklarında Wedge Plate ve Dinamik Kalça Vidası Uygulamalarının Fonksiyonel Sonuçlarının Karşılaştırılması: Retrospektif Bir Çalışma

Öz

Amaç: Bu retrospektif çalışmanın amacı, erişkin trokanterik femur kırığı olan hastalarda wedge plate ve dinamik kalça vidası (Dynamic Hip Screw, DHS) ile yapılan tespitlerin klinik ve fonksiyonel sonuçlarını karşılaştırmaktır. Yöntemler: Bu retrospektif karşılaştırmalı analize, 2005-2010 yılları arasında trokanterik femur kırığı nedeniyle wedge plate (n=38) veya dinamik kalça vidası (DHS; n=26) ile primer tespit uygulanan 18-60 yaş aralığındaki 63 hastaya ait 64 kalça dahil edildi. Potansiyel olarak uygun 149 hastanın 66'sına ulaşılamadı. Son değerlendirmeden önce ölen hastalar, tespit yetersizliği sonrasında parsiyel artroplastiye dönüştürülen kalçalar ve wedge plate veya DHS dışındaki implantlarla tedavi edilen kalçalar karşılaştırma dışında bırakıldı. İmplant yetersizliği ve redüksiyon kaybı sonrasında parsiyel artroplastiye dönüştürülen bir DHS kalçası, kohort oluşturulurken dışlandı. Fonksiyonel sonuçlar Harris Kalça Skoru (HKS) kullanılarak değerlendirildi. Bulgular: Hastaların ortalama yaşı 47,89±14,66 yıl olup olguların %92,2'si erkekti. Kırıkların %73,4'ü instabil özellikteydi ve instabil kırık oranı wedge plate grubunda DHS grubuna göre daha yüksekti (%84,2'ye karşı %57,7; P=,018). Ortalama Harris Kalça Skoru 89,85±12,47 olarak bulundu ve kalçaların %86,0'ında iyi veya mükemmel fonksiyonel sonuç elde edildi. HKS, fonksiyonel sonuç kategorilerinin genel dağılımı ve kaydedilen postoperatif komplikasyon kategorilerinin her biri bakımından gruplar arasında istatistiksel olarak anlamlı fark saptanmadı. Karşılaştırma kohortunda wedge plate grubunda plak eğilmesi ve/veya kırılması biçimindeki mekanik yetersizlik nedeniyle beş revizyon gerekirken 26 DHS olgusunun hiçbirinde revizyon yapılmadı (Fisher kesin testi P=,074). Sonuç: Seçilmiş, retrospektif ve nispeten küçük bu kohortta wedge plate ile DHS tespiti arasında HKS'ye dayalı fonksiyonel sonuçlar bakımından istatistiksel olarak anlamlı fark gösterilememiştir. Kırık stabilitesindeki anlamlı dengesizlik, wedge plate grubundaki beş mekanik yetersizlik ve artroplastiye dönüştürülen bir DHS kalçasının dışlanmış olması karşılaştırmalı çıkarımları sınırlandırmaktadır. Bulgular iki yöntemin eşdeğer olduğunun kanıtı olarak yorumlanmamalıdır.

Anahtar Kelimeler

• Trokanterik femur kırıkları
• dinamik kalça vidası
• iç tespit
• Harris Kalça Skoru
• fonksiyonel sonuç

Proje Numarası

B.30.2.ATA.0.01.00/18

Etik Beyan

Etik kurul onayı Atatürk Üniversitesi Yerel Etik Kurulu’ndan (Tarih: 09.07.2010, Sayı: B.30.2.ATA.01.000/18) alınmıştır.

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