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Abstract
Purpose
To assess the effectiveness of additional fixation using a trochanter stabilizing plate for the case of an unstable intertrochanteric fracture of the femur.
Materials and Methods
Between February 2003 and February 2009, one hundred twenty-one consecutive patients with unstable intertrochanteric fractures were treated with CHSs and a TSP with or without additional screws and wiring. The follow up period was an average of twenty-eight months (range: six to sixty-one months). The fractures were classified according to the Jensen classification. We retrospectively evaluated the fracture healing time, the sliding length, the incidence of fixation failure and clinical failure, and the functional recovery.
Results
The mean time to radiologic bony union was 16.2weeks. The average amount of lag screw sliding was 8.4 mm. Overall, 119 of 121 patients had bony union and 2 patients showed nonunion. Mechanical failure was noted in 5 patients and 8 patients showed clinical failure. Ninety-four patients (78%) had at least returned to their pre-fracture level of walking ability.
Conclusion
Fixation with compression hip screws (CHSs) and a trochanter stabilizing plate (TSP) for treating unstable intertrochanteric fracture of the femur seemed to be helpful for decreasing excessive sliding and the rate of fixation failure. Short barrel CHSs and TSP fixation with additional screws and wiring are necessary for treating unstable intertrochanteric fracture of the femur, and especially for the cases with a large posterior greater trochanteric fragment or a displaced lesser trochanter.
Figures and Tables
Figure 1
1A-D. A 68-year-old male underwent closed reduction and internal fixation using CHS and TSP with additional screw and wiring due to unstable intertrochanteric fracture. (A, B) Preoperative anteroposterior and lateral radiographs show three fragmentary fracture with displaced posterior greater trochanteric fragment (white arrow). (C) Six month follow-up anteroposterior radiograph and (D)11 month follow-up anteroposterior radiograph show cut-out of a lag screw.
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