Anisuddin Bhatti, Suresh Kumar, Azad A Shaikh, Jamali A R, Kashif Mehmood.
Outcome of lateral stabilization of unstable inter trochanteric fractures with trochanteric stabilization plate as an adjunct to dynamic hip screw fixation.
J Pak Orthop Assoc Jan ;22(2):98-107.

Objectives: To evaluate the results of Trochanteric Stabilization Plate (TSP) superposed on to the Dynamic Hip Screw (DHS) along with an anti-rotatory screw through TSP in an unstable Inter-Trochanteric (IT) fractures. To achieve stable bone-device construct to prevent excessive collapse of fragments, failure of fixation and to achieve satisfactory fracture union in due time without significant limb shortening. Study Design: A Prospective Descriptive study. Place and Duration of Study: Department of Orthpaedic Surgery, Ward 17, Jinnah Postgraduate Medical Centre, Karachi, from January, 2006 to June, 2009. Patients and Methods: Fourty five out of Sixty consecutive patients with unstable IT fractures, of age group 60 years and above were included. They have fracture duration < weeks and follow-up duration >six months. The fractures were classified according to Evan's & AO classifications, included were Evan's type 1-C&D and AO Class 31- A2.2, 31-A2.3, 31-A3.3. Patients were treated with an addition of TSP superposed on DHS plating. Patients were evaluated on the criteria of prevention of lateralization of grater trochacter, limb shortening , radiological evidence of healing and adequate union, at the specified duration not less than six months. The functional results were evaluated according to Salvati-Wilson score. Results: Lateralization of greater trochanter with resultant medialization of the femoral shaft was successfully prevented in 34 (75.55% )fractures with limited fracture impaction of less than 7mm. Whereas, fracture impaction 8-10 mm was noticed in 8 (17.77%) fractures, and impaction >10mm in 3 (6.66%) fractures (P=0.001, Chi-Square=55.40). The average leg length discrepancy was 15.5mm (ranging from 15-20mm). This discrepancy included both true shortness & shortness due to flexion-varus contracture of the knee. Four patients with moderate to excessive collapse developed DHS bolt back out, cut out superiorly and fixation failure with non-union. Fractures in two (4.44%) healed during 06-12 months and in thirty nine (86.66%) patients fractures healed in less than six months duration (P=0.001, Chi-square=86.60). The 28 (62.66%) patient achieved excellent to good score on Salvati-Wilson Fuctional score, 11 (24.44%) fair and 6 (13.33%) patients achieved poor score, (P=0.001, Chi-square=20.24). Conclusion: In unstable Inter trochanteric fracture with primary / iatrogenic fracture of greater trochanteric or with a small cortical buttress, the addition of TSP superposed over DHS and the placement of anti-rotation screw, effectively support the unstable greater trochanter fragment, prevent medialisation of shaft, and rotation of the head-neckfragment. The early mobilization & weight bearing in these cases leads to significant socio-psychological impact, minimize limb shortening and fracture healing in due course of time.

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