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The unstable intertrochanteric fracture in the elderly

A technical note on valgus resection osteotomy and fixation with 150° dynamic hip screw

Archives of Orthopaedic and Trauma Surgery volume 108, pages 182–184 (1989)Cite this article

Summary

Valgus resection osteotomy has proven its effectiveness for the treatment of unstable intertrochanteric fractures in the elderly. A modified technique is presented, which consists in (a) resection of triangular fragments proximally and distally, (b) reduction and impaction in valgus, (c) fixation through the osteotomy site by a 150° dynamic hip screw, and (d) reattachment of the greater trochanter by an 8-shaped wire cerclage. The postulated advantage is that the implant acts as an intramedullary splinting in crossing the “osteotomy” site, with minimization of implant cutting out compared with a 130° angled blade plate or an I-Beam Nail Plate.

Zusammenfassung

Die primäre Valgisationsosteotomie zur Behandlung instabiler pertrochanterer Frakturen und deren Effizienz beim betagten Patienten sind bekannt, in den letzten Jahren fand die Methode aber kaum mehr Erwähnung. Wir berichten über eine technische Modifikation mit (a) Resektion am proximalen und/oder distalen Hauptfragment gemäß präoperativer Planung, (b) Reposition und Impaktion in valgus, (c) Fixation durch die “Osteotomie” mittels 150° DHS und (d) Refixation des großen Trochanters mittels 8-er förmiger Drahtcerclage. Postulierte Vorteile: das Implantat wirkt als innere Schienung in Richtung der bei Last einwirkenden Kräfte, und die Gefahr der Implantatperforation ist geringer, weil die Reposition vor der Implantation der DHS erfolgt und weil bei eventueller sekundärer Zusammensinterung die Schraube zurückgleiten kann.

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Affiliations

  1. Service de Chirurgie Orthopédique, Hôpital Canfonal, CH-1700, Fribourg 8, Switzerland

    M. K. Zehntner & H. B. Burch

Authors
  1. M. K. Zehntner
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  2. H. B. Burch
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Zehntner, M.K., Burch, H.B. The unstable intertrochanteric fracture in the elderly. Arch Orthop Trauma Surg 108, 182–184 (1989). https://doi.org/10.1007/BF00934265

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  • DOI: https://doi.org/10.1007/BF00934265

Keywords

  • Great Trochanter
  • Osteotomy Site
  • Angle Blade
  • Wire Cerclage
  • Blade Plate