Methods to Increase the Effectiveness of Trochanteric Stabilizing Plate for Unstable Femoral Intertrochanteric Fractures with Gtreater Trochanteric Fracture - Fixation of Greater Trochanter with Wire and Screw -

Abstract

The clinical outcome is favorable for the treatment of unstable femoral intertrochanteric fractures using both dynamic hip screw (DHS) and trochanter stabilizing plate (TSP) in elderly patients. However, there are sometimes complications related to excessive sliding. Therefore, the aim of this study was to evaluate the value of additional fixation of greater trochanter using wires and screw in the unstable femoral intertrochanteric fractures with a greater trochanter fracture. Materials and Methods: From March 2004 through December 2005, thirty-seven patients, who were more than sixty-five years of age and were diagnosed with osteoporosis, were treated with DHS and TSP in unstable femoral intertrochanteric fractures with a follow-up of more than 6 months (mean duration, 13.5 months). The patients were divided into two groups. One group (group A: 20 patients) was treated with DHS and TSP only, whereas the other (group B: 17 patients) was treated with DHS and TSP augmented by a wire and screw. The average age was 80.9 (range 68 to 89) and 83.2 years (range 72 to 91) in groups A and B, respectively. All the patients in both groups were assessed radiographically immediately after surgery and at the last follow-up. The level of sliding of the lag screw and displacement of the greater trochanter were evaluated statistically. Results: Bony union was achieved in all cases except for two cases in group A. At the last follow-up, the average of lag screw sliding in groups A and B was 8.96±5.98mm and 4.80±3.68, respectively, showing a statistical difference (P value<0.05). The average greater trochnateric displacement in groups A and B was 2.06±2.86mm and 0.99±1.41mm, respectively, showing no statistical significance (P value > 0.05). Conclusion: Unstable femoral intertrochanteric fractures can be treated successfully using a hip screw and TSP alone. However, the addition of wires and screws in the greater trochanter can prevent excessive sliding that occurs after displacing the greater trochanteric fragments out of the plate in the presence of a greater trochanteric fracture line or severe bone defect in the lateral aspect.

Additional Fixations for Sliding Hip Screws in Treating Unstable Pertrochanteric Femoral Fractures (AO Type 31-A2): Short-Term Clinical Results

“…The fractures of the greater trochanter involving the vastus ridge were not type A2 but type A3, which were not covered in this study. Some reported that this posterior fracture fragment can be fixed with screws to increase the stability, but we could reduce and fix this as well as the posteromedial bone fragment with one cerclage wiring alone 15). The fractured greater trochanteric fragment not involving the vastus ridge could also be supported with the addition of a TSP.…”

“…In both groups, an antirotation screw was also inserted for additional stability. A cancellous screw used parallel to the lag screw was reported to be helpful in preventing rotation of the femoral head portion in the early weight bearing period 15). This antirotation screw was used in twenty one cases (group I-III).…”

“…A cancellous screw used parallel to the lag screw was reported to be helpful in preventing rotation of the femoral head portion in the early weight bearing period. 15) This antirotation screw was used in twenty one cases (group I-III). Apel et al 11) showed that in unstable intertrochanteric femoral fractures, the fixation of large and small posteromedial bone fragments increased the mechanical stability by 57% and 17%, respectively.…”