Fixation options for reconstruction of the greater trochanter in unstable intertrochanteric fracture with arthroplasty

Abstract

Introduction: With the aggravation of population aging, the incidence of intertrochanteric fracture also increases dramatically. Patients are often elderly accompany with severe osteoporosis and various complications. Therefore, we should select an individualized treatment based on the each patient's state. Arthroplasty is recommended for unstable fractures with obvious osteoporosis, ipsilateral femoral head necrosis or arthritis. Rigid fixation of the greater trochanter with arthroplasty is challenging because of the powerful pulling forces created by multiple muscles being transmitted to the greater trochanter. Currently, there are few contemporary literatures on the evaluation of unstable intertrochanteric fracture with efficient fixation of the greater trochanter. Moreover, there is no consensus to choose which implant to immobilize the greater trochanter. The purpose of this study was to review previous literatures and provide a valuable guidance. Conclusions: The locking plate, which not only provides rigid fixation but also results in lower rate of postoperative complications. However, further prospective randomized and cohort studies are needed.

Proximal femoral nail anti‐rotation vs dynamic hip screws decrease the incidence of surgical site infections in patients with intertrochanteric fractures: A meta‐analysis

“…DHS is suitable for stable intertrochanteric fractures and is advantageous in its ease of use, rapid recovery, and limited postoperative complications. Combined, these factors significantly improve the treatment outcome for intertrochanteric fractures 8,9 …”

“…Combined, these factors significantly improve the treatment outcome for intertrochanteric fractures. 8,9 PFNA is a modification of PFN. Its main feature includes the fact that the proximal end may be changed from two screws to a spiral blade.…”

“…One end of the nail holds the bone fragments in place and ensures that they resume their original positions. 8,9 Directional pressure is then applied to the fracture site via the other end of the nail. This promotes bone healing and reconstruction.…”

“…DHS insertion involves passing a nail through the femoral bone and into the medullary cavity. One end of the nail holds the bone fragments in place and ensures that they resume their original positions 8,9 . Directional pressure is then applied to the fracture site via the other end of the nail.…”

Trochanteric Bolt Failure in a Modular Femoral Revision System

“…Total hip arthroplasty (THA) in the setting of fracture increases the risk of instability and implant subsidence. 1 Complex periprosthetic fracture cases may require fixation of the greater trochanter—failure of which to fixate can result in bursitis, altered gait, and increased dislocation rates. 2 3 4 5 Claw plates with multifilament cables and screws can be used to decrease the nonunion rate.…”