Thurs., 10/18/07 Femur, Paper #3, 1:12 pm OTA-2007
Leg Length Shortening in Hip Fractures of Younger Patients
Gerald E. Wozasek, MD (n); Patrick Platzer, MD (n);
Gerhild Thalhammer, MD (n); Vilmos Vécsei, MD (n);
Medical University Vienna, Department of Traumatology, Vienna, Austria
Purpose: Femoral shortening is a well-known clinical finding after surgical treatment of peri- and intertrochanteric fractures. The purpose of this study was to determine incidence and degree of femoral shortening in patients younger than 60 years of age after fixation of different types of per- and intertrochanteric fractures. In addition, we compared the results of two different implants, which were used for operative treatment.
Methods: Ninety-five patients younger than 60 years of age were evaluated for femoral shortening after surgical treatment of per- and intertrochanteric fractures between 1997 and 2002. Follow-up examination took place at an average time of 2.7 years. Fractures were classified by the AO/OTA system and divided into subtypes 31 A1, 31 A2 and 31 A3. Two different implants (dynamic hip screw [DHS] and gamma nail [GN]) were used for operative treatment, mainly depending on type and stability of the fracture. Femoral shortening was determined by standardized lower extremity radiographs measuring the distance from the top of the femoral head to the center of a line drawn between the most distal part of the medial and lateral femoral condyles. For functional assessment, we used the Harris hip score.
Results: Fifty-seven patients were treated by GN, and 38 by DHS. Femoral shortening was seen in 46 patients (48%), with a mean value of 11 mm. 22 patients had a femoral inequality of less than 10 mm, 17 patients an inequality between 10 and 20 mm, and 7 patients a shortening of more than 20 mm. Statistical analysis revealed that fracture type and implant had a significant influence on the shortening: In patients with fracture types 31 A2 and A3, femoral shortening was found to be more severe than in patients with fracture type 31 A1. Additionally, in unstable fracture types (31 A2 and A3) femoral shortening was significantly larger, when patients were treated by DHS than by GN. The average hip score was 92 points regardless of the implant.
Conclusion: Femoral shortening following operative treatment of per- and intertrochanteric fractures was found to be a common clinical finding in nongeriatric patients. Nearly half of them showed a lower limb-length inequality after fracture fixation. The degree of the shortening was rather low and mainly depended on the fracture type. Comparing the two different implants used for operative treatment, GN was more successful in preventing limb-length discrepancy in unstable fracture types than DHS.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.