DYNAMIC HIP SCREW WITH TROCHANTERIC STABILIZING PLATE IN THE TREATMENT OF UNSTABLE INTERTROCHANTERIC FRACTURES: A PRELIMINARY REPORT OF 20 CONSECUTIVE PATIENTS

摘要

Purpose: The present study was conducted to evaluate the use of a trochanteric stabilizing plate (TSP) as an adjunct to dynamic hip screw (DHS) fixation in the treatment of unstable intertrochanteric fractures.Materials & Methods: Twenty consecutive patients were treated with DHS and additional TSP between October 2006 and October 2008. All of the fractures were unstable intertrochanteric fractures according to the Evans classification. All fractures were fixed with a 4-hole, 135deg DHS and additional TSP and an antirotation cancellous screw. Patients were followed for at least 12 months.Results: No incidents of lag screw cutout, excessive varus collapse, or implant failure were observed. Radiographs showed callus formation at 6 to 8 weeks and solid bony union within 5 months. The neck-shaft angle of the operative side was equal to that of the contralateral hip on immediate postoperative radiographs in all cases, but a decrease averaging 3deg (range, 0-5deg) was observed at the time of solid bony union. Compared with the initial postoperative radiographs, those at the time of solid bony union revealed lag screw backsliding of around 10 mm (range, 3-15 mm) and leg-length shortening of around 7 mm (range, 2-10 mm). Functional evaluation was performed using the Harris hip score. The scores were good at the time of bony union, even in patients with leg-length shortening.Conclusions: The results of this study show that DHS with TSP fixation is effective in the treatment of unstable intertrochanteric fractures and results in fewer complications than DHS alone.