A study on functional and radiological outcome of unstable intertrochanteric fractures managed by modular extension of dynamic hip screw

Selvakumar, P (2016) A study on functional and radiological outcome of unstable intertrochanteric fractures managed by modular extension of dynamic hip screw. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

INTRODUCTION: Intertrochanteric fractures continues to be a challenge for all orthopaedic surgeons. A variety of implants of internal fixation have been employed to achieve this goal with variable success.The Diversity of fixation devices available for the treatment of trochanteric fractures illustrates the difficulties encountered in the actual treatment,and the discussion about ideal implant still continues.In Recent years the use of DHS in Unstable trochanteric fractures has been associated with significant medial displacement of the shaft resulting from excessive sliding of screw within the barrel and a higher incidence of srew cut out.Morever 12% of unstable intertrochanteric fractures shows radiologically identifiable rotation of proximal fragment when fixed with DHS, as DHS provides single point fixation over which the proximal fragment rotates on hip movements.This leads to more malunions and nonunions. Hence stabilization of lateral wall in unstable fractures by addition of TSP to DHS prevents the excessive collapse and varus malpositioning. BACK GROUND: To emphasis the importance of the modular trochanter stabilizing plate (TSP) in addition to the dynamic hip screw (DHS) prevents excessive telescoping/varus malposition and limb shortening in all unstable trochanteric fractures with lateral communitions. MATERIAL AND METHOD: In our study conducted in Government Kilpauk Medical College and Hospital Chennai, 20 consecutive patients of unstable intertrochanteric fractures with lateral wall communition were treated with trochanteric stabilization plate between August 2013 and August2015. The fractures were classified according to AO/OTA classification and fractures of AO Type 31A2.1 to 31A2.3 were included in our study.All cases were followed up for a minimum of 9 months and were assessed for clinical, radiological and functional outcome. The results were analysed RESULTS: The postoperative radiological outcome was assessed by taking serial X rays of affected hip in anteroposterior and lateral view. All patients achieved union radiological and clinical union. 6 patients underwent radiological union by 16 weeks, 4 patients underwent by 18 weeks, 5 patients underwent union by 20 weeks and 3 patients underwent union by 22 weeks.Two patients had varus malunion, Average limb length discrepancy was 1.4 cm with 7 patients having <1cm shortening, 11 had shortening of 1.5 to 2 cm and 2 had shortening of more than 2 cm (1 patient had shortening of 2.5 cm and another had shortening of 2.9 cm).Average time for radiological union was 23.5 weeks. The postoperative functional outcome was assessed by Harris Hip Score at 20 weeks. Average Harris hip score was 83.2. We had 3 excellent results, 14 good results and 3 fair results. CONCLUSION:Trochanteric stabilization plate with sliding hip screw is a biomechanically stable construct allowing reconstruction of lateral wall to maintain adequate lever arm and abductor strength (power arm) in unstable intertrochanteric fractures with lateral wall communition. Additional anti rotation screw provides enhanced rotational stability to the proximal fragment. Lateral wall buttress effect reduces the chance of varus collapse and screw cutout. The operative technique being similar to sliding hip screw.Overall in patients with unstable intertrochanteric fractures with lateral wall communition, trochanteric stabilization plate can give a superior functional and radiological outcome.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Intertrochanteric fractures ; Trochanteric stabilization plate Dynamic hip screw (DHS).
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 19:37
Last Modified: 16 Sep 2017 19:37
URI: http://repository-tnmgrmu.ac.in/id/eprint/3199

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