- 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;
- 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;
- Biomechanical evaluation of anatomic reduction versus medial displacement osteotomy in unstable intertrochanteric fractures.
- 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 in order 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.
Unstable intertrochanteric fracture of the femur. A prospective randomised study comparing anatomical reduction and medial displacement osteotomy.
Treatment of comminuted trochanteric femoral fractures with Dimon Hughston displacement fixation and acrylic cement--a preliminary report of sixteen cases.