Indirect reduction with sliding compression screw stabilization for subtrochanteric fractures.

BACKGROUND

Subtrochanteric fractures possess unique characteristics, and no single device used in their treatment is considered absolutely superior to others. Use of sliding compression screws (SCSs) is technically simple. The feasibility of SCS stabilization was evaluated using indirect reduction of fracture fragments.

METHODS

One hundred and thirty-one acute subtrochanteric fractures without extensive shaft involvement were treated using this technique, and they were classified into 4 groups to evaluate the success rate. After the lag screw was inserted into the femoral head, the side plate was applied onto the distal fragment without exploring the fracture site. At least 4 cortical screws were used to stabilize the distal fragment. Postoperatively, ambulation with protected weight bearing was encouraged at as early a time as was possible.

RESULTS

One hundred and thirteen fractures were followed-up for 12 to approximately 38 (mean, 22) months. The union rate was 94.7% (107/113), and the time period until union occurred was 2.5 to approximately 8 (mean, 3.8) months. No statistical difference was noted among the individual groups. Complications included 6 nonunions (5.3%), which were associated with infection in 1 case (0.9%) and implant failure in 2 cases (1.8%).

CONCLUSIONS

Compared to other techniques, indirect reduction with SCS stabilization is a feasible method for treating acute subtrochanteric fractures. However, because plate insertion normally requires a large dissecting wound and biomechanically the tension band principle might not be applicable, there may be greatly increased complications with extensively comminuted fractures. Accordingly, if this technique is used for carefully selected fractures, a high success rate can be expected.