The treatment of trochanteric fractures using a sliding screw-plate

Abstract

Summary" The authors report a retrospective study of 307 trochanteric fractures treated with a sliding screw-plate (trochanteric hip screw, THS) between J a n u a r y 1989 a n d D e c e m b e r 1994. M e c h a n i c a l f a i l u r e was u n c o m m o n (3.6%); c u t t i n g -o u t of the screw was the m a i n complication. The revision rate was also low (4%); the 12 cases included 5 total hip replacememts and 2 sliding-screw r e p l a c e m e n t s . W h a terer the fracture type, the main factors preventing mechanical failure were the quality of the fracture reduction, the g o o d p o s i t i o n i n g of the screw in the femoral h e a d and the range of postoperative sliding of the screw. Of those patients who h a d p r e v i o u s l y lived at home, 20% were able to return there directly while 73% were admitted to a r e h a b i l i t a t i o n c e n t e r , o l d p e o p l e ' s h o m e or medical unit. At the date of the last follow-up, 72% of patients who initially lived at h o m e h a d r e t u r n e d t h e r e b u t z4% were still d e p e n d e n t . These results confirm the effectiveness of the device, provided the initial surgical indications and technical operating conditons are satisfactory.Code Méary: 4338.0; o795.1Correspondence to: S.R. Babin Key w o r d s : T r o c h a n t e r i c fractures -O s t e o s y n t h e s i s -Sliding screw-plateThe greatly increased incidence of fractures of the upper end of the femur in recent decades has created a serious s o c i a l p r o b l e m , p a r t i c u l a r l y as c o n c e r n s the fate o f m o s t o f t h e s e elderly operated patients. In 8o-9o% of cases these fractures occur in persons aged over 6o (mean age 75 years), with a female p r e d o m i n a n c e (sex-ratio Z:l) and with a proportion of 1 true cervical fractures to 3 fractures of the trochanteric r e g i o n [5, 7, 3o]. The statistics show that the mortality at 3 months is between 15 and z5% [1, 3, 8, 12» 18, 32]; it is independent of the type of treatment b u t p r i m a r i l y l i n k e d to a s s o c i a t e d defects. However, the results of treatment of fractures of the upper end of the f e m u r have been i m p r o v e d since the 198os by methods of osteosynthesis which a v o i d c e r t a i n m e c h a n i c a l failures [6,15] . The THS c o m p r e s s i o n s c r e w -p l a t e , d e v e l o p e d in France b y Langlais in 1985 [16] bears comparison w i t h o t h e r s c r e w -p l a t e s ( R i c h a r d s , D H S ) [zS, z6, 31] o r s c r e w e d n a i l s (gamma-nail, HMS) [1]. We report our e x p e r i e n c e w i t h t h i s c o m p r e s s i o n screw-plate with p a r t i c u l a r e m p h a s i s on the occurrence of mechanical complications and on establishing our indications in terms of the different fracture types. Material and methods PatientsThis was a retrospective study of 307 patients with a fracture of the trochanteric region treated with the THS screw-plate in a university hospital department from 1 January 1989 to 31 December 1994.Cases were excluded if full cl...