Extramedullary fixation of 569 unstable intertrochanteric fractures: A randomized multicenter trial of the Medoff sliding plate versus three other screw-plate systems

Lunsjö, Karl; Ceder, Leif; Thorngren, Karl–Göran; Skytting, Björn; Tidermark, Jan; Berntson, Per-Olof; Allvin, Ingemar; Norberg, Sigge; Hjalmars, Krister; Larsson, Sune; Knebel, Richard; Hauggaard, Anders; Stigsson, Leif

doi:10.1080/000164701317323372

Cited by 60 publications

(20 citation statements)

References 17 publications

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“…The rate of failure of 5.5% compares favourably with that in previous studies on the SHS 3,4,6-9 and is somewhat better than the 6.7% reported for the MSP in the Swedish multicentre study, 22 but not as good as the 2.0% reported by Lunsjö et al 10 or the 3.8% reported by Watson et al 4 For the limited group of subtrochanteric fractures, the rate of failure was surprisingly high for the MSP. The two revisions because of technical failures were due to excessive medialisation in patients with Seinsheimer type-S 2C fractures, 5 also referred to as the reversed oblique subtrochanteric fracture.…”

Section: Discussionsupporting

confidence: 70%

“…11 Furthermore, in clinical practice, the differentiation between low trochanteric fractures and high subtrochanteric fractures may be difficult and lead to erroneous uniaxial dynamisation in trochanteric fractures. This was the situation in the Swedish multicentre study 22 in which the locking set screw was erroneously used in 29 of 268 patients and contributed to penetration of the lag screw in nine. The suboptimal results of uniaxial dynamisation in unstable trochanteric fractures was also demonstrated in an early study by Lunsjö et al 40 with a rate of penetration of the lag screws of 6.7%.…”

Section: Discussionmentioning

confidence: 99%

“…We have used the MSP and SGN in clinical practice for several years, the MSP since 1992, including participation in the Swedish multicentre study, 9,22 and the SGN since 1996. In order to evaluate our results with the SGN, a randomisation vs the MSP seemed logical considering the good results previously reported.…”

mentioning

confidence: 99%

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The standard Gamma nail or the Medoff sliding plate for unstable trochanteric and subtrochanteric fractures

Miedel

Ponzer

Törnkvist

et al. 2005

The Journal of Bone and Joint Surgery. British volume

122

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We studied 217 patients with an unstable trochanteric or subtrochanteric fracture who had been randomly allocated to treatment by either internal fixation with a standard Gamma nail (SGN) or a Medoff sliding plate (MSP, biaxial dynamisation mode). Their mean age was 84 years (65 to 99) and they were reviewed at four and 12 months after surgery. Assessments of outcome included general complications, technical failures, revision surgery, activities of daily living (ADL), hip function (Charnley score) and the health-related quality of life (HRQOL, EQ-5D).The rate of technical failure in patients with unstable trochanteric fractures was 6.5% (6/ 93) (including intra-operative femoral fractures) in the SGN group and 5.2% (5/96) in the MSP group. In patients with subtrochanteric fractures, there were no failures in the SGN group (n = 16) and two in the MSP group (n = 12). In the SGN group, there were intraoperative femoral fractures in 2.8% (3/109) and no post-operative fractures. There was a reduced need for revision surgery in the SGN group compared with the MSP group (8.3%; 9/108; p = 0.072). The SGN group also showed a lower incidence of severe general complications (p < 0.05) and a trend towards a lower incidence of wound infections (p = 0.05). There were no differences between the groups regarding the outcome of ADL, hip function or the HRQOL. The reduction in the HRQOL (EQ-5D index score) was significant in both groups compared with that before the fracture (p < 0.005).Our findings indicate that the SGN showed good results in both trochanteric and subtrochanteric fractures. The limited number of intra-operative femoral fractures did not influence the outcome or the need for revision surgery. Moreover, the SGN group had a reduced number of serious general complications and wound infections compared with the MSP group. The MSP in the biaxial dynamisation mode had a low rate of failure in trochanteric fractures but an unacceptably high rate when used in the biaxial dynamisation mode in subtrochanteric fractures.The negative influence of an unstable trochanteric or subtrochanteric fracture on the quality of life was significant regardless of the surgical method.The treatment of stable trochanteric fractures of type 1 or type 2 according to the classification of Jensen and Michaelsen (J-M) 1 is uncontroversial and good results can be expected with various implants. 2 Most authors favour the sliding hip screw (SHS) and recent studies on this method have shown rates of failure below 2%. 3,4 In the case of unstable trochanteric fractures (J-M type 3 to 5) 1 and subtrochanteric fractures, 5 the treatment is more controversial and the rate of failure for the SHS in these fractures is considerably higher, ranging from 4% to 15%. 3,4,[6][7][8][9] The Medoff sliding plate (MSP) evolved from the SHS and gives axial compression along both the femoral neck (optional) and the femoral shaft. It has produced remarkably good results in prospective trials in both unstable trochanteric and subtrochanteric fractures with a rate of fa...

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The standard Gamma nail or the Medoff sliding plate for unstable trochanteric and subtrochanteric fractures

Miedel

Ponzer

Törnkvist

et al. 2005

The Journal of Bone and Joint Surgery. British volume

122

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“…No implant failure reported in both groups of this series while according to Lunsjo et al average fracture fixation failure rate is about 10% in unstable inter-trochanteric fractures. 15 Complications such as malunion, femur shortening was slightly higher in DHS group. Although PFN seems to be a better implant in patients with unstable intertrochanteric fractures but it is technically demanding as we encountered intraoperative complications as iatrogenic fracture of lateral cortex in one patient and fracture displacement by nail insertion in another patient.…”

Section: Discussionmentioning

confidence: 99%

A comparative study of 70 cases of inter-trochanteric fracture femur treated with dynamic hip screw and proximal femoral nailing

Singla

2017

Int J Res Orthop

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Background: Inter-trochanteric fracture femur is a common and grievous injury, mostly suffered in elderly people. It accounts for approximately half of hip fractures in elderly and out of this, more than 50% of fractures are unstable. In old age, it occurs mostly due to trivial trauma. Various procedures of internal fixation had been proposed as a treatment. DHS considered to be the standard procedure for comparison of outcomes. The advantage of proximal femur nailing fixation is that it provides a more biomechanically stable construct by reducing the distance between hip joint and implant. The goal of this study is to compare the clinical and radio-graphical results of the DHS and PFN for the treatment of Intertrochanteric hip fractures (load bearing vs. load sharing).Methods: Seventy patients (more than 55 years old) presented to Adesh Hospital from March 2015 to November 2015 with trochanteric fracture femur. Patients were treated with osteosynthesis with dynamic hip screw (DHS) and proximal femoral nailing (PFN). The clinical results were compared between the dynamic hip screw and proximal femoral nailing groups of 35 patients each. All surgeries done on traction table and were followed up at regular intervals of 4 weeks, 6 weeks, 8 weeks, 10 weeks, 12 weeks, 6 months and at 1 year.Results: We observed no statistically significant difference between two groups in view of late & early complications and time to union. We observed significantly better outcomes in PFN group for unstable inter-trochanteric fractures and in unstable fractures reduction loss is significantly lower in PFN group.Conclusions: We concluded that PFN may be the better fixation device for most unstable inter-trochanteric fractures.

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“…In our study, only 2 failures of fixation (1.3%) occurred. In previous studies on trochanteric fractures treated with the SHS, the rate of fixation failure has varied between 0% and 26% (Sernbo et al 1988, Davis et al 1990, Nungu et al 1991, Barrios et al 1993, Desjardins et al 1993, Radford et al 1993, Stappaerts et al 1995, Leung et al 1996, Buciuto et al 1998, Watson et al 1998, Lunsjö et al 2001b). The most common mode of fixation failure has been a cut-out of the lag screw through the femoral head.…”

Section: Discussionmentioning

confidence: 99%

The Hansson Twin Hook is adequate for fixation of trochanteric fractures: 2 fixation failures in a series of 157 prospectively followed patients

et al. 2008

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Background and purpose The Hansson Twin Hook (HTH) is an alternative to the lag screw in the treatment of trochanteric fractures. In osteoporotic bone, mechanical tests have indicated that the HTH has better fixation properties than the lag screw. We evaluated the fixation stability of the HTH in a large series of elderly patients with trochanteric fractures. Many surgeons were involved in assessment of whether the device was user-friendly.Patients and methods In a prospective bicentric study, 55 surgeons used the HTH and a standard plate in 157 consecutive patients with trochanteric fractures, 83% of which were unstable. The mean age of the patients was 83 (43-98) years. They were followed regularly clinically and radiographically for at least 4 months, with a radiographic file search at 2 years.Results Technical errors occurred intraoperatively in 7 cases. The reduction of the fracture was inaccurate in these patients; thus, the HTH had not been placed centrally in the femoral head. One of these errors was immediately and easily corrected without interference with the standard plate, and caused no further problems. 2 of the remaining 6 intraoperative errors developed into failures of fixation during the 2-year period.Interpretation The HTH gives adequate fixation in the bone of elderly patients with trochanteric fractures and has a low failure rate. It is also easy to use.

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Extramedullary fixation of 569 unstable intertrochanteric fractures: A randomized multicenter trial of the Medoff sliding plate versus three other screw-plate systems

Cited by 60 publications

References 17 publications

The standard Gamma nail or the Medoff sliding plate for unstable trochanteric and subtrochanteric fractures

The standard Gamma nail or the Medoff sliding plate for unstable trochanteric and subtrochanteric fractures

A comparative study of 70 cases of inter-trochanteric fracture femur treated with dynamic hip screw and proximal femoral nailing

The Hansson Twin Hook is adequate for fixation of trochanteric fractures: 2 fixation failures in a series of 157 prospectively followed patients

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