Dr Md Sonaullah, Assistant Professor, Department of Orthopedics and Traumatology, Mymensingh Medical College (MMC), Mymensingh, Bangladesh; E-mail:
Mymensingh Med J. 2024 Oct;33(4):1016-1025.
The treatments of subtrochanteric femoral fractures are a challenge. It accounts about 10.0% to 34.0% of all hip fractures with a high complication rate. This area consists of mostly cortical bone with high stress generation thus heal slowly. The fracture is too proximal to adequately control with implants for femoral shaft and too distal to control with implants for intertrochanteric fractures. The intrinsic insecurity of this fracture and forces of the muscles with comminuted medial calcar is giving the fracture a tendency to varus crumple. Extramedullary implants are associated with higher rate of implant failure while intramedullary nails are not suitable for short proximal segment and wide medullary canal. Recently proximal femoral locking compression plate (PF-LCP) has been applied in treatment of proximal femur including subtrochanteric fractures. It has an excellent result in respect of union, fewer complications and early rehabilitation. The aim of this study was to assess the rate and time taken for union of fractures by PF-LCP and determine perioperative parameters. This prospective study was conducted from March 2019 to September 2020 at Mymensingh Medical College Hospital through non randomized purposive sampling. Total 25 patients aged above 18 years irrespective of sex with closed subtrochanteric fracture were included but pathological fractures, multiple injuries were excluded from the study. Union status evaluated by Radiographic Union Score for Tibial (RUST) fracture of Whelan; where antero-posterior and lateral radiographs (X-ray) based assessment of healing of the four cortices done. The entity cortical scores were added to give an entire score; 4 being the least amount demonstrating fracture are positively not healed and 12 being the highest score representing that the fracture is positively healed. The mean age of the patients was 42.04±14.97 years with range 22-70 years. Majority of patients were male (60.0%) and most of injury (64.0%) due to road traffic accident with most fractures was Seinsheimer type III (48.0%). Average operative time was 121.92 minutes, follow up period was 41.12 weeks (24-48 weeks) and time taken for union was 14.16 weeks (11-28 weeks). According to RUST scores; fracture union rate 88.0% with delayed union 12.0% and no nonunion. There were two patients with superficial wound infection and no implant failure. This study concludes that PF-LCP is a safe and reliable implant for the treatment of subtrochanteric femoral fractures.
股骨转子下骨折的治疗是一个挑战。它约占所有髋部骨折的 10.0%至 34.0%，并发症发生率高。该区域主要由皮质骨组成，产生的应力较大，因此愈合缓慢。骨折位置太靠近股骨骨干，无法用植入物充分控制，太靠近转子间骨折，无法用植入物控制。骨折的内在不稳定性和粉碎性内侧股骨距的肌肉力量使骨折有内翻卷曲的趋势。髓外植入物与更高的植入物失败率相关，而髓内钉不适合短的近端节段和宽的髓腔。最近，股骨近端锁定加压钢板（PF-LCP）已应用于治疗包括转子下骨折在内的股骨近端骨折。它在愈合、并发症少和早期康复方面有很好的效果。本研究旨在评估 PF-LCP 治疗股骨转子下骨折的愈合率和时间，并确定围手术期参数。这项前瞻性研究于 2019 年 3 月至 2020 年 9 月在孟加拉国迈门辛医科大学医院进行，采用非随机目的抽样。共纳入 25 名年龄在 18 岁以上的患者，无论性别如何，均为闭合性转子下骨折，但排除病理性骨折和多发伤。采用 Whelan 胫骨骨折愈合评分（RUST）评估愈合情况；通过 X 线前后位和侧位片（X 线）评估 4 个皮质骨的愈合情况。实体皮质评分相加得出总分；4 分表示骨折未愈合，12 分表示骨折完全愈合。患者的平均年龄为 42.04±14.97 岁，范围为 22-70 岁。大多数患者为男性（60.0%），大多数损伤（64.0%）是由于道路交通意外，最常见的骨折是 Seinsheimer 型 III 型（48.0%）。平均手术时间为 121.92 分钟，随访时间为 41.12 周（24-48 周），愈合时间为 14.16 周（11-28 周）。根据 RUST 评分，骨折愈合率为 88.0%，延迟愈合率为 12.0%，无不愈合。有 2 例患者出现浅表伤口感染，无植入物失败。本研究得出结论，PF-LCP 是治疗股骨转子下骨折的一种安全可靠的植入物。
