Highlights
- •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.
Abstract
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.
Methods
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).
Results
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.
Interpretation
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.
Keywords
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Article info
Publication history
Published online: February 06, 2019
Accepted:
January 30,
2019
Footnotes
☆A trial including one hundred patients treated with sliding hip screws for multi-fragmental trochanteric fractures randomized with or without Trochanteric Support Plates, showing negligible effect on radiological and clinical parameters.
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
