[Ortho] перелом проксимальной бедренной пластинки

[Alexander Chelnokov]

> Уважаемые коллеги, что делать?

Удалять. Чем менее травматично, тем лучше. И закрыто штифтовать 
проксимальным гвоздем.
И эти пластинки больше не использовать. Ниже две свежих публикации на 
эту тему:

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Injury. 2013 Mar 20. pii: S0020-1383(13)00094-6. doi: 
10.1016/j.injury.2013.02.020. [Epub ahead of print]
High failure rate of trochanteric fracture osteosynthesis with proximal 
femoral locking compression plate.
Wirtz C, Abbassi F, Evangelopoulos DS, Kohl S, Siebenrock KA, Krüger A.
Source

Department of Orthopaedic Surgery, Inselspital, University of Bern, 
Bern, Switzerland.
Abstract
INTRODUCTION:
Stable reconstruction of proximal femoral (PF) fractures is especially 
challenging due to the peculiarity of the injury patterns and the high 
load-bearing requirement. Since its introduction in 2007, the PF-locking 
compression plate (LCP) 4.5/5.0 has improved osteosynthesis for 
intertrochanteric and subtrochanteric fractures of the femur. This study 
reports our early results with this implant.
METHODS:
Between January 2008 and June 2010, 19 of 52 patients (12 males, 7 
females; mean age 59 years, range 19-96 years) presenting with fractures 
of the trochanteric region were treated at the authors' level 1 trauma 
centre with open reduction and internal fixation using PF-LCP. 
Postoperatively, partial weight bearing was allowed for all 19 patients. 
Follow-up included a thorough clinical and radiological evaluation at 
1.5, 3, 6, 12, 24, 36 and 48 months. Failure analysis was based on 
conventional radiological and clinical assessment regarding the type of 
fracture, postoperative repositioning, secondary fracture dislocation in 
relation to the fracture constellation and postoperative clinical 
function (Merle d'Aubigné  score).
RESULTS:
In 18 patients surgery achieved adequate reduction and stable fixation 
without intra-operative complications. In one patient an ad latus 
displacement was observed on postoperative X-rays. At the third month 
follow-up four patients presented with secondary varus collapse and at 
the sixth month follow-up two patients had 'cut-outs' of the proximal 
fragment, with one patient having implant failure due to a broken 
proximal screw. Revision surgeries were performed in eight patients, one 
patient receiving a change of one screw, three patients undergoing 
reosteosynthesis with implantation of a condylar plate and one patient 
undergoing hardware removal with secondary implantation of a total hip 
prosthesis. Eight patients suffered from persistent trochanteric pain 
and three patients underwent hardware removal.
CONCLUSIONS:
Early results for PF-LCP osteosynthesis show major complications in 7 of 
19 patients requiring reosteosynthesis or prosthesis implantation due to 
secondary loss of reduction or hardware removal. Further studies are 
required to evaluate the limitations of this device.
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J Orthop Trauma. 2013 Jan;27(1):22-8. doi: 10.1097/BOT.0b013e318251930d.
Mechanical failure after locking plate fixation of unstable 
intertrochanteric femur fractures.
Streubel PN, Moustoukas MJ, Obremskey WT.
Source

Orthopedic Trauma Service, Department of Orthopedics, Vanderbilt Medical 
Center, Nashville, TN 37232, USA. philipp.n.streubel на vanderbilt.edu
Abstract
OBJECTIVES:
The aim of this study was analyze modes of mechanical failure in a 
consecutive cohort of patients and establish possible risk factors.
DESIGN:
This was a retrospective cohort study.
SETTING:
The study was conducted at an academic level-1 trauma center.
PATIENTS:
Twenty-nine patients (mean age 56 years, range 21-92; 45% males, 41% 
smokers, 17% diabetic, mean body mass index 26.9, range 20-56) with 30 
OTA 31A3 fractures treated between 2003 and 2007 were included.
TREATMENT:
Operative fixation using 4.5-mm locking compression plate (LCP) proximal 
femur plate (Synthes, Paoli, PA).
MAIN OUTCOME MEASUREMENTS:
Mechanical failure was defined as loss of alignment of at least 10° or 
shortening of at least 2 cm. Secondary outcomes included patient and 
fixation construct variables as possible predictors for mechanical failure.
RESULTS:
At 20 months of follow-up, 11 failures (37%) occurred. Mean time to 
failure was 18 weeks (range 2-84). Cumulative failure rates were 10%, 
20%, 27%, and 33% at 1, 2, 6, and 12 months, respectively. The most 
frequent failure mode was varus collapse with screw cut out (5 cases). 
There was no statistically significant difference between groups with 
regards to age, body mass index, diabetes, or smoking habit. The 
presence of a "kickstand screw" and medial cortical reduction were not 
significantly different in cases with and without failure. Proximal 
screw number and type were similar in both groups.
CONCLUSIONS:
A high rate of mechanical failure can be expected with proximal locking 
plate fixation of unstable proximal femur fractures. The use of a 
"kickstand" screw could not be established to reduce the risk for 
mechanical failure.
LEVEL OF EVIDENCE:
Therapeutic Level IV. See Instructions for Authors for a complete 
description of levels of evidence.
PMID: 22549030  [PubMed - in process]
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Alexander Chelnokov
г. Ижевск, гор. б-ца№3
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