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Minimally invasive plate osteosynthesis of subtrochanteric femur fractures with a locking plate: a prospective series of 20 fractures

Archives of Orthopaedic and Trauma Surgery volume 129, pages 1659–1665 (2009)Cite this article

Abstract

Background

Intramedullary nailing is a mainstay in the treatment of subtrochanteric femoral fractures. But nailing is often unsuitable for difficult fracture patterns with comminution or when the medullary canal is narrow. The purpose of this study was to clarify the efficacy of minimally invasive plate osteosynthesis (MIPO) with locking compression plate in the treatment of subtrochanteric fractures.

Methods

Twenty patients with subtrochanteric fractures (mean age 49.6 years) were prospectively treated using the MIPO technique using a locking plate. Indications of procedure were fractures with the greater trochanter or medial comminution, and multiple injured patients with a narrow femoral canal. According to the AO/OTA classification, there were three of type A, eight of type B, and nine of type C.

Results

All healed without bone graft, at an average of 20.1 weeks (range 16–32). With the exception of two patients with minor internal rotation deformity and one patient with 1 cm of shortening, most achieved acceptable alignment. All patients were able to walk with no or only a slight limp, and median Merle d’Aubigne score was 17.3 (15–18). Four patients complained of a slight pain in the trochanteric area due to plate prominence.

Summary

The MIPO technique with a locking plate provides an alternative method for fixing subtrochanteric femur fractures, when IM nailing is inappropriate. This technique provides stable fixation, with a high union rate and a minimal complication rate.

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References

  1. Bedi A, Toan Le T (2004) Subtrochanteric femur fractures. Orthop Clin North Am 35:473–483

    Article  PubMed  Google Scholar 

  2. Blatter G, Janssen M (1994) Treatment of subtrochanteric fractures of the femur: reduction on the traction table and fixation with dynamic condylar screw. Arch Orthop Trauma Surg 113:138–141

    Article  CAS  PubMed  Google Scholar 

  3. Celebi L, Can M, Muratli HH, Yagmurlu MF, Yuksel HY, Bicimoğlu A (2006) Indirect reduction and biological internal fixation of comminuted subtrochanteric fractures of the femur. Injury 37:740–750

    Article  CAS  PubMed  Google Scholar 

  4. Craig NJ, Sivaji C, Maffulli N (2001) Review article. Subtrochanteric fractures. A review of treatment options. Bull Hosp Jt Dis 60:35–46

    CAS  PubMed  Google Scholar 

  5. Datir SP, Bedi GS, Curwen CH (2004) Unreamed femoral nail with spiral blade in subtrochanteric fractures: experience of 55 cases. Injury 35:191–195

    Article  CAS  PubMed  Google Scholar 

  6. de Vries JS, Kloen P, Borens O, Marti RK, Helfet DL (2006) Treatment of subtrochanteric nonunions. Injury 37:203–211

    Article  PubMed  Google Scholar 

  7. Garnavos C, Peterman A, Howard PW (1999) The treatment of difficult proximal femoral fractures with the Russell–Taylor reconstruction nail. Injury 30:407–415

    Article  CAS  PubMed  Google Scholar 

  8. Gerber C, Mast JW, Ganz R (1990) Biological internal fixation of fractures. Arch Orthop Trauma Surg 109:295–303

    Article  CAS  PubMed  Google Scholar 

  9. Haidukewych GJ, Berry DJ (2004) Nonunion of fractures of the subtrochanteric region of the femur. Clin Orthop 419:185–188

    Article  PubMed  Google Scholar 

  10. Higgins TF, Pittman G, Hines J, Bachus KN (2007) Biomechanical analysis of distal femur fracture fixation: fixed-angle screw-plate construct versus condylar blade plate. J Orthop Trauma 21:43–46

    Article  PubMed  Google Scholar 

  11. Kang S, McAndrew MP, Johnson KD (1995) The reconstruction locked nail for complex fractures of the proximal femur. J Orthop Trauma 9:453–463

    Article  CAS  PubMed  Google Scholar 

  12. Krettek C, Miclau T, Grun O, Schandelmaier P, Tscherne H (1998) Intraoperative control of axes, rotation and length in femoral and tibial fractures-technical note. Injury 29(3):C29–C39

    Article  PubMed  Google Scholar 

  13. Kulkarni SS, Moran CG (2003) Results of dynamic condylar screw for subtrochanteric fractures. Injury 34:117–122

    Article  PubMed  Google Scholar 

  14. Matta JM, Anderson LM, Epstein HC, Hendricks P (1986) Fractures of the acetabulum. A retrospective analysis. Clin Orthop 205:230–240

    PubMed  Google Scholar 

  15. Menezes DF, Gamulin A, Noesberger B (2005) Is the proximal femoral nail a suitable implant for treatment of all trochanteric fractures? Clin Orthop 439:221–227

    Article  PubMed  Google Scholar 

  16. Nungu KS, Olerud C, Rehnberg L (1993) Treatment of subtrochanteric fractures with the AO dynamic condylar screw. Injury 24:90–92

    Article  CAS  PubMed  Google Scholar 

  17. Oh CW, Song HR, Jeon IH, Min WK, Park BC (2007) Nail-assisted percutaneous plating of pediatric femoral fractures. Clin Orthop 456:176–181

    Article  PubMed  Google Scholar 

  18. Pai CH (1996) Dynamic condylar screw for subtrochanteric fractures with greater trochanteric extension. J Orthop Trauma 10:317–322

    Article  CAS  PubMed  Google Scholar 

  19. Pakuts AJ (2004) Unstable subtrochanteric fractures–gamma nail versus dynamic condylar screw. Int Orthop 28:21–24

    Article  PubMed  Google Scholar 

  20. Parker MJ, Dutta BK, Sivaji C, Pryor GA (1997) Subtrochanteric fractures of the femur. Injury 28:91–95

    Article  CAS  PubMed  Google Scholar 

  21. Perren SM (2002) Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 84:1093–1110

    Article  PubMed  Google Scholar 

  22. Pryce Lewis JR, Ashcroft GP (2007) Reverse LISS plating for proximal segmental femoral fractures in the polytrauma patient: a case report. Injury 38:235–239

    Article  CAS  PubMed  Google Scholar 

  23. Saarenpää I, Heikkinen T, Jalovaara P (2007) Treatment of subtrochanteric fractures. A comparison of the Gamma nail and the dynamic hip screw: short-term outcome in 58 patients. Int Orthop 31:65–70

    Article  PubMed  Google Scholar 

  24. Sanders R, Regazonni P (1989) Treatment of subtrochanteric femur fractures using the dynamic condylar screw. J Orthop Trauma 3:206–213

    CAS  PubMed  Article  Google Scholar 

  25. Siebenrock KA, Muller U, Ganz R (1998) Indirect reduction with a condylar blade plate for osteosynthesis of subtrochanteric femoral fractures. Injury 29(3):C7–C15

    Article  PubMed  Google Scholar 

  26. Sims SH (2002) Subtrochanteric femoral fractures. Orthop Clin North Am 33:113–126

    Article  PubMed  Google Scholar 

  27. Vaidya SV, Dholakia DB, Chatterjee A (2003) The use of a dynamic condylar screw and biological reduction techniques for subtrochanteric femur fracture. Injury 34:123–128

    Article  PubMed  Google Scholar 

  28. Valverde JA, Alonso MG, Porro JG, Rueda D, Larrauri PM, Soler JJ (1998) Use of the gamma nail in the treatment of fractures of the proximal femur. Clin Orthop 350:56–61

    PubMed  Google Scholar 

  29. Warwick DJ, Crichlow TP, Langkamer VG, Jackson M (1995) The dynamic condylar screw in the management of subtrochanteric fractures of the femur. Injury 26:241–244

    Article  CAS  PubMed  Google Scholar 

  30. Yoshino N, Watanabe Y, Takenaka N, Watanabe N, Fukuda Y, Fujita N, Maruyama N, Sumiyoshi H, Takai S (2006) Implant failure of long Gamma nail in a patient with intertrochanteric-subtrochanteric fracture. J Orthop Sci 11:638–643

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by BK 21 and Bio-Medical Research Institute grant, Kyungpook National University Hospital (2009).

Author information

Affiliations

  1. Department of Orthopedic Surgery, Kyungpook National University Hospital, 50, 2-Ga, Samdok, Chunggu, Daegu, 700-721, Korea

    Chang-Wug Oh, Joon-Woo Kim, Shin-Yoon Kim, Byung-Chul Park & Hyun-Joo Lee

  2. Asan Medical Center, University of Ulsan, Seoul, Korea

    Jung-Jae Kim

  3. Fatima Hospital, Daegu, Korea

    Young-Soo Byun

  4. Guro Hospital, Korea University, Seoul, Korea

    Jong-Keon Oh

Authors
  1. Chang-Wug Oh
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  2. Jung-Jae Kim
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  3. Young-Soo Byun
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  4. Jong-Keon Oh
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  5. Joon-Woo Kim
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  6. Shin-Yoon Kim
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  7. Byung-Chul Park
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  8. Hyun-Joo Lee
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Corresponding author

Correspondence to Chang-Wug Oh.

Additional information

The study was conducted at Kyungpook National University Hospital, Daegu, Korea.

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Oh, CW., Kim, JJ., Byun, YS. et al. Minimally invasive plate osteosynthesis of subtrochanteric femur fractures with a locking plate: a prospective series of 20 fractures. Arch Orthop Trauma Surg 129, 1659–1665 (2009). https://doi.org/10.1007/s00402-009-0815-y

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  • DOI: https://doi.org/10.1007/s00402-009-0815-y

Keywords

  • Subtrochanteric fracture
  • Minimally invasive plate osteosynthesis
  • Locking plate