[Effect of adjunctive cancellous screw in treatment of intertrochanteric fractures with dynamic hip screw fixation].

OBJECTIVE: To study the technique and effect of adjunctive cancellous screw in treatment of intertrochanteric fractures with dynamic hip screw (DHS) fixation.

METHODS: Between April 2004 and August 2007, 33 patients with intertrochanteric fracture were treated with DHS fixation and adjunctive cancellous screw. There were 13 males and 20 females, aging 43-82 years with an average age of 67 years. Fractures were caused by traffic accident in 7 patients, by falling from height in 11 patients, by sprain in 15 patients. All fractures were closed. The patients were operated 3-12 days after injury. According to Evans classification, there were 12 cases of type II, 15 cases of type III, and 6 cases of type IV. Twenty-two cases had osteoporosis. Weight bear time and complication were recorded. Fracture healing and neck-shaft angle were observed on radiogram. Hip functions were evaluated using Radford criterion.

RESULTS: Thirty-three patients had no intraoperative complications with incision healing by first intension. All patients were followed up from 14 months to 38 months, with an average of 21 months. Fracture healing was achieved within 14 weeks to 21 weeks, with an average of 17 weeks after operations. The neck-shaft angles were (134.2 +/- 13.7) degrees 3 days after operation, (128.6 +/- 8.9) degrees 8 weeks after operation, and (128.5 +/- 9.3) degrees after fracture healing, showing no significant difference when compared with that of the third day after operation (P > 0.05). According to the Radford criterion at last follow-up, the excellent and good rate of hip function was 93.9% (excellent in 21 cases, good in 10 cases, and poor in 2 cases). Complications such as loosening, breakage, or grievous migration of hardware were not observed.

CONCLUSION: The adjunctive cancellous screw in treatment of intertrochanteric fractures with DHS fixation can provide counteraction of tension and rotation, promote fixation stability, enhance fracture healing and decrease complication.