Abstract
The greater trochanter and its role in stability in fixation of extracapsular hip fractures has been neglected in comparison with the lesser trochanter. In unstable fracture types, gradual medial translation of the femoral shaft occurs as a consequence of the use of sliding hip screws and, if excessive, may be associated with fixation failure. In a live bio-mechanical trial with the Medoff sliding plate (MSP), we wanted to evaluate how the fracture configurations of the lateral and the medial femoral cortices affected the reduction and the impaction of the fracture as well as the femoral medialisation.
The MSP is a modified hip screw-plate, which acts to prevent medialisation by allowing only vertical impaction of the fracture along the femoral shaft (uniaxial dynamisation). It also has an optional lag screw sliding along the neck of the femur, allowing biaxial dynamisation. Intertrochanteric fractures in 189 elderly patients were treated by either uni- or biaxial dynamisation and followed for one year with serial radiographs.
Fractures with a broken lateral cortical spike from the femoral shaft commonly had medial reduction as well as medialisation and also had a significant increase in both lag screw and plate slide compared with fractures with an intact lateral cortical spike. A medial cortical fracture with a major defect larger than the size of the lesser trochanter had less influence on sliding or on medialisation.
We conclude that involvement of the greater trochanter is an important factor in determining stability in complex intertrochanteric fractures
Get full access to this article
View all access options for this article.