Haastava lonkkamurtumatyyppi: epästabiili pertrokanteerinen reisiluun murtuma

https://www.journal-cot.com/article/S0976-5662%2816%2930248-X/fulltext# 

Full length article| Volume 8, ISSUE 3, P209-214, July 2017

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Management of unstable pertrochanteric fractures with proximal femoral locking compression plates and affect of neck-shaft angle on functional outcomes

• Emrah Kovalak
• Cenk Ermutlu
• Tolga Atay
• Özgür Başal

Published:July 20, 2017DOI:https://doi.org/10.1016/j.jcot.2017.07.006

Pertrochanteric fractures account for nearly 50% of all proximal femoral fractures with mortality rates ranging from 4.5% to 22%.

These fractures are associated with functional disability, loss of mobility and independence.

While stable intertrochanteric fractures are usually managed with sliding hip screws (SHS), the fractures remain a challenge with various implant choices and less clearly defined indications with mechanical complication rates reaching 20%. Although unfavorable results have been shown with the use of SHS and the side plates, the 95° angle blade plates have better results.  However, the 95° angle blade plates are technically difficult to implant and have higher failure and revision rates when compared to intramedullary nails. And also, 95° angle blade plates clinical outcome is similar to locking plates but they require a more extensile approach.

When unstable trochanteric fractures are managed by dynamic hip screws (DHS), shortening, medialisation of the distal fragment, implant cut–out, lateralization of proximal fragment and, varus collapse are common.

Proximal femoral locking compression plates (PFLCP) offer certain advantages to address these complications of DHS. The intramedullary devices are usually preferred for the management of the unstable fractures because of biomechanical advantages. ^, But, when nailing is difficult or unsuitable for difficult fracture patterns with comminution or when the medullary canal is narrow for the intramedullary implantation, extra medullary procedures are preferred.

As an extra medullary implant PFLCP is a contact limited implant that allows multiple angularly stable fixations.It preserves more bone stock after implantation and, it is also stronger and stiffer than the other angular stable implants especially in osteoporotic fractures

The intact lateral trochanteric wall is an another key point of the stabilization of unstable trochanteric fractures and breakage of this wall causes collapse of the fixation. This complication has not been yet reported while fixing unstable trochanteric fractures via percutaneous plating. Locking plates with lateral wall buttress are also useful for maintaining reduction of unstable fractures.

There are only a few reports in the literature about the osteosynthesis of unstable trochanteric fractures with proximal femoral locking compression plates and their results are still conflicting.

Considering the issues mentioned above, we have aimed to report the clinical and radiological results of PFLCP in the management of unstable trochanteric fractures. We hypothesized that the functional results are independent in terms of the change in neck-shaft angles and reduction quality.