[Unstable pertrochanteric fractures, biomechanic, classification and therapy.].
The authors deal with unstable pertrochanteric, intertrochanteric and subtrochanteric fractures extending as far as calcar femorale. The treatment of pertrochanteric issues is a serious issue as their total number in the Czech Republic exceeds 5.000 annually and with the exception of those which are contraindicated due to their health condition, all patients are indicated to surgery. In the treatment of unstable pertrochanteric fractures there occurs failure of internal fixation also with the use of implants such as dynamic hip screw or Gamma nail. The cause of unsuccessful treatment of unstable fractures is the defect in calcar femorale - impairment of the weightbearing area of proximal femur and failure of the implant as a result of its cyclic overloading - breakage of the nail, cutting out of the screw from the head in the osteoporotic bone or breaking out of screws fixing the plate to the femoral shaft. For a causal procedure the authors consider the reconstruction of the calcar femorale by a wedge valgus osteotomy of the comminuted zone after the original design of Debrunner and Cech (1969). Simultaneously with reconstruction of the medial cortical support in the calcar femorale the 160 degrees valgization is performed. In the AO classification the authors consider for unstable the fractures of types 31.A2.1, A2.2, A3.3. Significant from the therapeutic viewpoint is the classification of stable fractures (with open reduction the anatomic reconstruction of weight-bearing calcar femorale is possible) and unstable fractures - where with open reduction the defect of calcar femorale persists. For stabilization of unstable the authors recommend fixation by DHS at 150 degrees angle. If need be, this fixation may be combined with lag screws and in case of a simultaneous fracture of greater trochanter and in reverse fractures a trochanteric buttress plate has to be added. Key words: unstable pertrochanteric fractures, nonanatomic valgus reduction, DHS fixation.
Cech
O
O
Ortopedicko-traumatologická klinika 3. LF UK a FNKV, Praha.
Kostál
R
R
Váchal
J
J