Abstract

Aim: The addition of the Trochanteric Support Plate (TSP) to the Dynamic Hip Screw is a very effective way of treatment of the reverse oblique fractures of the proximal femur. It secures the stabilisation of the greater trochanter as well as it prevents from the lateral transposition of the greater trochanter during the impaction of the fracture postoperatively.

Method: The reversed oblique fractures of the proximal femur is a group of unstable fractures characterised by a fracture line going from lateral distal to medial proximal of the lesser trochanter. The OTA classifies them as 3.1 A3 fractures and subdivides them in 31 A3.1, 31 A3.2. and 31 A3.3 groups. We operated on 1535 fractures of the hip in our Department during Jan. 1998 to Dec. 2002, 997 of them were introchanteric or subtochanteric fractures. Among them there were 35 reversed oblique fractures. Five of them were fixed by an interlocking nail (gamma nail), nire of them by a Dynamic Hip Screw and twenty one by the Dynamic Hip Screw with the addition of a Trochanteric Support Plate. We surveyer the duration of the operation as well as the duration of the operation as well as the radiation time in each of them.

Results: Five out of nine fractures treated by the dynamic hip screw alone failed and were reoperated one out of four fractures treated by the gamma nail developed a pseudarthrosis and was reoperated, too. Only one out of twenty one fractures treated by the dynamic hip screw with the addition of the trochanteric support plate (TSP) failed because of inadequate reduction of the fracture and wrong placement of the screw.

Conclusion: The addition of the Trochanteric Support Plate to the Dynamic Hip Screw is a more satisfactory way of treatment of the reversed oblique fractures of the proximal femur when compared to the other methods of osteosynthesis. The advantages are: lower percentage of complications, easy application of the plate and short radiation time. However the result may be disastrous in case of a bad reduction of the fracture and a wrong placement of the screw.

Footnotes

  • The abstracts were prepared by Eleni Koutsoukou. Correspondence should be addressed to him at the Hellenic Association of Orthopaedic Surgery and Traumatology (HAOST), 20, A. Fleming str, 15123 Marousi, Athens, Greece.