RAB-plate vs Richards CHS plate for unstable trochanteric hip fractures: A randomized study of 233 patients with 1 -year follow-up

Buciuto, Robert; Uhlin, Bo; Hammerby, Staffan; Hammer, Richard

doi:10.3109/17453679809002350

Cited by 34 publications

(18 citation statements)

References 22 publications

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“…The results with the SGN compare favourably with those of previous reports on the SHS 3,4,[7][8][9]31 and are comparable with those previously reported with the MSP. 4,9-11 The main problem remains the risk of intra-operative fractures, 3/109 (2.75%) in our study, although, in most cases, they were induced by inappropriate surgical technique.…”

Section: Discussionsupporting

confidence: 90%

“…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 failure of 2% to 4%.…”

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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: 90%

mentioning

confidence: 99%

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

View full text Add to dashboard Cite

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“…Parker (1996) found that femoral medialization was closely associated with fixation failure, and failures increased 7-fold, if medialization of more than 1/3 of the femoral diameter at the fracture site occurred. Although the DHS is the most widely used implant, the average fixation failure rate is about 10% in unstable intertrochanteric fractures (Bannister et al 1990, Bridle et al 1991, Leung et al 1992, Desjardins et al 1993, Buciuto et al 1998, Watson et al 1998). Addition of a trochanteric stabilizing plate to the DHS aims to prevent or reduce excessive femoral medializa-tion (Madsen et al 1998), but it may impede the function of the lag screw thus preventing bone-tobone contact at fracture impaction.…”

mentioning

confidence: 99%

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

Lunsjö¹,

Ceder²,

Thorngren³

et al. 2001

Acta Orthopaedica Scandinavica

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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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RAB-plate vs Richards CHS plate for unstable trochanteric hip fractures: A randomized study of 233 patients with 1 -year follow-up

Cited by 34 publications

References 22 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

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

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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