Treatment of AO/OTA 31-A3 intertrochanteric femoral fractures with a percutaneous compression plate

OBJECTIVE: AO/OTA 31-A3 intertrochanteric femoral fractures have completely different fracture line directions and biomechanical characteristics compared with other types of intertrochanteric fractures. The choice of the fixation method has been a focus of dispute among orthopedic trauma surgeons. The purpose of this study was to review the outcomes of these fractures treated with a percutaneous compression plate at our institute. METHOD: Seventeen patients with AO/OTA 31-A3 intertrochanteric femoral fractures were treated with a percutaneous compression plate at our institute from January 2010 to December 2011. The clinical data and imaging results were retrospectively analyzed. RESULTS: The medical complication of popliteal vein thrombosis occurred in one patient. Sixteen patients were followed up for 12 to 21 months. Two patients had malunion and mild pain. Fracture collapse occurred in two patients, with one having head penetration. These two patients had moderate pain. There were no occurrences of nonunion or reoperation. The mean Harris hip score obtained during the last follow-up was 84.1 (61-97). Patients with a poor quality of reduction were more likely to have pain results (p = 0.001). A trend existed toward the presence of a poor quality of reduction (p = 0.05) in patients with a collapse of fracture. Patients with poor preoperative mobility were more likely to have a lower Harris hip score (p = 0.000). CONCLUSION: The percutaneous compression plate is an alternative device for the treatment of AO/OTA 31-A3 intertrochanteric femoral fractures. Good fracture reduction and an ideal placement position of the neck screw are important in the success of the device. .

Percutaneous compression plate versus sliding hip screw in treatment of elderly patients with osteoporotic and stable intertrochanteric fracture / 重庆医学

Objective To investigate the clinical outcomes of minimally invasive treatment of elderly patients with osteoporotic and stable intertrochanteric fracture with percutaneous compression plate as compared with sliding hip screw.Methods Retrospec-tive analysed 86 old patients with stable intertrochanteric fracture treated by PCCP(PCCP group)or SHS(SHS group)from Janu-ary 2009 to December 2010.There was 39 cases in the PCCP group and 47 cases in the SHS group.The operation time,blood loss, transfusion rate,incidence of lateral wall rupture,full weight bearing time and last Harris hip scores were recorded and compared between two groups.Results Shorter operation time,less blood loss and high Harris scores were observed in the PCCP group(P0.05). Conclusion compared with SHS,PCCP can lead to a lower surgery blood loss,shorter operation time and a better hip function.It is a suitable impant for elderly patients with osteoporotic and stable intertrochanteric fracture.

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

BACKGROUND: To evaluate the utility of additional fixation methods and to suggest a method of reduction in the treatment of unstable pertrochanteric femur fractures with a sliding hip screw (SHS). METHODS: A retrospective study was performed on thirty patients with unstable pertrochanteric femur fractures, who were operated on with a SHS between September 2004 and September 2009 and were followed up for at least 6 months. The additional fixation devices were as follows; antirotation screw (21 cases), fixation of displaced fractures of the posteromedial bone fragment (cerclage wiring, 21 cases and screw, 2 cases) and trochanter stabilizing plate (27 cases). Clinically, the Palmer's mobility score and Jensen's social function group were used. Radiologically, alignment and displacement were observed. The tip-apex distance (TAD) and sliding of the lag screw were measured, and the position of the lag screw within the femoral head was also examined. RESULTS: The mean age at the time of surgery was 76 years (range, 56 to 89 years) and the average follow-up period was 25 months (range, 6 to 48 months). At the last follow-up, the average mobility and social function score was 6.2 (+/- 3.5) and 2.3 (+/- 1.5). Postoperatively, the alignment and displacement indices were adequate in almost all the cases. The mean amount of lag screw sliding and the mean TAD was 5.1 mm (range, 2 to 16 mm) and 6 mm (range, 3 to 11 mm) respectively. The lag screws were located in the center-center zone in 21 cases. The average period to union was 18.7 weeks without any cases of nonunion or malunion. Mechanical failure was noted in one case with breakage of the lag screw and clinical failure was noted in another case with persistent hip pain related to excessive sliding (16 mm). CONCLUSIONS: With additional fixations, the unstable pertrochanteric femur fractures could be well stabilized by SHS until bone union.

Treatment of OTA type A2 Intertrochanteric Fractures of the Femur Using Sliding Hip Screw: An Analysis of Risk Factors

PURPOSE: This study was performed to evaluate the risk factors affecting the failure of fixation and to analyze the clinical and radiologic results after operation with using a sliding hip screw for treating OTA type A2 intertrochanteric fractures of the femur. MATERIALS AND METHODS: From January 2001 to June 2005, we reviewed the clinical records and the serial radiographs of 53 patients (OTA type A2 intertrochanteric fractures of the femur) who were treated with a 135-degree angled sliding hip screw. We analyzed the change in the neck-shaft angle, the sliding distance and failure of the sliding screw, according to the reduction of the lesser trochanteric fragment and the stability of the lateral buttress. RESULTS: Among 53 patients, there were 15 cases (28.3%) of failures to reduce the lesser trochanteric fragment. Losses of the lateral buttress were observed in 35 cases (66.0%). There were 8 cases (15.1%, 8/15) that failed radiologically, including cutting out of the sliding hip screw from a femoral head (3 cases), metal failure (1 case) and excessive sliding (4 cases). There were significantly differences for the changes of the angle of the neck-shaft, the distance of sliding and the length of penetration of the sliding hip screw, according to the reduction of the lesser trochanteric fragment and the stability of the lateral buttress. CONCLUSION: It is important to consider the reduction of the lesser trochanteric fragment and the stability of lateral buttress when treating OTA type A2 intertrochanteric fractures with using a sliding hip screw.

Disengagement of the Lag Screw from Side plate in a Subtrochanteric Fracture of the Femur treated with Compression Hip Screw: A Case Report

Subtrochanteric fractures of the femur can be treated by sliding hip screw devices. We encountered a subtrochanteric fracture in a 43 years old male. Open reduction and fixation with a sliding hip screw and plate were performed. One week later, the sliding screw disengaged from the side plate. In the operating room, the side plate was changed to the long barrel type and a compression screw was inserted. At two year follow-up, the fracture was united with good function.

New Wiring Method for Lesser Trochanter Fixation in Unstable Intertrochanteric Fractures: Technical Note

In unstable femoral trochanteric fracture, we usually used transversing K-wires through the lesser trochanter to achieve an anatomical reduction, and using sliding hip screws. However, in patients with comminuted lesser trochanter or osteoporosis, an intrusion of the wire into the lesser trochanter and/or iatrogenic intertrochanteric fractures were often resulted. Those who were not familiar with a technique of puncturing two holes through the lesser trochanter might have had to face some difficulties. In order to overcome aforementioned drawbacks, the authors had quite satisfactory results by employing the method of passing each of two wires above and below the iliopsoas muscle, and they were twisted posteriorly and then anteriorly; and finally they were pulled together posteriorly. Through this technique, both firm fixation of the lesser trochanter and more stable bony union were obtained.

Treatment of Unstable Trochanteric Fracture Using Sliding Hip Screw with Wiring of Lesser Trochanter / 대한정형외과학회잡지

PURPOSE: To evaluate the effect of the sliding hip screw with wiring of lesser trochanter for the treatment of unstable trochanteric fractures. MATERIALS AND METHODS: we analysed retrospectively 39 cases between 1995 and 1999. All cases were followed up for more than 1 year. Using modified Watson-Jonson approach, we performed reduction of the fracture as anatomically possible extent. RESULTS: Bony union was obtained in average 6 months. Nonunion with metal failure occurred in one case. The average sliding of lag screw was 11mm. The average change of neck-shaft angle (NSA) was 1.8degrees respectively. Satisfactory NSA was achieved in 33 cases except 2 cases of varus and 4 cases of valgus both exceeding 10degrees. CONCLUSION: The sliding hip screw with wiring of lesser trochanter is a useful option for unstable trochanteric fractures because of its initial stability as buttress effect on posteromedial cortex to allow early ambulation.