RAB-Plate versus Sliding Hip Screw for Unstable Trochanteric Hip Fractures: Stability of the Fixation and Modes of Failure???Radiographic Analysis of 218 Fractures

Abstract

The RAB-plate provided a more stable fixation, especially with regard to maintained postoperative alignment. However, positive predictors for fixation failure were identical for both devices. Here, the screw/neck angle deviation has had the strongest significance for prediction of fixation failure.

Postoperative stability on lateral radiographs in the surgical treatment of pertrochanteric hip fractures

“…If eVective bone-on-bone impaction is not applied, however, excessive sliding can occur. Excessive sliding indicates that the intended compression was not obtained and has been shown to predict clinical failure [6,7,21].…”

“…These devices allow the proximal head and neck fragments to slide under control, achieve bone-on-bone impaction between the head and neck fragment and distal femoral shaft fragment. When sliding is excessive, the intended impaction on the fracture site may not be properly achieved, leading to unsatisfactory results [6,7].…”

In vitro comparison of resistance to implant failure in unstable trochanteric fractures fixed with intramedullary single screw versus double screw device

“…Until recently, most of these fractures were treated by a sliding hip screw system. Since this device performed less well in an unstable trochanteric fracture with a high rate of failure, intramedullary fixation devices have become increasingly popular 3. The PFN was developed to improve the rotational stability of the proximal fracture fragment, combining the features of an unreamed intramedullary femoral nail with a sliding, load bearing femoral neck screw 11.…”

“…Until recently, most of these fractures were treated by a sliding hip screw system. Since this device performed less well in unstable trochanteric fracture with a high rate of failure, intramedullary fixation devices have become increasingly popular 3. Two varieties of intramedullary nail are available one with single proximal screw and other with double screw 45.…”

Unstable intertrochanteric fractures: How to prevent uncontrolled impaction and shortening of the femur

“…Operative procedures for the reduction and fixation of IT fractures are technically challenging. Reoperation rates of 4% to 12% have been reported following the standard technique of fixation with a sliding compression hip screw [1][2][3][4][5] .…”