Aims. Despite limited clinical scientific backing, an additional trochanteric stabilizing plate (TSP) has been advocated when treating unstable trochanteric fractures with a sliding hip screw (SHS). We aimed to explore whether the TSP would result in less post operative fracture motion, compared to SHS alone. Methods. Overall, 31 patients with AO/OTA 31-A2 trochanteric fractures were randomized to either a SHS alone or a SHS with an additional TSP. To compare postoperative fracture motion, radiostereometric analysis (RSA) was performed before and after weightbearing, and then at four, eight, 12, 26, and 52 weeks. With the “after weightbearing” images as baseline, we calculated translations and rotations, including shortening and medialization of the femoral shaft. Results. Similar migration profiles were observed in all directions during the course of healing. At one year, eight patients in the SHS group and 12 patients in the TSP group were available for analysis, finding a clinically non-relevant, and statistically non-significant, difference in total translation of 1 mm (95% confidence interval -4.7 to 2.9) in favour of the TSP group. In line with the migration data, no significant differences in clinical outcomes were found. Conclusion. The TSP did not influence the course of healing or postoperative fracture motion compared to SHS alone. Based on our results, routine use of the TSP in AO/OTA 31-A2 trochanteric fractures cannot be recommended. The TSP has been shown, in biomechanical studies, to increase stability in sliding hip screw constructs in both unstable and intermediate stable trochanteric fractures, but the clinical evidence is limited. This study showed no advantage of the TSP in unstable (AO 31-A2) fractures in elderly patients when fracture movement was evaluated with radiostereometric analysis. Cite this article: Bone Jt Open 2024;5(1):37–45

Lateral unstable fractures of the femoral neck represent a controversial problem for the surgical treatment, due to the difficulty in achieving an adequate mechanically stable bone-devices system. Compression hip screw alone has proven to be inadequate, while in association with the trochanteric stabilizing plate (TSP) it offers better results. The authors analyse functional results and complications of a series of 87 lateral unstable fractures of the femoral neck (type A2 and A3 of the AO classification). Weight bearing was allowed 48 hours after surgery. The most important complications reported were: persistent trochanteric pain (12 cases) shaft medialization and device mobilization (2 cases) shortening of more than 2cm (3 cases). All complications were reported in A3 type fractures. Our data confirm the efficacy of the TSP the treatment of lateral unstable fractures of the femoral neck (type A2) because it stabilizes the lateral cortex. In A3 type fractures, intramedullary devices offers better results than compression hip screw and TSP in terms of complications rate and stability

Aim: Unstable lateral fractures of the proximal femur (type A2 and A3 of AO classiþcation) present a controversial problem for surgical treatment, due to the difþculty to achieve an adequate mechanically stable bone-device system, so to allow an early weight-bearing. To improve the stability of bone-device complex, a trochanteric stabilizing plate (TSP) has been introduced. The properties of TSP is to avoid shaft medialization in the postoperative. The aim of our study was report results of surgical treatment of unstable trochanteric fractures using a dynamic hip screws in association with TSP. Methods: From January 2000 to March 2002, 51 patients affected by this kind of fractures (type A2 of the AO classiþcation 37 cases and type A3 14 cases) were treated with the association of dynamic hip screw and trochanteric stabilizing plate. Results: The average time that patients spent in the hospital was 7.8 days for the group A2,2, 8.5 days for the group A2,3, 9.9 days for A3,1 and 10.3 days for A3,2. The average healing time was 6 weeks for A2 fractures and 7.2 weeks for the A3. According to the HSS at 6 months for the group A2,2 the average score was 85,5 for the group A2,3 was 81,7 for the group A3,1 was 74,4 and for the group A3,2 was 70,1. The main postoperative complications were 3 superþcial infection of surgical wound, 3 deep vein trombosis and 1 pulmonary embolism. Conclusions: Our series show that this device, although it interferes with trochanteric structures, is a real aid for the dynamic hip screw system in the treatment of unstable lateral fractures of proximal femur due to the possibility of stabilizing the great trochanter and the lateral cortex in order to avoid the medialization forces of the femoral shaft

Aims: The aim of our study was to assess results of treatment of trochanteric fractures using a speciþc algorythm Methods: From January 2000 to March 2002, 215 patients affected by fractures of trochanteric region were treated. 130 were female and 85 male, the average age was 72,5 (5–96). Author used an algorythm based on the analysis of stability of the bone-device system considering three groups: GROUP 1: stable fractures (A1 and A2.1 according to AO classiþcation) in which dynamic hip screw was employed, GROUP 2: unstable fractures (A2.2, A2.3, A3.1) in which dynamic hip screw and trochanteric stabilizing plate were employed, GROUP 3:unstable fractures (A3.2 and A3.3) in which intramedullary nailing was performed. Results: The average healing time was 6 weeks for GROUP 1 and GROUP 2 and 7,2 weeks for GROUP 3. According to the HHS at 12 months the average score for GROUP 1 was 83,1, with 72% of excellent results, 20% good, 4% fair and 4% poor; for GROUP 2 the average score was 79,7 with 56% of excellent results, 25% good, 10% fair and 9% poor; for GROUP 3 the average score was 77,2 with 40% of excellent results, 29% good, 18% fair and 13% poor. In GROUP 2 we observed 2 cases of limb shortening more then 2 cm and 9 cases of pain due to trochanteric plate. In 2 cases of cut-out of the lag screw cemented endoprosthesis was required. In GROUP 3 we observed 5 cases of limb shortening more then 2 cm and 4 cases of persistent trochanteric pain. Conclusions: Following this algorythm a low rate of complication were observed specially in GROUP 2