The role of biological fixation with bridge plating for comminuted subtrochanteric fractures of the femur

BACKGROUND: The surgical outcomes of comminuted subtrochanteric fractures result in high incidence of nonunion and malunion due to high energy trauma. Biological fixation offers decrease in these complications while preserving soft tissue vascularity. The aim of this study was to evaluate the results of patients treated with bridge plating for comminuted subtrochanteric femoral fractures retrospectively. METHODS: Ten patients with comminuted subtrochanteric femoral fractures between 1996 and 2002 were included into this study. All patients were male and mean age was 46±15.2 years (range: 29-76 years). Six patients had C-3-1 and four patients had C-3-2 type fractures according to AO/OTA classification. Bridge plating under fluoroscopy control, according to biological fixation principles was carried out on all patients. Pain, walking capacity, functionality, motion, daily activities, radiological assessment for Sander’s criteria and shaft-neck angles of both fractured and the other sides were recorded for statistical analysis, at the last follow-up. RESULTS: Mean follow-up period was 62±20.9 months (range: 37-104 months). Partial and full weight-bearing were recommended at an average period of 3.3±1.1 (range: 1.5-4.5 months) and 4,8±1 months (range: 3-6 months) respectively (range: 3-6 months). There were eight excellent (80%), one good (10%) and one poor (10%) results according to Sanders’ criteria. There was no statistically significant difference between the healthy and fractured sides with respect to femoral shaft-neck angles. CONCLUSION: We have concluded that biological fixation applied with bridge plating offered an alternative method in the treatment of comminuted subtrochanteric femoral fractures.

Parçalý subtrokanterik femur kýrýklarýnda köprü plaklama ile biyolojik tespitin rolü

AMAÇ: Parçalý subtrokanterik kýrýklar, yüksek enerjili yaralanma olmalarýndan dolayý cerrahi tedavi sonrasý yüksek kaynamama ve kötü kaynama riski taþýrlar. Biyolojik tespit yumuþak doku kanlanmasýný korurken, bu komplikasyonlarý azaltmayý hedefler. Bu çalýþmada amaç, parçalý subtrokanterik kýrýklý olgularýn köprü plaklama sonrasý geriye dönük olarak sonuçlarýný deðerlendirmektir. GEREÇ-YÖNTEM: 1996-2002 yýllarý arasýnda parçalý subtrokanterik kýrýklý 10 olgu çalýþmaya dahil edildi. Tüm olgular erkekti, ortalama yaþ 46±15,2 yýl (daðýlým 29-76) idi. AO/OTA sýnýflamasýna göre altý olguda C-3-1, dört olguda C-3-2 tip kýrýk mevcuttu. Tüm olgulara floroskopi kontrolünde biyolojik tespit kurallarýna uygun köprü plaklama uygulandý. Son kontrolde Sander’s kriterleri için, aðrý, yürüme kapasitesi, fonksiyonel durum, hareket, günlük aktiveteler, radyolojik deðerlendirme, kýrýk ve saðlam taraf femur boyun-cisim açýlarý ölçüldü. BULGULAR: Ortalama izleme süresi 62±20,9 aydý (daðýlým 37-104). Kýsmi yüklenme ortalama 3,3±1,1 ayda (daðýlým 1,5-4,5), tam yüklenme ortalama 4,8±1 ayda (daðýlým 3-6) önerildi. Sander’s kriterlerine göre sekiz çok iyi (%80), bir iyi (%10) ve bir kötü (%10) sonuç saptandý. Femur boyun-cisim açýlarý bakýmýndan kýrýklý ve saðlam taraflar arasýnda anlamlý fark saptanmadý. SONUÇ: Parçalý subtrokanterik femur kýrýklarýnýn tedavisinde, köprü plaklama ile uygulanan biyolojik tespitin alternatif bir yöntem olduðunu düþünüyoruz.