Research Article| Volume 50, ISSUE 3, P733-737, March 2019

A prospective randomized trial of 100 patients using trochanteric support plates; worth their mettle?

Published:February 06, 2019DOI:


      • We conducted a prospective trial of 100 patients treated with sliding hip screws for unstable trochanteric fractures randomized with or without a Trochanteric Support Plate (TSP).
      • Trochanteric support plates minimally reduced fracture subsidence in unstable trochanteric fractures in our study.
      • We found no correlation between subsidence and our measurement of pain and function in unstable trochanteric fractures.
      • This minimal reduction of subsidence seems clinically irrelevant.


      Background and purpose

      To compare the radiological and clinical results of sliding hip screw (SHS) fixation with or without a Trochanteric Support Plate (TSP) on unstable three-or-more-part trochanteric fractures.


      A randomized prospective non blinded study of one hundred patients with trochanteric fractures; Evans-Jensen type 3, 4 and 5, reduced and fixed with SHS. Patients were randomized into two study groups; with or without TSP supplementation (‘TSP’ and ‘NoTSP’ groups). Radiologic measurements of the hip in the frontal plane (primary outcome), including fracture movement, nonunion and loss of fixation were measured, as well as pain, ambulation, mobility, institution residence, complications and death, twelve months post operatively (secondary outcomes).


      At one-year follow-up four patients in the TSP and ten patients in the NoTSP group had either died or been lost in follow-up. Within this period, forty-three fractures healed and three had a loss of fixation in the TSP group; thirty-nine fractures healed and one had a loss of fixation in the NoTSP group.
      Frontal X-rays showed fracture subsidence on average 1 mm less in the TSP group compared to the NoTSP group.
      This difference was negligible, as was the difference in all subgroups, in fixation failure/cutout, modified Merle d’Aubigne Postel scores (measuring function and pain), institution residence, complications and death between the groups.


      This study cannot confirm that TSP has any beneficial effects on unstable three-or-more-part trochanteric fractures. If any effect at all, the difference is most likely slight and clinically irrelevant.


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        • Parker M.J.
        Trochanteric hip fractures. Fixation failure commoner with femoral medialization, a comparison of 101 cases.
        Acta Orthop Scand. 1996; 67: 329-332
        • Simpson A.H.
        • Varty K.
        • Dodd C.A.
        Sliding hip screws: modes of failure.
        Injury. 1989; 20: 227-231
        • Haddon J.W.A.
        Trochanteric fractures at Trondheim University 2005-2006.
        Oral and poster presentation at Norwegian Orth Assoc annual meeting 2008]. 2008; (Available from:
        • Palm H.
        • et al.
        Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation.
        J Bone Joint Surg Am. 2007; 89: 470-475
        • Hsu C.E.
        • et al.
        Trochanter stabilising plate improves treatment outcomes in AO/OTA 31-A2 intertrochanteric fractures with critical thin femoral lateral walls.
        Injury. 2015; 46: 1047-1053
        • Babst R.
        • et al.
        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.
        J Orthop Trauma. 1998; 12: 392-399
        • Madsen J.E.
        • et al.
        Dynamic hip screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the Gamma nail and compression hip screw.
        J Orthop Trauma. 1998; 12: 241-248
        • Shetty A.
        • et al.
        Dynamic hip screw with trochanteric stablization plate fixation of unstable inter-trochanteric fractures: a prospective study of functional and radiological outcomes.
        J Clin Diagn Res. 2016; 10: RC06-RC08
        • Parker M.J.
        • Bowers T.R.
        • Pryor G.A.
        Sliding hip screw versus the Targon PF nail in the treatment of trochanteric fractures of the hip: a randomised trial of 600 fractures.
        J Bone Joint Surg Br. 2012; 94: 391-397
        • Parker M.J.
        • Cawley S.
        Sliding hip screw versus the Targon PFT nail for trochanteric hip fractures: a randomised trial of 400 patients.
        Bone Joint J. 2017; 99–B: 1210-1215
        • Parker M.J.
        • Handoll H.H.
        Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults.
        Cochrane Database Syst Rev. 2010; (CD000093)
        • Bridle S.H.
        • et al.
        Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw.
        J Bone Joint Surg Br. 1991; 73: 330-334
        • Matre K.
        • et al.
        TRIGEN INTERTAN intramedullary nail versus sliding hip screw: a prospective, randomized multicenter study on pain, function, and complications in 684 patients with an intertrochanteric or subtrochanteric fracture and one year of follow-up.
        J Bone Joint Surg Am. 2013; 95: 200-208
      1. Norwegian National Hip Fracture Rapport 2017. 2017; Available from:

        • Jensen J.S.
        Classification of trochanteric fractures.
        Acta Orthop Scand. 1980; 51: 803-810
        • Haidukewych G.J.
        • Israel T.A.
        • Berry D.J.
        Reverse obliquity fractures of the intertrochanteric region of the femur.
        J Bone Joint Surg Am. 2001; 83–A: 643-650
        • Ovre S.
        • et al.
        Comparison of distribution, agreement and correlation between the original and modified Merle d’Aubigne-Postel Score and the Harris Hip Score after acetabular fracture treatment: moderate agreement, high ceiling effect and excellent correlation in 450 patients.
        Acta Orthop. 2005; 76: 796-802
        • Zielinski S.M.
        • et al.
        Femoral neck shortening after internal fixation of a femoral neck fracture.
        Orthopedics. 2013; 36: e849-e858
        • Zlowodzki M.
        • et al.
        The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study.
        J Bone Joint Surg Br. 2008; 90: 1487-1494