Extra medullary fixation in unstable trochanteric/subtrochanteric fracture by proximal femoral-locking compression plate (pre contoured proximal femoral plate)

<p>K K Mittal</p>

Extra medullary fixation in unstable trochanteric/subtrochanteric fracture by proximal femoral-locking compression plate (pre contoured proximal femoral plate)

K K Mittal

Krishna Hospital and Trauma Centre, India

: Clin Res Orthop

Abstract

Introduction: Fracture geometry, anatomy and biomechanics render trochanteric and subtrochanteric region susceptible to instability, reduction loss, and implant failure and non-union. An implant providing complete angular stability by creating fixed angle dynamic lock, PF-LCP meets all needs of these fracture fixation minimizing complications. PF-LCP provides advantage of TSP, blade plate and LCP.

Method: Supine on fracture table under spinal anaesthesia, lateral vastus splitting approach, biological/open fixation depending upon indirect/ direct reduction respectively. Rotation maintained by keeping patella horizontal. PF-LCP on lateral aspect of proximal femur, 3 guide wires passed through wire guide mounted on plate in desired position under C Arm control, three screws in neck and minimum 3 distal to fracture.49 cases done in last 3 years. Discussion: Posterio-Medial column reconstruction is of paramount importance. PF-LCP acts as tension band plate, provides lateral shield, angular screws in neck provide torsional, bending stiffness, combi hole plate provides compression at Metaphysealdiaphyseal junction, kick stand screw prevents varus collapse.

Result: All patients followed till union. No revision or additional surgery done. Subtrochanteric fractures took longer to heal. Two patients had screw backout but not enblock screw backout from neck. Three elderly patients had loss of initial position due to early weight bearing. No cut-out of hip screws. No patient developed infection, DVT, non-union, implant failure. Conclusion: PF-LCP provides stable, effective extramedullary fixation in unstable trochanteric like revere oblique, fracture lateral trochanteric wall, four part fractures and sub-trochanteric fractures, fractures with narrow medullary canal, previous deformities, revision for malunion/ non-union.