MANAGEMENT OF UNSTABLE TROCHANTERIC FRACT URES (TYPE A0 A3) WITH THE USE OF THE SLIDING HIP SCREW AND A NEW CONNECTABLE BUTT-PRESS PLATE

ORIF management of unstable trochanteric fractures of type A3 of the A 0 classification is difficult because of lateral dislocation of the pr oximal fractured segments, particularly when only the sliding hip-scre w is used for fixation. A connectable butt-press plate was recently de veloped in order to prevent this type of dislocation. We review the re sults with this fixation technique in 22 elderly patients with an aver age age of 76 years who presented with highly unstable trochanteric fr acture of the A3 type. Three patients died of diseases unrelated to th e trauma or operation before the fractures had healed. The other 19 we re followed prospectively until fracture healing had occurred. Complai nts, leg shortening and changes in the CCD angle were recorded. Furthe rmore, the mobility score was determined. Although the patients were a ble to bear full weight after the operation, no lateral dislocation of fragments was observed. Only 1 patient had a varus dislocation of 5'' until the fracture had consolidated. This was due to severe osteopeni a and subsequent dislocation of the screw within the femoral head. No pseudarthrosis, osteitis or rotational malalignment was noted. Five of the surviving patients had a lower mobility score after fracture heal ing as compared to the status before the fracture was sustained. On th e basis of this review we recommend the use of this new connectable bu ttress plate with sliding hip screws because it provides sifficient fi xation of highly unstable fractures of type A3.