The stability of intertrochanteric fractures treated with a sliding screw-plate

Abstract

Failure of fixation is a major complication of the treatment of unstable intertrochanteric fractures. A retrospective review was performed of 54 such fractures treated with a sliding screw-plate device. Linear and angular displacements were calculated from radiographs taken at operation and serially until healing was complete. Linear displacement was related to fracture instability, but the neck-shaft angle was relatively constant during healing. Complications were often due to failure of the sliding mechanism of the implant. We conclude that a sliding screw-plate allows controlled collapse of the major fragments but maintains the neck-shaft angle even in unstable fractures.

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

“…The number of varus dislocations of the head-neck fragment more than 10 degrees during fracture healing was also higher in group B (p = 0.1). It seems to confirm previous observations that telescoping movement of the CHS due to fracture impaction does not prevent such complications (Simpson et al 1989, Davis et al 1990, Flores et al 1990). …”

“…Therefore, until proven otherwise, we would not recornmend the use of the RAB-plate in trochanteric fractures with an associated subtrochanteric extension below the lateral end of the buttress rod. The telescoping of the sliding screw and impaction of the fracture fragments during weight bearing that leads to limb-shortening is usually a minor problem (Heyse-Moore et al 1983, Flores et al 1990). However, substantial limb-shortening occurred in 16% of patients treated with the CHS.…”

“…Treatment failure of unstable trochanteric fractures has been related to the type of internal fixation (Laros and Moore 1974, Jensen 1981, Anderson et al 1984, MGller et al 1984, Paaschburg Nielsen et al 1985, instability after fixation (Flores et al 1990), inadequate reduction, osteoporosis and poor placement of the screw in the femoral head (Laros and Moore 1974, Wolfgang et al 1982, Davis et al 1990). Currently, the compression hip screw (CHS), which allows impaction of the fracture, is commonest (Meislin et al 1990, Kyle et al 1994.…”

Biaxial dynamization in unstable intertrochanteric fractures Good experience with a simplified Medoff sliding plate in 94 patients

“…The complication rate was in accordance with that reported for the sliding hip screw as well as for the Gamma nail (Bannister et al 1988, Davis et a1 1990, Flores et al 1990, Larsson et al 1990, Boriani et al 1991, Bridle et al 1991, Leung et al 1992, Goldhagen et al 1994.…”

Analysis of the Factors Involved in Failed Fixation in Elderly Intertrochanteric Femoral Fracture

“…노년층의 평균 수명의 증가 로 그 빈도가 증가하고 있으며 교통 수단의 증가로 장년층 에서도 발생 빈도가 증가하고 있다 7) . 이러한 골절의 치료 원칙은 견고한 내고정을 통한 조기 보행과 골유합의 획득 이며, 수술적 치료는 크게 활강 압박 고나사를 이용한 금 속판 고정술 및 골수강내 금속정을 이용한 고정술이 있다 6) . 활강 압박 고나사는 골절 근위부의 활강을 유도함으로써 골절부의 안정과 골유합을 촉진시키며, 골수강내 금속정을 이용한 고정술은 불안정성 골절에서도 지렛대 간격을 감소 시키므로 체중 부하에도 견고한 내고정을 유지할 수 있다 는 장점이 있다.…”