Η χειρουργική αντιμετώπιση των ασταθών διατροχαντηρίων καταγμάτων με τη μέθοδο βλαισοποίησης κατά Dimon - Hughston: Συγκριτική μελέτη

The surgical management of throchanteric fractures is preferred, to conservative management. Older patients are mobilized earlier avoiding complications of long immobilazation in bed with less percentages of mortality. Classification of trochanteric fractures as stable or unstable is essential because the choice of surgical management is dependent on the type of fractures present. We studies 103 unstable intertrochanteric fractures that were operated on in our department between 1977 to 1984. Of these, 41 patients - group one - were handled by means of anatomical reduction and internal fixation. A second group of 62 patients were hendled by means of primary medial displacement fixation of Dimon-Hughston. This method consists of osteotomy and elevation of major trochanter. The nail is inserted in to the fracture and osteosynthesis is done by displacing the femoral diaphysis inwards and impacting the medial cortex of the neck into the femur in valgus position. 37 patients of group one were followed up for 5 months to 7 years (mean 2 years), while 57 patients of group too were followed up from 5 months to 3 years (mean 1 year). There were in total 42 men and 61 women. Age ranged from 45 to 96, the majority of patients were between 71 and 80 years old. The general condition of the patients ranged from severe in 12, average in 39 and good in 52. The type of material used was, Jewett nail in 62 patients, Smith Petersen nail combined with Mc Laughlin plate in 35 and sliding screw of Richards's in 6. Ideal osteosynthesis that is good reduction, satisfactory orientation of nail and correct distance of nail tip from the head was used in 8 patients of group one (20%) and 40 patiends of group two (64,5%). The duration of immobilization in bed following anatomical reduction (group one) was 2,5 weeks, but only 1,5 weeks for the patients operatied on by the method of Dimon-Hughston (group two). Hospitalization of group one patients lasted for an average of 5 weeks while in group two only for 3 weeks. Full weight bering using crutches was permitted in 2,5 months in group one patients and 1,5 months in group two patients. Postoperative complications in group one patients were 32% and group two 29%. Complications of osteosynthesis, mainly varus position, were 20% for group one and only 8% for group two patients. Mortality ranged 20% for both groups. Satisfactory outcome for group one was 82% and group two 89%. Comparing the two methods, we come to the conclusion that the Dimon-Hughston method is superior because: 1. Provides better stability after fixation of an unstable fractures. 2. Reduces the incidense of mechanical complications, mainly the varus displacement of the fracture. 3. Permits an early mobilization of patients. 4. Decreases hospitalization time.

Grantor dc:publisher

Aristotle University Of Thessaloniki (AUTH)

Year dc:date

1990

Authors dc:creator

• Krystallis, Christos
• Κρυστάλλης, Χρήστος

• Ιατρική και Επιστήμες Υγείας
• Κλινική Ιατρική
• Medical and Health Sciences
• Clinical Medicine

Language dc:language

gre

Identifier

10.12681/eadd/1356

OAI identifier oai:identifier

oai:10442/1356