A reinforced rigid fixation device for unstable intertrochanteric fractures

Area of Science:

• Orthopedic Surgery
• Trauma Management
• Biomedical Engineering

Background:

• Intertrochanteric and proximal subtrochanteric fractures are common in elderly patients, often presenting with instability.
• Existing fixation devices like the Gamma nail and sliding hip screw have limitations in managing these complex fractures.

Purpose of the Study:

• To introduce and evaluate a novel 120-degree blade plate reinforced with a strut for treating unstable hip fractures.
• To assess the mechanical strength and clinical efficacy of this reinforced device in elderly patients.

Main Methods:

• Mechanical testing of the reinforced blade plate against established implants (Gamma nail, sliding hip screw).
• Clinical evaluation of 358 patients (age > 60) treated with the device between 1987 and 1991, with a mean follow-up of 16 months.
• Analysis of fracture union, weight-bearing status, complication rates, and fixation failure.

Main Results:

• The reinforced blade plate demonstrated significantly higher mechanical strength (11,758 N) compared to Gamma nail and sliding hip screw.
• 82% of patients achieved fracture union and were walking unaided or with a cane within 6 months post-surgery.
• Early weight-bearing was feasible (average 5 days), with low intraoperative (3%) and postoperative (7.1%) complication rates; fixation failure rate was 5.4%.

Conclusions:

• The reinforced blade plate provides superior mechanical stability for treating unstable intertrochanteric fractures, particularly Evans' Grades 4 and 5.
• This device facilitates early weight-bearing and good functional recovery in elderly patients with hip fractures.
• The reinforced implant is an effective treatment option for unstable hip fractures, offering improved outcomes and reduced complications.