Introduction: Unstable trochanteric fractures are challenging with a high rate of implant failure and re-operation. Cephalomedullary nails proved to be a rational management choice for these injuries, yet other management options have not been well assessed. The aim of this study was to compare the use of DHS with trochanteric stabilizing plate (TSP) and proximal femoral locked plate (PFLP) in unstable pertrochanteric fractures. Methods: This randomized controlled trial (RCT) included 40 patients (22 males, 18 females) with unstable pertrochanteric fractures (AO/OTA 31A2.2/A2.3). The patients were randomized into group 1 managed by DHS with TSP while group 2 was managed by PFLP. All patients were followed up for 1 year. Patients were assessed radiographically and clinically using Harris hip score (HHS) at 3, 6 and 12 months. Operative time, estimated blood loss and time to union were also compared. Results: The difference of intra-operative variables, including operative time and intra-operative blood loss, between both groups was statistically insignificant. Time to bony union was faster in the first group with a statistically significant P value (p = 0.04). Functional outcome per HHS was significantly better in group 1 (p < 0.01) and implant failure in group 1 occurred statistically lesser (p < 0.01). Discussion: DHS with TSP appears to be a good option of management for unstable pertrochanteric fractures. In contrast, the use of PFLP in unstable pertrochanteric fractures in the elderly does not appear to be a good alternative.

Background:Trochanteric hip fractures represent one of the most challenging injuries in orthopaedic practice. Dynamic hip screw (DHS) remains the gold standard in management of these fractures. Lateral femoral wall thickness (LWT) is an evolving parameter for detecting the potential for lateral wall fracture. The aim of this study was to determine the mean and cutoff levels for LWT that predict lateral wall fracture and its various implications. Methods:This prospective cohort study included 42 patients with trochanteric hip fractures treated with DHS. LWT was assessed in all patients preoperatively. Patients were divided into two groups according to the postoperative integrity of the lateral femoral wall; in group A the patients sustained a lateral femoral wall fracture, and in group B the lateral femoral wall remained intact. All patients were regularly followed for 12 mo. Results:At 12 mo, 12% of patients suffered postoperative lateral wall fracture, while in 88% the lateral femoral wall remained intact. The mean LWT in group A was 18.04 mm compared to 26.22 mm in group B. Revision surgery was 40% in group A and 5% in group B. The cutoff point of LWT below which there is a high chance of postoperative lateral wall fracture when fixed with DHS was 19.6 mm. Conclusions:Preoperative measurement of LWT in elderly patients with trochanteric hip fractures was decisive. The cutoff point for postoperative lateral wall fracture according to this study was 19.6 mm; hence, intramedullary fixation should be considered in this situation.