Fixation of rotationally unstable extracapsular proximal femoral fractures [Ulus Travma Acil Cerrahi Derg]
Ulus Travma Acil Cerrahi Derg. Ahead of Print: UTD-47041 | DOI: 10.5505/tjtes.2017.47041  

Fixation of rotationally unstable extracapsular proximal femoral fractures

Elsayed Ibraheem Elsayed Massoud
Orthopaedic Department, Sohag Teaching Hospital, General Organization For Teaching Hospitals And Institutes

BACKGROUND: It was thought that the AO types A1.2 and A1.3 fractures a rotationally stable, however, revealed instability when fixed with the dynamic hip screw. Therefore, we hypothesized these fractures should be treated as rotationally unstable.
METHODS: A series of 83 fractures of the AO types A1, A2 and B2.1 were treated using DHS/DRS composite then prospectively followed for 24 months. Adequacy of reduction and fixation were assessed immediately postoperative and fracture collapse was assessed at six months or when fractures healed. In order to investigate the feasibility of our hypothesis fractures were classified into two groups: the inevitably unstable group (IUG) included the AO types A1.1, A2.1, 2, 3 and B2.1 and the potentially unstable group (PUG) included the AO types A1.2 and A1.3 and then results were statistically analysed.
RESULTS: Adequate reduction was achieved in 77 and adequate fixation in 71 fractures. All fractures healed at average 13.5 weeks and fracture collapse averaged 5.8 mm. Equalization of both lower limbs achieved in 66 patients and hip motion range equalized the healthy contralateral in 80 patients. Re-operation was performed in one case with AO type A1.2. Comparison of IUG and PUG using outcomes revealed insignificant differences.
CONCLUSION: Using the DHS / DRS composite, anatomical features of the proximal femoral end were restored and maintained during the follow-up period. Insignificant differences between outcomes of IGU and PGU render the addition of the AO types A1.2 and A1.3 to the rotationally unstable fractures reasonable.

Keywords: Rotational instability, Dynamic hip screw, Derotation screw, DHS/DRS composite; Trochanteric fractures; Basicervical fracture; Proximal femoral fractures

Corresponding Author: Elsayed Ibraheem Elsayed Massoud, Egypt

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