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Hughston’s Medial Displacement Osteotomy for Intertroch Frx

- 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;
          - Biomechanical evaluation of anatomic reduction versus medial displacement osteotomy in unstable intertrochanteric fractures.

- 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 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.