Unstable trochanteric Fracture Fixation with P.F.N. augmented by T.B.W.

For inter trochanteric fracture Proximal Femoral Nail (PFN) is a better choice of implant biomechanically. But in communicated inter trochanteric fractures it is associated with screw breakage, cut out through femoral head, ”Z” & reverse “Z” effect and lateral migration of screws. The purpose of this study is to evaluate the results of PFN in terms of post-operative complication and failure rates in unstable trochanteric fracture with addition of 1 or 2 tension band wires. Material & Method:We did study of 21 unstable trochanteric fractures from January 2016 to November .2020. 14 patients were males & 7 patients were females. Age group between 25 to 80 was included in this group. There were 15 A0 A2 (2.2, 2.3) and 6 were A0 A3 (3.1, 3.2, 3.3). All fractures were ?xed with 25cm, 0135PFN mainly 11 mm, 12mm in diameter with addition of one or two 16 gauge tension band wire, strengthening lateral trochanteric wall and holding either communiated fragments or lesser trochanteric fracture. Results:The fracture was united in all cases with mean period of 16 weeks. Two patients developed complication of TBW (Tension Band Wire) breakage; one developed lateral migration of screws. Patients were followed till bone was united. At the end of follow up hip function were 30 (out of 40) in 80% patients by using Salvati and Wilson hip score. Conclusion: The stabilization of lateral trochanteric wall fracture and communiated fragments of inter trochanteric fractures, additional one or two TBW increases the stability of construct enhancing bony union & better results.

Comparison of the Treatment Results between Reduction with Percutaneous Wiring and Reduction without Percutaneous Wiring in Reverse Oblique Trochanteric Fractures (AO Classification 31-A3.3)

PURPOSE: The aim of this study was to investigate the utility of percutaneous wiring in the reduction of reverse oblique trochanteric fractures (AO classification 31-A3.3) by analyzing the treatment results with or without the use of percutaneous wiring. MATERIALS AND METHODS: Thirty-five cases from January 2008 to August 2014 that could be followed-up for at least one year were selected among patients with unstable trochanteric fractures who underwent either internal fixation or open reduction. Seventeen patients underwent surgery with percutaneous wire fixation but another 18 patients underwent surgery without it. All patients received a closed reduction and internal fixation with an intramedullary nail. The factors evaluated were as follows: the length of operation, loss of blood, length of in-hospital stay, lower limb function scale, return to preinjury daily life, change in femur neck shaft angle, postoperative gap of the fracture site, time taken for bone attachment, quality of post-operative reduction, and complications. RESULTS: No significant difference in the mean operative time, loss of blood, length of in hospital stay, lower limb function scale, return to pre-injury daily life, change in femur neck shaft angle, postoperative gap of the fracture site, and quality of postoperative reduction was observed between the two groups. A significant difference was noted in the time taken for bone attachment (p=0.032). Bone attachment took 13.3 weeks (9–17 weeks) on average when fixed with percutaneous wiring and no patient was found to have any complications. When treated without percutaneous wiring, however, bone attachment took 17.8 weeks (12.5–28.0 weeks) on average and three cases resulted in delayed union. CONCLUSION: Percutaneous wiring is a recommended treatment option for patients with an unstable trochanteric fracture.

Role of proximal femur locking plate fixation in certain unstable trochanteric fractures.

Background: Comminution of the lateral trochanteric wall, postero-medial communition, reverse oblique fractures, fractures involving communition of greater trochanter are unstable fractures which had poor results with the regular methods of fixation. Our aim in this study is to evaluate radiological and functional outcome at the end of one year following proximal femur locking plate fixation for certain group of unstable intertrochanteric fractures. Methods: 20 patients (14 male and 6 female patients) with per trochanteric fractures underwent proximal femur locking plate fixation in Sri Ramachandra Medical College hospital. Intertrochanteric fractures were classified according to Boyd and Griffin. Mean age of the patients was 55.2 years (26-82 years). The Schatzker & Lambert Criteria used to evaluate the functional outcome at the end of one year. Minimum follow up period was six months and maximum follow up was one year. Results: The functional outcome was assessed by Schatzker and Lambert criteria and was excellent in 8 patients; good in 6, Fair in 4 and Poor in 2.The average time to bear weight fully and walk was 6.5 weeks. Conclusions: Union was achieved in unstable, comminuted trochanteric fractures without significant complications and neck shaft angle was maintained in majority of the cases following proximal femur locking plate fixation.One of the major drawbacks of using proximal femur locking plate is that weight bearing is to be controlled and done only after radiological evidence of callus formation.

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.