Outcome of buttress plate-nail construct used for reconstruction of broken lateral wall in intertrochanteric fractures / 中华创伤杂志(英文版)

PURPOSE@#Intramedullary implants are well accepted fixation of all types of intertrochanteric (IT) fractures, both stable and unstable types. Intramedullary nails have an ability to effectively support the posteromedial part, but fail to buttress the broken lateral wall requiring lateral augmentation. The aim of this study was to evaluate the outcome of proximal femoral nail augmented with trochanteric buttress plate for broken lateral wall with IT fractures, which was fixed to the femur through hip screw and anti-rotation screw nail.@*METHODS@#Of 30 patients, 20 had Jensen-Evan type III and 10 had type V fractures. Patients with IT fracture of broken lateral wall and aged more than 18 years, in whom satisfactory reduction was achieved by closed methods, were included in the study. Patients with pathologic or open fractures, polytrauma, prior hip surgery, non-ambulatory prior to surgery, and those who refused to participate were excluded. The operative time, blood loss, radiation exposure, quality of reduction, functional outcome, and union time were evaluated. All data were coded and recorded in Microsoft Excel spread sheet program. SPSS 20.0 was used for data analysis and normality of the continuous data was checked using Kolmogorv Smirnov test.@*RESULTS@#The mean age of patients in the study was 60.3 years. The mean duration of surgery (min), mean intra-operative blood loss (mL) and mean number of exposures were 91.86 ± 12.8 (range 70 - 122), 144.8 ± 3.6 (range 116 - 208), and 56.6 (range 38 - 112), respectively. The mean union time was 11.6 weeks and the mean Harris hip score was 94.1.@*CONCLUSION@#Lateral trochanteric wall in IT fractures is significantly important, and needs to be reconstructed adequately. Nail-plate construct of trochanteric buttress plate fixed with hip screw and anti-rotation screw of proximal femoral nail can be successfully used to augment, fix or buttress the lateral trochanteric wall giving excellent to good results of early union and reduction.

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.