Intertochanteric Hip Fractures - 16/8/2000

TSP

J Orthop Trauma 1998 Aug;12(6):392-9

Clinical results using the trochanter stabilizing plate (TSP): the modular extension of the dynamic hip screw (DHS) for internal fixation of selected unstable

intertrochanteric fractures.

Babst R, Renner N, Biedermann M, Rosso R, Heberer M,

Harder F, Regazzoni P

Department of Surgery, University of Basel , Switzerland .

CONCLUSION: In unstable

pertrochanteric fractures with small or missing lateral cortical buttress, the addition of a TSP to the DHS effectively supports the unstable greater trochanter fragment and can prevent rotation of the head-neck fragment. Excessive fracture impaction and consecutive limb shortening was prevented by this additional implant in 90 percent of these patients.

Need for # reduction

Clin Orthop 1980 Jan-Feb;(146):62-70

Internal fixation of intertrochanteric hip fractures: a clinical and

biomechanical study.

  Jacobs RR, McClain O, Armstrong HJ

One hundred seventy-three cases of intertrochanteric fractures treated by internal fixation are reviewed: 72 treated with the Jewett nail and 101 with the Richards compression hip screw. Both devices maintained adequate reduction in the majority of cases. Treatment failure: loss of fixation, symptomatic joint penetration, aseptic necrosis, malunion and nonunion occurred in 25% of the Jewett nail cases and 6% of the Richards screw cases. In vitro biomechanical studies demonstrate that the compression screw is subjected to less bending stress by acting as a lateral "tension band" in stable reductions and by allowing sliding, thus shortening the bending movement lever arm in unstable reductions. The compression hip screw is valuable in the treatment of intertrochanteric hip fractures. In stable conditions, it acts as a tension band producing more force transmission through the medial cortex, stressing the implant more in tension and less in bending. In unstable conditions with higher shearing forces, the device will shorten the lever arm, decreasing the bending moment, as well as avoiding penetration of the femoral head.

Dimon-Hughston Medial Displacement Osteotomy

J Bone Joint Surg Am 1967 Apr;49(3):440-50

Unstable intertrochanteric fractures of the hip.

Dimon JH, Hughston JC

Screw Position

Fracture of the femoral neck: identification of the optimal screw position

by migration ratio.

Levi N, Kofoed H

Department of Orthopaedic Surgery, Frederiksberg Hospital , University Hospital of

Copenhagen , Denmark .

Injury 1993 Jul;24(6):393-6

A consecutive series of fractures of the femoral neck treated with sliding screw and plate osteosynthesis were evaluated radiographically for the optimal position of the screw by use of migration indices. A naturally occurring optimal position of the screw was discovered. It was characterized by four positional indices in the head-neck region which were significantly correlated with minimal migration (or best stability). This optimal screw position gave a better prognostication of reduced risk of early fracture failure compared with the usual sectional division of the femoral head as indicator of screw position.