Abstract
Purpose: The management of comminuted inter trochanteric fracture are a serious and difficult problem. The proper selection of fixation device is must to avoid significant complication in the management of this common fracture.
The use of contoured side plate screw attached to the sliding screw plate anchors the comminuted fragments thus gives better stability, compression, early mobility and bony union to this fracture where other implant fails.
Material and method: Since 1997 to 2000, 60 comminuted inter trochanteric fracture- age of 67yrs (46–91year) were treated by close/open reduction and internal fixation with 135 dynamic hip screw plate +side screw plate.
The side plate is a narrow D.C.P. (4/5 hole) which is contoured to the fl are of greater trochanter proximally and is attached to the sliding screw plate. The proximal holes of side plate hold the comminuted fragment of greater trochanter with cancellous screw above the sliding hip screw The patient were encouraged to walk on 2nd post operative day with support to start with partial weight bearing followed by weight bearing at 4 wk.
Result: On an average 12-week (8–16 wk) all the Tranzo grade II/ III fracture went into union . There was lengthening of 2.5cm (2–5 cm) in 15 cases due to valgus reduction which reduced to 1.5 cm (2–3cm) at end of 6 months. Backing up of the side plate screw and sliding hip screw was seen in 40% of case (24) (mainly in poor bone stock and valgus reduction case).
Conclusion: The side plate/ screw with sliding hip screw stables buttress for comminuted trochanter fragments gives compression, prevent rotation and better bony union the piece. This implant is an extended arm for holding fragment. The major trochanteric fracture fragment are held by side plate to sliding screw plate thus gives stability to the device, better bony contact thus early mobility and union. The sliding screw device with side plate is “forgiving” it allows subsequent displacement to achieve stability in comminuted fracture. The success of the implant assembly rest on the ability of slide and hold the fragment to give stability and bony union. This method gives an option of open reduction and bone grafting.
The abstracts were prepared by Professor Jegan Krishnan. Correspondence should be addressed to him at the Flinders Medical Centre, Bedford Park 5047, Australia.
