- Discussion:
- medial displacement osteotomy to stabilize
unstable 4 part intertrochanteric frx;
- in 4 part frx, adductors tend to displace frx into varus secondary to lack of medial cortical opposition;
- disadvantages:
- in a biomechanical study by
Chang el al, it was noted that an antomic reduction of a 4 part frx (and
sliding hip screw) provided more compression across the frx site than seen w/ the medial displacement osteotomy;
- other disadvantages include increased blood loss and operative time;
- Technique:
-
incision:
- if the greater trochanter remains attached to the femur, then a transverse
osteotomy needs to be made at a level 2 cm below the lesser troch;
- this greater trochanteric fragment is reflected superiorly for exposure;
- insert a Steinman pin into the superior third of the femoral head;
- also consider inserting a large towel clip onto superior portion of neck
segment inorder to control rotation;
- key the calcar spike (proximal fragment) into the medially displaced distal fragment;
- guide wire is placed into lower half of femoral head;
- this wire position will ensure a more valgus orientation of femoral
neck, once the screw and side plate have been applied;
- determine the appropriate screw length (usually 50-70 mm);
- insert compression screw;
- abduct thigh to bring the reduction into valgus;
- apply the side plate which consists of 135 deg angle w/ short barrel segment;
- release traction, and apply the compression screw;
- consider reattaching the trochanteric fragment w/ use of wires;
Biomechanical evaluation of anatomic reduction versus medial displacement
osteotomy in unstable intertrochanteric fractures.
Unstable intertrochanteric fractures of the hip.
JH Dimon and JC Hughston. JBJS 49-A. 1967. p 440.
Unstable intertrochanteric fracture of the femur.
A prospective randomised study comparing
anatomical reduction and medial displacement osteotomy.
AL Desjardins et al.
JBJS-Br.
May 75(3) 1993. p 445-447.
Treatment of comminuted trochanteric femoral fractures with Dimon Hughston displacement fixation
and acrylic cement - a preliminary report of 16 cases.
HK Lau et al.
Injury 1983. Sep 15(2) p 129-135.
