Trochanteric Stabilizing Plate Research Articles

No benefit of the trochanteric stabilizing plate on loss of fracture reduction in AO/OTA 31-A2 trochanteric fractures.

Despite limited clinical scientific backing, an additional trochanteric stabilizing plate (TSP) has been advocated when treating unstable trochanteric fractures with a sliding hip screw (SHS). We aimed to explore whether the TSP would result in less post operative fracture motion, compared to SHS alone. Overall, 31 patients with AO/OTA 31-A2 trochanteric fractures were randomized to either a SHS alone or a SHS with an additional TSP. To compare postoperative fracture motion, radiostereometric analysis (RSA) was performed before and after weightbearing, and then at four, eight, 12, 26, and 52 weeks. With the "after weightbearing" images as baseline, we calculated translations and rotations, including shortening and medialization of the femoral shaft. Similar migration profiles were observed in all directions during the course of healing. At one year, eight patients in the SHS group and 12 patients in the TSP group were available for analysis, finding a clinically non-relevant, and statistically non-significant, difference in total translation of 1 mm (95% confidence interval -4.7 to 2.9) in favour of the TSP group. In line with the migration data, no significant differences in clinical outcomes were found. The TSP did not influence the course of healing or postoperative fracture motion compared to SHS alone. Based on our results, routine use of the TSP in AO/OTA 31-A2 trochanteric fractures cannot be recommended. The TSP has been shown, in biomechanical studies, to increase stability in sliding hip screw constructs in both unstable and intermediate stable trochanteric fractures, but the clinical evidence is limited. This study showed no advantage of the TSP in unstable (AO 31-A2) fractures in elderly patients when fracture movement was evaluated with radiostereometric analysis.

Comparison of intra-operative outcomes following internal fixation with trochanteric stabilisation plate or intramedullary nail in intertrochanteric fractures

PurposeIntertrochanteric fractures can be classified as stable (AO-OTA 31-A1) or unstable (AO-OTA 31-A2/3). For A3 fractures there is no recommended treatment, often fixed with either an intramedullary nail (IMN) or a dynamic hip screw and trochanteric stabilisation plate (DHS/TSP). This study retrospectively reviews peri-operative outcomes of patients treated with either fixator.MethodsPre-operative demographics, operative information and patient outcome data from 213 patients who suffered intertrochanteric fractures and were treated with either DHS/TSP or IMN at a major trauma centre from 01/2015 to 01/2022 was collected. Unpaired T tests were performed to assess levels of significance between peri-operative outcomes.ResultsThe mean age for DHS/TSP-treated patients was 2.63 years greater than IMN-treated (P = 0.039). There were no other significant differences in pre-operative characteristics. We found a significantly shorter mean operative time in the DHS/TSP group (88.05 min, 95% CI: 82.1–94.0) compared to IMN counterparts (100.8 min, 95% CI: 92.7–109.0, P = 0.012), but no statistically significant difference in length of hospital stay or patient mortality, blood transfusion, re-operation or complication rates. When A3 fractures were analysed, a statistically significant greater proportion of IMN patients required blood transfusions (DHS/TSP: 35.90%, IMN: 65.00%, P = 0.0093). All other factors were found to have no significant differences.ConclusionThis study provides evidence to support the national guidelines regarding A1 fractures and suggests that DHS/TSP is a valid alternative to the IMN in A3 intertrochanteric fractures, with reduced blood loss. With the flexibility to add the TSP intraoperatively to prevent femoral head medialisation, and cheaper implant costs, the DHS/TSP may become the preferred method of internal fixation.

Comparison of dynamic compression screw with trochanteric stabilization plate vs proximal femoral nail in intertrochanteric fracture

Background: Fracture of hip is long considered a major contributor to disability. Unstable trochanteric fractures with coronal split continue to be a challenge for orthopaedic surgeons. Objective: Comparison of dynamic compression screw with trochanteric stabilization plate vs proximal femoral nail in intertrochanteric fracture. Methodology: The current study was prospective cohort study, carried out at the Department of Orthopedic Surgery, Hayatabad Medical Complex, Peshawar for duration of six months after approval of synopsis. Patients were divided into two groups each having 63 patients. Group DHS/TSP was treated by Dynamic hip screw with Trochanteric Stabilizing Plates and Group PFN was treated by Proximal Femoral nail. On each visit X-ray of hip Harris Hip Score was calculated. Data was analyzed by statistical analysis program (IBM-SPSS.Version.23). Results: In the current study, a total of 126 patients were enrolled. There were 63 patients in DHS/TSP group and 63 in PFN group. The mean age (SD) in DHS/TSP group was 56 (8.14) years while the mean age (SD) in PFN group was 58 (7.25) years. The mean (SD) incision length in DHS/TSP group was 7.60 (0.8) cm while in PFN group it was 4.68 (0.49) cm.

Functional outcome of intertrochanteric fractures treated with trochanteric stabilizing plates

Background: Intertrochanteric fractures account for significant percentage of health care costs and result in high rates of morbidity and mortality. Since higher rate of mortality and complications most fractures can be successfully treated with trochanteric stabilizing plates. This study was conducted to assess functional outcome in intertrochanteric fracture femur treated with trochanteric stabilizing plates and define ideal mode of fixation for such fractures. Trochanter stabilizing plate (TSP) is modular extension of dynamic hip screw (DHS) that is mounted on lateral femoral wall to stabilize greater trochanter. It provides the flexibility to achieve plate to bone apposition as well as axial compression or angular stability because of three screw fixations at the proximal fragment. TSF can provide a stress shield for the lateral trochanteric wall and prevent lateral migration of proximal fragments. Thus, TSF does not fail at the screw bone interface and provide a strong anchor in osteoporotic bone. The multiple locking screw holes of the TSF provide various options to tackle complex fracture pattern. It functions as an internalized external fixator and minimizes the pressure on the periosteum and encourages biological healing. Methods: A total of 30 subjects of intertrochanteric fractures undergoing treatment with trochanteric stabilizing plates were taken up for the study after informed consent. Results: Significant results were obtained using Harris hip score (HHS) at different postoperative follow up time intervals with good outcome and low complication rate. Conclusions: Trochanteric buttress plate creates biomechanically stable construct by incorporating the comminuted trochanter it restores the proximal femoral anatomy, ensuring anatomical reduction hence subsequently reduces limb length discrepancy. We thus conclude this is an effective technique and has excellent functional and radiological outcomes with minimal complication and early rehabilitation rates. As Intertrochanteric fractures of the hip is a very common condition affecting a large number of patients of variable demographics and racial background, a more widespread study is required for a more conclusive study.

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

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.

Study of surgical management of unstable trochanteric fractures using trochanteric supporting/stabilization locking compression plate

Aim: This study has been undertaken to study surgical management of unstable trochanteric fractures using trochanteric supporting/stabilization locking compression plate. Materials and methods: 20 patients (15 male and 5 female) underwent closed reduction and internal fixation with Trochanteric Stabilisation Plate at Department of Orthopaedics J.J.M. Medical College, attached to Chigateri District Hospital, Davangere and Bapuji Hospital, Davangere during the period of October 2019 to October 2021. Patients were followed up regularly. Results: The average age was 66.25 (range of 42 to 80yrs). Excellent results were obtained in 10 cases (50%), good results in 7 cases (35%) and fair in 2 cases (10%) poor in 1 case (5%). In the study the average time for union was 14 weeks. Most common complications encountered were abduction limitation on clinical examination which no patient complained directly and limping. Conclusion: The study showed Trochanteric stabilization locking compression plates is a versatile, stable, acceptable implant fixation in unstable trochanteric fractures and osteoporotic patients.

Irreducible Posterior Hip Dislocation with Associated Isolated Comminuted Greater Trochanter Avulsion Fracture Treated with Universal Locking Trochanteric Stabilization Plate: A Rare Combination of Hip Injury

Posterior hip dislocation with greater trochanter fracture is an uncommon injury pattern in the acute trauma patient. Frequently associated injury includes a combination of hip dislocation with posterior wall of acetabulum, head of femur fracture, intertrochanteric fracture and even the most severe type of combined acetabular fracture. We report a 42-year-old man post traumatic bilateral hip injuries with irreducible posterior hip dislocation and associated isolated greater trochanteric fracture successfully managed with open reduction and fixation of greater trochanter with universal locking trochanteric stabilization plate.

The lateral femoral wall thickness on the risk of post-operative lateral wall fracture in intertrochanteric fracture after DHS fixation: A finite element analysis

BackgroundPatients with a lateral femoral wall (LFW) fracture were reported to have high rates of re-operation and complication. Although the LFW thickness was a reliable predictor of post-operative or intra-operative LFW fracture, there was a paucity of literature evaluating the critical stress distributions on the femur and screws of intertrochanteric fractures treated with dynamic hip screw (DHS). This study aimed to investigate the biomechanical performance of intertrochanteric fractures with different LFW thickness treated with DHS device. MethodsA three-dimensional model of the proximal femur was established by computed tomography images. The intertrochanteric fracture model with three different LFW thickness (10 mm, 20.5 mm and 30 mm, respectively) was created, which was fixed by DHS. The von Mises stress on the proximal femur, lateral femoral wall, DHS and the total displacement of the device components were evaluated and compared for three different LFW thickness model. ResultsThe maximum von Mises stress in the proximal fragment of the 10 and 20.5 mm model increased by 80.56% and 57.97% when compared with the 30 mm model. The peek von Mises stress around the blade entry point of the 10 mm and 20.5 mm model increased by 89.26% and 66.39% when compared with the 30 mm model. The peek von Mises in the DHS located near the junction of the barrel and side plate of each model and the 30 mm model had the smallest von Mises stress compared with the other two models. Furthermore, the maximum displacement in the 30 mm model was much smaller than that in the10mm model and 20 mm model. ConclusionsThe intertrochanteric fracture with a thinner LFW tended to have a higher risk of LFW fracture stabilized by a DHS device. Thus, the intertrochanteric fractures with a thinner LFW should not be treated by DHS alone and the intramedullary nail or an addition of trochanteric stabilization plate(TSP) was recommended.

Comparative study of extramedullary versus intramedullary fixation for unstable Intertrochanteric femur fracture

Context: Most frequent fractures of proximal femur are intertrochanteric fractures which involve upper end of femur between both trochanters with or without extending into the upper femoral shaft occuring commonly in geriatric patients. Unstable contribute to about 50%-60% of all intertrochanteric fractures. Aims: Though intertrochanteric fractures unite without surgical intervention, malunion with coxa vara deformity occur with conservative management. The aim of fixation of intertrochanteric fractures is to prevent morbidity and mortality. With this aim of stable surgical reconstruct of intertrochanteric fracture this study was done to evaluate functional, clinical and radiological outcome of unstable intertrochanteric fracture operated with dynamic hip screw with trochanteric stabilization plate (extra meduary fixation) and proximal femoral nailing (intramedullary fixation) and study epidemiology and demographics of intertrochanteric femur fractures in Indian scenario. Settings and Design: Methods and Material: The study was conducted at New Civil Hospital Surat. 50 patients with unstable intertrochanteric femur fractures admitted between february 2018 to march 2019. Conclusions: In this study we found that both-extra-medullary or intramedullary fixation were able to provide good clinical result for unstable Intertrochanteric femur fracture. We conclude that there is statistically significant difference between patients operated with DHS with TSP (Extra medullary implant) and Proximal Femoral Nail (Intramedullary implant) in terms of Blood loss, Mean operative time and functional outcome. Harris hip score in patients treated with PFN had better Harris hip score at final follow up which was statistically significant. All patients in both groups had bony union at final follow up. Blood loss and duration of surgery was significantly less with intramedullary Implant.

Trochanteric stabilizing plate in the treatment of trochanteric fractures: a scoping review

Background and purpose — The trochanteric stabilizing plate (TSP) may be used as an adjunct to a sliding hip screw (SHS) in the treatment of trochanteric fractures to increase construct stability. We performed a scoping review of the literature to clarify when and how the TSP may be useful. Methods — A systematic search was performed in 5 databases and followed by a backwards-and-forwards citation search of the identified papers. 24 studies were included. Results — 6 biomechanical studies and 18 clinical studies were included in the review. The studies presented mainly low-level evidence. All studies were on unstable trochanteric fractures or fracture models. Due to the heterogeneity of methods and reporting, we were not able to perform a meta-analysis. In the biomechanical trials, the TSP appeared to increase stability compared with SHS alone, up to a level comparable with intramedullary nails (IMNs). We identified 1,091 clinical cases in the literature where a TSP had been used. There were 82 (8%) reoperations. The rate of complications and reoperations for SHS plus TSP was similar to previous reports on SHS alone and IMN. It was not possible to conclude whether the TSP gave better clinical results, when compared with either SHS alone or with IMN. Interpretation — The heterogeneity of methods and reporting precluded any clear recommendations on when to use the TSP, or if it should be used at all.

Breakage of sliding hip screw after fixation of pertrochanteric hip fracture: A rare complication.

IntroductionThe authors report a rare case of lag screw breakage in a patient treated using locking DHS with home-made trochanteric stabilizing plate (TSP) for pertrochanteric hip fracture.Case presentationA 67 year-old female was operated for pertrochanteric hip fracture with incompetent lateral wall using locking DHS with home-made TSP. At seven months postoperative, there was radiographic nonunion with breakage of the sliding lag screw. Patient was consequently scheduled for total hip replacement.DiscussionBreakage of DHS lag screw has been attributed to multiple-cycle, low-stress fatigue failure associated with nonunion. Predisposing factors are: situation of the medial edge of the barrel at the level of the fracture site prohibiting fracture compression, and mechanical obstacle to the lag screw back sliding into the barrel. In our case, the use of handmade TSP interdicted lag screw back sliding and prevented fracture impaction which was already impaired by the location of the medial edge of the barrel at the fracture level. Additionally our fixation construct was very rigid because of the use of locking screws in the DHS side plate.ConclusionWhen DHS fixation is planned for unstable or potentially unstable trochanteric hip fracture the surgeon should be prepared by making available a TSP from the manufacturer in the operative room rather than improvising intra-operatively with handmade TSP; this augmentation device shouldn't interfere with lag screw back sliding. Furthermore the DHS barrel should ideally not impinge with the fracture site, and the use of locking screws in the DHS plate should be cautious.

Functional outcome of proximal femoral nailing in intertrochanteric fractures: A prospective study

Background: The study was conducted to assess clinical and functional outcome of Proximal Femoral nailing in intertrochanteric fractures and to determine the rate of union, complications, operative risks and co morbidities associated with intertrochanteric fractures.Intertrochanteric fractures form around half of the total hip fractures in the elderly and pose a number of management dilemmas depending on the fracture configuration and status of the bones. There are numerous implants available for the internal fixation of these fractures ranging from dynamic hip screw which can be combined with trochanteric stabilisation plate; locking plates; intramedullary implants such as proximal femoral nail (PFN), trochanteric femoral nail (TFN) and Gamma nail.Materials and Methods: The fractures were classified according to BOYD and GRIFFIN classification system. 40 patients of intertrochanteric fractures fulfilling the inclusion and exclusion criteria, were managed surgically using Proximal Femoral Nail. The results were analyzed according to age, type of fracture, operative details and functional outcome using KYLE’s criteria.Results: Totally 40 patients with intertrochanteric fractures were operated with PFN and were included in the study. The mean age of the patients was around 68 years with minimum age being 52 years and the maximum being 88 years. The mean duration of operation was recorded to be 54.59 min. Complications in this study were seen in 3 patients (8%). Complication was surgical site infection 2 patients (5%), greater trochanteric fracture 1 patient (2.5%).Conclusion: The proximal femoral nail acts as a buttress to prevent medialisation of the shaft & provides more effective load transfer. It has a chance of failure in the comminuted and severely osteoporotic fractures. It is superior implant for both stable & unstable fractures. It also has advantages of having decreased blood loss, decreased operating time, decreased complication rates.

Functional outcome of proximal femoral nailing Antirotation (PFN-A) in intertrochanteric fractures: A prospective study

Introduction: The study was conducted to assess clinical and functional outcome of Proximal Femoral nailing antirotation in intertrochanteric fractures and to determine the rate of union, complications, operative risks and co morbidities associated with intertrochanteric fractures. Intertrochanteric fractures form around half of the total hip fractures in the elderly and pose a number of management dilemmas depending on the fracture configuration and status of the bones. There are numerous implants available for the internal fixation of these fractures ranging from dynamic hip screw which can be combined with trochanteric stabilisation plate; locking plates; intramedullary implants such as proximal femoral nail (PFN), trochanteric femoral nail (TFN) and Gamma nail.Materials and Methods: The fractures were classified according to BOYD and GRIFFIN classification system. 40 patients of intertrochanteric fractures fulfilling the inclusion and exclusion criteria, were managed surgically using Proximal Femoral Nail A. The results were analyzed according to age, type of fracture, operative details and functional outcome using KYLE’s criteria.Results: Totally 40 patients with intertrochanteric fractures were operated with PFNA and were included in the study. The mean age of the patients was around 64 years with minimum age being 52 years and the maximum being 88 years. The mean duration of operation was recorded to be 49.59 min. Complications in this study were seen in 2 patients (5%), Complication was surgical site infection. Conclusion: Our study suggests that the PFNA is a better implant in elderly patients with severe osteoporosis as there is the shorter operating time and easier placement of the helical blade and also allows for early mobilization. The main benefits being the shorter surgical time and the decreased need for fluoroscopy. It has a excellent functional outcome and least least failure rates.

Implants for trochanteric fractures in Norway: the role of the trochanteric stabilizing plate\u2014a study on 20,902 fractures from the Norwegian hip fracture register 2011\u20132017

BackgroundThe trochanteric stabilizing plate (TSP) is used as an adjunct to the sliding hip screw (SHS) in unstable trochanteric and subtrochanteric fractures. We wanted to describe the choice of implant for trochanteric fractures with a focus on the TSP in Norway.MethodsA total of 20,902 fractures from the Norwegian Hip Fracture Register treated surgically in 43 hospitals from 2011 to 2017 were included. Logistic regression analyses were performed to detect factors potentially influencing implant choice.ResultsThe mean age was 83 years, and 15,137 (72%) were women. An SHS was used in 13,273 (63%) fractures, of them 4407 (33%) with a TSP. Fracture classification was the most important determinant of TSP. In cases where an SHS was used, the odds ratio (OR) for using a TSP was 14 for AO/OTA 31A2 fractures and 71 for AO/OTA 31A3 and subtrochanteric fractures, compared to AO/OTA 31A1 fractures. The probability of receiving a TSP was higher in urban, academic, and high-volume hospitals (OR 1.2 to 1.3) and lower in Central and Northern Norway (OR 0.3 to 0.7). The use of an intramedullary nail (IMN) (n = 7629 (36%)) was also to a degree decided by fracture classification (OR 1.8 to 5.3). However, hospital factors, with OR 0.1 to 0.4 for IMN in academic, urban, and high-volume hospitals and OR 1.5 to 2.6 outside South-Eastern Norway (all p < 0.001), were also important.ConclusionsFracture classification was the main determinant for TSP use. Any additional benefit from a TSP on postoperative fracture stability or clinical outcome needs to be clarified.

Comparative analysis between dynamic hip screw with trochanteric stabilisation plate and dynamic hip screw alone in the management of unstable intertrochanteric femur fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Intertrochanteric fractures of the femur are difficult to manage because of the complex patterns they present with. A dynamic hip screw (DHS) and a DHS supplemented with a trochanteric stabilisation plate (TSP) are among a variety of fixation methods used in the management of such injuries. We compared the efficacy of DHS with TSP to DHS alone in the treatment of unstable intertrochanteric femur fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 30 patients of intertrochanteric femur fractures (mean age 72 years) were included in the study, 14 were treated using DHS with TSP while 16 were treated using DHS alone, they were followed up till 16 weeks and the progress was recorded according to the parameters in the Salvati and Wilson score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 14 patients were treated using DHS with TSP, 11 of them had excellent Salvati and Wilson scores, 3 patients recorded good scores, 11 patients were able to walk with no pain while 3 needed aids for walking due to pain, normal function was restored in 12 patients while very little restriction was seen in 2 patients&lt;/p&gt;&lt;p class="abstract"&gt;Of the16 patients treated using DHS alone, 10 had excellent scores, 6 recorded a good score, 10 patients walked with no pain while 6 needed aids for walking due to pain, normal function was re-stored in 11 patients, very little restriction was seen in 4 patients while 1 patient had restricted nor-mal activity.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; DHS with TSP appears to provide better fixation and functional outcome in unstable inter trochanteric fractures over DHS alone.&lt;/p&gt;

Dynamic Hip Screw with Trochanter-Stabilizing Plate Compared with Proximal Femoral Nail Antirotation as a Treatment for Unstable AO/OTA 31-A2 and 31-A3 Intertrochanteric Fractures.

Background The dynamic hip screw (DHS) with the addition of an angular stable trochanter-stabilizing plate (TSP) has been considered the ideal treatment for the unstable intertrochanteric fracture type. However, there have been few comparisons between DHS+TSP augmentation with intramedullary (IM) nailing. The aim of this retrospectively registered study was to compare the clinical outcomes of patients with the unstable type of intertrochanteric fractures treated with DHS+TSP or IM nailing (proximal femoral nail antirotation (PFNA)). Methods From June 2013 to April 2018, 358 patients with proximal femur fracture AO/OTA type 31A2 and 31A3 treated with PFNA or DHS+TSP and followed for ≥10 months postoperatively were included. The surgical-dependent outcome evaluation included the operation time, intraoperative blood loss, postoperative decrease in hemoglobin, and blood transfusion amount. Functional status was also measured. Radiographic findings and postoperative complications were recorded and analyzed. Result The operation time was significantly shorter in the DHS+TSP group than that in the PFNA group for both A2 and A3 fractures (A2 type: 84.0 vs.96.4 min; p < 0.05; A3 type: 102.4 vs.116.1 min; p < 0.05). Postoperative decrease in hemoglobin was more significant in the PFNA group than that in the DHS+TSP group for both fracture types (A2 type: −1.88 vs. −1.29 (mg/dL); p < 0.05; A3 type: −1.63 vs. −1.04 (mg/dL); p < 0.05). However, the patients treated with DHS+TSP had significantly more residual pain than those treated with PFNA during the final follow-up (Visual Analog Scale score, A2 type: 28.4 vs.23.2; p < 0.05; A3 type: 27.5 vs.23.6; p < 0.05) and complained of greater implant irritation. Conclusion We found that DHS+TSP was associated with less operation time and less postoperative decrease in hemoglobin but more residual pain and implant irritation than those of PFNA. As a treatment for unstable intertrochanteric fracture, DHS+TSP provided ideal surgical outcomes which were not inferior to the PFNA.

Management of unstable pertrochanteric fractures, evaluation of forgotten treatment options

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.

PFNA and DHS for AO/OTA 31-A2 fractures: radiographic measurements, morbidity and mortality.

For this retrospective cohort study, we assessed pertrochanteric fracture types AO/OTA 31-A2. PFNA and DHS were the devices used. We determined both devices in relation to peri-operative variables, postoperative radiographic measurements, implant-related complications and mortality up to 2years. The null hypothesis was no effect between the two devices. This single-centre study was conducted based on our computerized data. The treatment period ranged from 2006 to 2015. Only patients with type AO/OTA 31-A2 fractures and an age ≥ 65years were included. Apart from descriptive variables, the following measurements were assessed: (1) duration of surgery, (2) blood loss, (3) transfusion, (4) hospitalization, (5) tip-apex distance (TAD), (6) fracture reduction, (7) screw position, (8) implant-related complications, and (9) mortality. The follow-up was 2years for each living patient. Missing data were evaluated by telephone call. A total of 375 consecutive patients were enrolled into three groups: (1) 75 patients treated with DHS and antirotation screw (ARS); (2); 100 patients treated with DHS + ARS + TSP (trochanteric stabilization plate); and (3) 200 patients treated with PFNA. Apart from dementia, the descriptive data (e.g., age and BMI) demonstrated no effects between the three groups. Compared to PFNA, DHS with or without TSP was adversely affected by a longer operation time, higher blood loss, increase in transfusion, and more implant-related complications including cut-out, infection and failure. The rate of cut-out was significantly higher in TAD ≥ 25mm (p = 0.005), and PFNA demonstrated significantly better TAD measurements (p = 0.001), better fracture reduction (0.002), more central-central screw positions (p = 0.014), and less poor screw placement (p = 0.001). The mortality rate was without effect between the three groups (log rank 0.698). DHS with or without TSP was associated with significantly higher rates of implant-related complications based on inferior radiographic measurements. Therefore, we only recommend PFNA for the treatment of proximal type AO/OTA 31-A2 femoral fractures. Therapeutic level III.

Comparative study between proximal femoral nail and dynamic hip screw with trochanteric stabilizing Plate (TSP) in unstable intertrochantric femur fractures

Comparative study between proximal femoral nail and dynamic hip screw with trochanteric stabilizing Plate (TSP) in unstable intertrochantric femur fractures

Clinico-radiological results of unstable trochanteric fractures treated with custom-made trochanteric stabilisation plate and dynamic hip screw (DHS)

Aim: To evaluate the clinico-radiological results of implantation of Custom-made Trochanteric stabilisation plate (TSP) along with Dynamic Hip Screw (DHS) in unstable trochanteric fractures and assess whether it prevents complications such as excessive collapse and femoral medialization.Materials and Methods: 58 consecutive patients with unstable intertrochanteric fractures (AO CLASSIFICATION) were treated with an additional custom-made TSP superimposed on the regular DHS at our institution between JAN 2012 TO DEC 2015.9 patients did not turn up for regular follow-up. Thus, 49 patients were followed-up for a period of 6 months. Patients were assessed clinically using Harris His Score and Salvati-Wilson score at each follow-up. Results: Excessive collapse and medialization of femur were successfully prevented in 49 patients. Clinico-radiological consolidation of fracture was observed at an average of 15.23 weeks in all the cases. The average sliding distance was 7.3 mm.38 patients had a Harris Hips Score (HHS) of above 90 at the final follow up and the rest had a HHS of above 80. Functional results were excellent in 88 percent of patients and good in the rest 12 percent according to Salvati- Wilson score. Conclusion: In unstable intertrochanteric fractures with lateral wall comminution, the use of our custom-made TSP along with DHS helps in achieving a stable fixation and prevents complications such as excessive collapse and femoral medialization. Custom-made TSP is easily available and is a cost-effective alternative for anatomical TSP.