Dynamic hip screw with stabilization plate in unstable intertrochanteric fractures: a case series

Abstract

Background: Unstable intertrochanteric fractures represent about 60% of all trochanteric fractures. Dynamic hip screw alone in an unstable fracture pattern has a high failure rate of about 50%. Proximal femoral nail is technically a difficult surgery and has complications including nail failure, femoral shaft fracture, malreduction, screw cut-out, and nonunion. Putting a buttress like a trochanteric-stabilization plate acts as a support to the dynamic hip screw and gives good lateral wall buttress, which prevents excessive shaft medialization. Methods: Twenty-one patients with closed unstable trochanteric fractures were treated by dynamic hip screw with trochanteric stabilization plate. Results: According to the modified Harris Hip Scoring system, 11 patients had excellent results, five patients had good results, four patients had fair results, and one patient had a poor result. Conclusions: The dynamic hip screw with trochanteric stabilization plate provides a stable construct for unstable intertrochanteric fractures as it gives a good lateral wall buttress which prevents excessive fracture collapse, femoral shaft medialization, and consecutive limb shortening. It effectively supports the unstable greater trochanteric fragment and can maintain the lever arm with adequate abductor strength. Level of Evidence: Level IV.