Management of unstable pertrochanteric fractures, evaluation of forgotten treatment options

Amr Ahmed Hosny Abdo Selim,Ahmed Samir Barakat,Ahmed Samir Farhat,Fady Kamal Beder,Ibrahim Taha Algeaidy,Nader M Diab

doi:10.1051/sicotj/2020020

Amr Ahmed Hosny Abdo Selim, Ahmed Samir Barakat + Show 4 more

Open Access

https://doi.org/10.1051/sicotj/2020020

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Journal: SICOT-J	Publication Date: Jan 1, 2020
Citations: 14	License type: CC BY 4.0

Affiliation: Cairo University

Abstract

Introduction: Unstable trochanteric fractures are challenging with a high rate of implant failure and re-operation. Cephalomedullary nails proved to be a rational management choice for these injuries, yet other management options have not been well assessed. The aim of this study was to compare the use of DHS with trochanteric stabilizing plate (TSP) and proximal femoral locked plate (PFLP) in unstable pertrochanteric fractures. Methods: This randomized controlled trial (RCT) included 40 patients (22 males, 18 females) with unstable pertrochanteric fractures (AO/OTA 31A2.2/A2.3). The patients were randomized into group 1 managed by DHS with TSP while group 2 was managed by PFLP. All patients were followed up for 1 year. Patients were assessed radiographically and clinically using Harris hip score (HHS) at 3, 6 and 12 months. Operative time, estimated blood loss and time to union were also compared. Results: The difference of intra-operative variables, including operative time and intra-operative blood loss, between both groups was statistically insignificant. Time to bony union was faster in the first group with a statistically significant P value (p = 0.04). Functional outcome per HHS was significantly better in group 1 (p < 0.01) and implant failure in group 1 occurred statistically lesser (p < 0.01). Discussion: DHS with TSP appears to be a good option of management for unstable pertrochanteric fractures. In contrast, the use of PFLP in unstable pertrochanteric fractures in the elderly does not appear to be a good alternative.

Highlights

Pertrochanteric femoral fractures are common injuries affecting the elderly population
Full clinical and radiological examinations were performed to all patients in the Accident & Emergency (A&E) department
Two patients (5%) had associated fractures in the form of nondisplaced distal radius fractures which were treated by cast application and were distributed evenly in each group

Summary

Introduction

Pertrochanteric femoral fractures are common injuries affecting the elderly population. They account for more than 50% of all hip fractures and are a common orthopaedic problem encountered in this age group [1], and are associated with considerable morbidity and mortality [2, 3]. Prototypical is the Evans classification which divides them into stable and unstable fractures based on the fracture pattern [4]. Fractures are defined as stable if they are two parts and unstable if they three or four parts. A2 type is further sub-divided into A 2.2 with one intermediate fragment and A2.3 with two or more intermediate fragments; both of them are considered unstable pertrochanteric fracture patterns [5]

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