Sa1.2 Implant related blocking of impaction – a possible cause of trochanteric non-union. The therapeutical role of lateral cortical notching (LCN)

Abstract

Introduction: Clinical Problem: the proximal femur ist he highest loaded part of the skeleton. On the other side the bone density is reduced in elderly patients so that these fractures occur mainly in elderly people. Therefore the cut out of the femur head and neck component is the most severe complication in the management of these fractures. The effect of an i beam shaped Neck component in a locked nail system (the Gliding Nail) was analysed. Material and Methods: In a five-year period 03.1996–03.2001 501 patients all patients with trochanteric and subtrochanteric fractures were evaluated. Re-examination was performed at least 6 months after therapy. All patients with no additional injury of the same leg were allowed full weight bearing immediately (98%). An experimental cut out test of Double T-Plate, single and double neck screw fixation was performed in sowbone and cadaver femora. Results: Early local complications occurred in 2.5%. Only wound revisions for haematoma (11 caseswith 5 times positive bacteriology) occurred but the general rate of complications was 28.5% especially urinary and pulmonary infections. Hospital mortality was 3.9%. Local complications were 3.3%, but in no case cut out was observed. In all cases joint preserving reosteosynthesis was possible. Central impaction of the blade was minimal with 0.24mm, varus displacement. The mean fracture impaction was only 2.2mm due to the rotation stability of the blade so that the neck could not rotate to dorsal located bone defect. The 3 months mortality was 14.9%. 15.3% were living in a nursing home. The experimental test showed 100% higher cut through in single and 400% in double screw fixation as compared to the double T plate. Conclusion: The results show that the event of a trochanteric fracture is still a serious risk but local complications especially cut out can be avoided by using the GN.