Results of Unstable Peritrochanteric Fractures Treated with Dynamic Hip Screws (DHS) Fixation with or without Trochanter Stabilizing Plate (TSP) Augmentation

Chun-Wei Yew, Chun-Yu Chang, Po-Wen Shen

43卷1期 (2010/2)

12-19

Objectives: To evaluate the outcomes of surgical treatment of unstable
peritrochanteric fractures with dynamic hip screws (DHS) enhanced with a
trochanter stabilizing plate (TSP).
Methods: We retrospectively reviewed the records of 183 patients with
peritrochanteric fracture including subtrochanteric fracture and reverse obliquity
fracture of the intertrochanteric region treated between August 2002 and April 2007.
Twenty-five patients in the TSP with DHS group and 17 patients in the DHS group
were followed up for at least one year. All peritrochanteric hip fractures were
classified by OTA criteria, which are based on the AO classification.
Results: TSP prevented excessive collapse, medial translation of the femoral shaft
and excessive sliding of the lag screw. Lateralization of the greater trochanter was
successfully prevented. In one patient the operation was converted to bipolar hemiarthroplasty
because of postoperative femoral neck fracture and implant failure.
The mean sliding distance in the TSP with DHS group was 5.9 mm, and in the DHS
group was 11.2 mm. Anti-rotation screws were used in 5 patients in the TSP + DHS
group to prevent rotation of the head-neck fragments.
Conclusion: In comparison with conventional DHS, the TSP superimposed on DHS
not only prevented excessive telescoping and medialization of the distal fracture
fragment, but also reduced excessive secondary lag screw sliding without affecting
fracture healing.

peritrochanteric fracture, trochanter stabilizing plate (TSP), dynamic hip screw (DHS)

Original Article