Hip Pelvis.  2017 Mar;29(1):68-76. 10.5371/hp.2017.29.1.68.

Surgical Outcomes of Biologic Fixation for Subtrochanteric Fracture Using Locking Compression Plates

• Jang JH
• Ahn JM
• Lee HJ
• Moon NH

• KMID: 2371770
• DOI: http://doi.org/10.5371/hp.2017.29.1.68

Abstract

PURPOSE
This study aimed to evaluate the surgical outcomes of biologic plating using locking compression plate-distal femur (LCP-DF) in patients with subtrochanteric fracture of the femur.
MATERIALS AND METHODS
Between January 2010 and December 2013, 28 consecutive patients with subtrochanteric fractures of the femur, treated with biologic fixation using LCP-DF, were enrolled. Preoperative values, including patient age, sex, body mass index, fracture type, type of lung injury, and surgical timing from injury to surgery, were retrospectively evaluated. Radiologic assessments included time to union, coronal alignment, rotational alignment, and complications such as implant breakage and screw breakage. Adverse events, including postoperative fat embolism and adult respiratory distress syndrome, infection during the follow-up period, and walking ability at the last follow-up visit, were assessed.
RESULTS
Union was achieved in 27 patients (96.4%) after a mean duration of 5.4 months (range, 3-14 months). No patients developed fat embolism or adult respiratory distress syndrome during the hospitalization period of this study.
CONCLUSION
Biologic fixation using locking compression plates may represent a safe surgical option which can be utilized in patients with subtrochanteric fracture regardless of injury severity, surgical timing, fracture type, and presence of lung injury.

Keyword

Biologic fixation; Subtrochanteric fracture; Locking compression plate

MeSH Terms

Body Mass Index
Embolism, Fat
Femur
Follow-Up Studies
Hip Fractures
Hospitalization
Humans
Lung Injury
Respiratory Distress Syndrome, Adult
Retrospective Studies
Walking

Figure

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  Fig. 1 Closed reduction based on the minimally invasive technique under fluoroscopic examination. (A, B) Hoffman retractor placing for the reduction of flexion and external rotation deformity of the proximal fragment. (C, D) Temporary wiring using a percutaneous wire passer.

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  Fig. 2 (A, B) A 62-year-old patient with a complex subtrochanteric fracture after pedestrian accident. (C) Postoperative radiography after fixation with an locking compression plate-distal femur. (D) Fracture union at one year after fixation. (E) Radiography at the last follow-up visit after implant removal.

• 

  Fig. 3 (A) A 43-year-old patient with a 31A32 fracture of the proximal femur after falling accident. (B) Postoperative radiography demonstrated slight lateral displacement of the proximal fragment (arrow). (C) Lorenz image showing failure of anterior cortical opposition due to a flexion and external rotation deformity (arrow). (D) Radiography at one-year follow-up demonstrating nonunion of the fracture site with implant breakage.

• 

  Fig. 4 (A, B) A 57-year-old patient with a complex subtrochanteric fracture and posteromedial fragment (arrow). (C) Postoperative radiography demonstrating accurate posteromedial buttressing using a lag screw (arrow). (D) Radiography at one-year follow-up demonstrating fracture union.

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