Concerning the proper length of femoral side plates

In a series of 41 subtrochanteric femoral fractures and 12 supracondylar fractures of the femur treated with internal fixation utilizing side plates, the number of cortices used to secure the shaft fragment to the plate varied from three to 24. Experimental evidence suggests that four screws, or eight cortices, provide a good margin of safety. This study provides a clinical confirmation of this experimental finding. Shaft fragments should be held with screws transfixing eight to ten cortices. Twenty-seven of the 53 fractures (51% of the fractures in this series) had fixation of the shaft fragment with more than ten cortices. These patients thus had excessive dissection, greater blood loss, the implantation of larger hardware, and a greater risk of infection than was necessary.