Indirect reduction with a condylar blade plate for osteosynthesis of subtrochanteric femoral fractures

Subtrochanteric fractures frequently occur as high energy trauma usually in younger patients and may lead to severe comminution of the medial cortex. The medial cortex of the proximal femur is exposed to high compressive forc es which make fracture stabilization a difficult problem. Bone healing may be seriously compromised due to extensive comminution and fragment devitali zation. This requires reduction techniques which do not cause additional da mage to the vitality of the bone. With indirect reduction techniques and th e use of a condylar blade plate the results have been significantly improve d in these fracture types in our department (1). In this report the essential aspects of indirect reduction for subtrochante ric fractures using a condylar blade plate and the treatment results from o ur department from earlier years (1) and from the last 21/2 years will be p resented. In the latter period, fifteen patients with a mean age of 49 year s (19-87 years) were treated with this method. Fractures resulted from traf fic incidents or falls from a great height in 11 cases (73%). Union was ach ieved in 14 cases (93%) with full weight-bearing after a mean of 3 months ( 1-41/2 months). Malunion was seen in two cases (13%) without the need for f urther surgery. Non union occurred in one patient (7%) with a III B open in jury due to early infection. After repeated debridements, bone grafting and decortication, the fracture was stabilized with a replacement condylar bla de plate and healed uneventfully. The results have been very encouraging and indirect reduction with a condyl ar blade plate in subtrochanteric fractures continues to be used in a large number of these fractures. With long, intact proximal fragments interlocki ng intramedullary devices are used instead.