J Korean Fract Soc.  2006 Oct;19(4):407-411. 10.12671/jkfs.2006.19.4.407.

Minimally Invasive Plate Osteosynthesis for Comminuted Subtrochanteric Fracture of the Femur

• Oh CW
• Oh JK
• Kim SJ
• Kim SY
• Baek SH
• Jeon IH
• Kim PT
• Lee SW

• KMID: 2290512
• DOI: http://doi.org/10.12671/jkfs.2006.19.4.407

Abstract

PURPOSE: To evaluate the outcomes of patients with comminuted subtrochanteric femoral fractures using minimally invasive plate osteosynthesis (MIPO) technique.
MATERIALS AND METHODS
Twelve patients with a mean age of 38.2 years, who sustained comminuted subtrochanteric femoral fractures, were treated using MIPO technique. All patients suffered these fractures either from traffic accidents (6) or falls from height (6). Average follow-up was 4.3 years (range, 29~78 months). Patients were assessed radiographically and clinically with regards to time to union, malunion, and complications. According to the Seinsheimer's classification, there were 1 type III, 7 type IV, and 4 type V. Type C fractures were ten according to AO-OTA classification.
RESULTS
Union was achieved in 7 of 12 cases, in an average of 23.4 weeks (range, 12~42 weeks). Three definite non-unions with implant failures, needed the procedure of implant change and bone graft. In other two patients, early bone graft was performed for anticipated nonunion of comminuted area. The most common complication was metal failures (2 plate failures and 3 screw breakages). Limb length shortening of 1.5 cm occurred in one patient, and external rotation malunion of 15 degrees was noted in one patient. No patients developed infection.
CONCLUSION
Preserving biology of the fracture fragments, the use of MIPO technique using DCS has proven to be less successful in comminuted subtrochanteric fractures, comparing to fractures in other areas. To avoid mechanical failure, the careful and protective weight bearing is needed until the callus-bridging is seen in the commniuted area.

Keyword

Comminuted subtrochanteric femoral fractures; MIPO; Dynamic condylar screw

MeSH Terms

Accidents, Traffic
Biology
Classification
Extremities
Femoral Fractures
Femur*
Follow-Up Studies
Hip Fractures
Humans
Transplants
Weight-Bearing