Subtrochanteric Fractures

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Subtrochanteric Fractures Sliding Plate
Fixations Peter Biberthaler LMU-Innenstadt Münche
n
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Aims

• Plate options
• Biomechanics
• Indications
• Surgical technique
• Cases
• Results in Literature

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Plate Options

• Condylar plate 95
• Dynamic compression screw 95
• Dynamic hip screw 135

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Plate Options
DHS
Condyle
DCS
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Biomechanics
A m. gluteus medius B m. ileopsoas C adductor
group (Adapted from Russell TA,
Taylor JC subtrochanteric fractures of the femur
in Browner BD, Jupiter JB and Levine AM editors.
Skeletal trauma 2nd edition Philadelphia PA, WB
Saunders 1992, p1836, drawing by Hella Thun)
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Classifications
AO 31A3
Seinsheimer
Russel-Taylor
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Surgery patient and C-Arm placement
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Surgical technique 95-condyle-plate
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Surgical technique 95-condyle-plate
Insertion of blade
Anterior 1/3 of femoral neck
Maintainance of reduction
Very carefully alignement to the shaft axis
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Surgical technique 95-condyle-plate
Insertion of plate
Fixation by screws
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Cases
Male, 35a, high energy impact accident Open
fracture Long ICU stabilization period
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Cases
Female, 65a, max. obesity
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Cases
Male, 58a, incompliance Salvage procedure for
failed IM
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Limitations
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Handicaps of the 95 condylar plate

• Extensive soft tissue
• detachment required
• for precise placement
• to the shaft
• Requires surgical
• expertise
• Long leather arm

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Results Data literature
Lundy, JOT 1999 Technical requirements of
implantations requires wide soft tissue
detachment, impaired bone healing 95-Condylar
plate is limited by long leather
arm/bending Bedi, 2004, Orthop Clin North
Am Craig, Disabil Rehab 2005 Race between bone
healing and plate breakage

• 95 Condylar plate limited to
• Heavily contaminated open fractures
• Very obese patients with technical impossibility
  of correct nail insertion
• Too narrow medullar space for nails

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Dynamic Compression Plate

• Combines sliding mechanism
• with 95 stronghold
• Technically less demanding but..
• Still unfavorable leather arm

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Cases
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Results Data literature
Lundy, JOT 1999 95 Dynamic compression plate
requires less soft tissue detachment and is
easier to handle but still has a bad leather
armBedi, 2004, Orthop Clin North Am

• 95 Dynamic Compression Plate
• Similar to Condyle plate
• Second/third choice

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Dynamic Hip Screw
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Conclusion

• Sliding plates were the first implants for better
  results for surgery as compared to conservative
  treatment
• Current data supports implantation only for
  special indications
• Multiple injury, wide open fractures, long
  stabilization period with Fix. Ex.
• Max. Obesity
• Contraindications for IM
• Salvage procedure for failed IM