Outcomes of Dynamic Condylar Screw Fixation for Unstable Peritrochanteric Fractures.

Gauhar N Khan,Jahanzeb Mazari,Hassan R Khosa,Muhammad Usman,Irfan Qadir

doi:10.7759/cureus.22866

Abstract

BackgroundThe optimal treatment modality and choice of implant for unstable peritrochanteric fractures is debatable, with multiple options ranging from intramedullary to extramedullary implants. The purpose of this study was to evaluate the radiological and functional outcomes of 95° dynamic condylar screws in unstable intertrochanteric fractures.Patients and methodsThis is a retrospective review of patients with unstable peritrochanteric fractures (31-A2 and A3 for Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF) classification) who underwent open reduction and internal fixation with 95° dynamic condylar screw at Recep Tayyip Erdogan Hospital between 2014 and 2018. All the patients had a minimum of one year of follow-up. Clinical outcomes were measured in terms of time to full weight bearing, Harris Hip Score, and time to radiographic union.ResultsThis study comprised 84 patients (including 56 males and 28 females with a mean age of 57.2 ± 9.7 years). The average time to full weight bearing was 4.2 months (range: three to six months). The radiological union was seen at a mean of 5.8 months (range: 4-11 months). Functional outcome in terms of Harris Hip Score was graded as excellent, good, fair, and poor in 18, 45, 16, and five patients, respectively. Implant failure was observed in three patients. One patient sustained a peri-prosthetic fracture, which was treated with a longer plate.ConclusionDynamic condylar screw proves to be a reliable implant when used in unstable peritrochanteric fractures and results in satisfactory functional and radiological outcomes.

Highlights

Increasing life expectancy has led to a considerable increase in the incidence of proximal femur fractures worldwide [1]
This is a retrospective review of patients with unstable peritrochanteric fractures (31-A2 and A3 for Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF) classification) who underwent open reduction and internal fixation with 95° dynamic condylar screw at Recep Tayyip Erdogan Hospital between 2014 and 2018
Dynamic condylar screw proves to be a reliable implant when used in unstable peritrochanteric fractures and results in satisfactory functional and radiological outcomes

Summary

Introduction

Increasing life expectancy has led to a considerable increase in the incidence of proximal femur fractures worldwide [1]. These fractures exhibit high morbidity and pose a significant socio-economic burden and are the most important public health issues encountered by orthopedic surgeons [1,2]. Peritrochanteric fractures are classified as stable or unstable. During one-leg standing, stable fractures are less affected by vertical stress, while unstable fractures either exhibit loss of posteromedial buttress or lateral femoral cortex [2,3]. Treatment goals are to obtain stable reduction and fixation of the fracture, allowing the earliest possible mobility [2]. The optimal treatment modality and choice of implant for unstable peritrochanteric fractures is debatable, with multiple options ranging from intramedullary to extramedullary implants. The purpose of this study was to evaluate the radiological and functional outcomes of 95° dynamic condylar screws in unstable intertrochanteric fractures

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