title: Unstable trochanteric fractures: the role of lateral wall reconstruction.
abstract: The sliding compression device, a widely used implant in unstable proximal femoral fractures, suffers from two major limitations: excessive collapse and screw cut-out. Commonly attributed reasons for these are lateral wall comminution and single-point fixation, respectively. We report our experience of stabilising 74 unstable trochanteric fractures, of which 46 cases underwent lateral wall reconstruction using a trochanteric stabilising plate (TSP) in combination with a dynamic hip screw (DHS), and 34 cases with an intact lateral wall had a DHS with an additional anti-rotation screw providing two-point fixation. Fracture consolidation was observed in all cases at an average of 13.56 weeks. Overall functional hip score as per the Salvati and Wilson scoring system was >30 points in 55 patients. Lateral wall reconstruction is an important component in stabilisation of unstable trochanteric fractures and a combination of TSP with a DHS appears to be a useful device to achieve this. Addition of an antirotation screw is likely to enhance the stability further by providing two-point fixation.
authors.affiliation: Department of Orthopaedics, Physical Medicine, Paraplegia and Rehabilitation, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, 1/7J, Medical Enclave, Rohtak, 124001 Haryana, India. drrk60@rediffmail.com
authors.forename: R K
authors.initials: RK
authors.lastname: Gupta
authors.forename: Kapil
authors.initials: K
authors.lastname: Sangwan
authors.forename: Pradeep
authors.initials: P
authors.lastname: Kamboj
authors.forename: Sarabjeet S
authors.initials: SS
authors.lastname: Punia
authors.forename: Pankaj
authors.initials: P
authors.lastname: Walecha
mesh_terms: D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005269:Femur / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D006620:Hip Fractures / Q000503:physiopathology / Q000601:surgery*; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D016268:Internal Fixators; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D011474:Prosthesis Design; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D020127:Recovery of Function