Palmetto Health-USC Orthopedic Center Columbia, Columbia, SC.
J Orthop Trauma. 2018 Apr;32(4):e151-e156. doi: 10.1097/BOT.0000000000001044.
Subtrochanteric femur fractures remain a challenge for surgeons to obtain and maintain adequate reduction and stable fixation. For this reason, multiple techniques have been described, but we are unaware of a detailed contemporary description of the combination of provisional plating before intramedullary fixation in the lateral decubitus position. We present our technique as it was used from 2011 to 2015 to treat 22 fractures and how it compared clinically to the other 48 subtrochanteric femur fractures treated during that period. The clinical and radiographic outcomes for all fractures were evaluated. The operative time was shorter when no open reduction was used but open cases showed no significant difference when using a provisional plate. Those patients treated with provisional plating were shown to have higher blood loss values and longer operative times, but when looking at the outcomes, the rate of malunion, which was defined as >5 degrees of angulation on postoperative radiographs, was significantly lower at 0% in the provision plating in the lateral decubitus position subset compared with the remaining subtrochanteric fractures, 27.7% (P = 0.013). As the quality of reduction and stability of fixation are the most significant factors in determining outcomes of subtrochanteric femur fractures, this study shows that this technique is a valuable tool in an orthopaedist's armamentarium and present it as such.
股骨转子下骨折仍然是外科医生获得和维持充分复位和稳定固定的挑战。出于这个原因，已经描述了多种技术，但我们不知道在侧卧位髓内固定前临时钢板固定的详细现代描述。我们介绍了从 2011 年到 2015 年我们使用这种技术治疗 22 例骨折的情况，以及它与同期治疗的另外 48 例股骨转子下骨折的临床比较。所有骨折的临床和影像学结果都进行了评估。如果不进行开放复位，手术时间会更短，但在使用临时钢板时，开放病例没有明显差异。那些接受临时钢板治疗的患者失血更多，手术时间更长，但从结果来看，在侧卧位临时钢板固定亚组中，定义为术后 X 线片上角度大于 5 度的畸形愈合率为 0%，明显低于其余转子下骨折，为 27.7%（P=0.013）。由于复位质量和固定稳定性是决定股骨转子下骨折结果的最重要因素，本研究表明，该技术是骨科医生的有效工具，并将其呈现出来。
