Treatment of subtrochanteric fractures of the femur: reduction on the traction table and fixation with dynamic condylar screw

Abstract

In the subtrochanteric region of the femur high tensile forces are active in the lateral cortex and even higher compressive forces in the medial cortex. Subtrochanteric fractures are often comminuted. The implant of choice for osteosynthesis of subtrochanteric femoral fractures is the condylar plate. Usually the various fragments are dissected intraoperatively and the medial cortex is reconstructed anatomically for improved abutment. This devitalizing of fragments leads to disturbed healing, so that failures are frequent despite cancellous bone grafting. The osteosynthesis technique introduced by Mast and Ganz of indirect reduction by distractor without dissection of the fragments and the medial cortex allowed the complication rate to be reduced to 0%. We have modified this technique in that we performed closed reduction on the traction table rather than using the distractor to achieve axial and rotational alignment, after which the fracture is stabilized with dynamic condylar screw (DCS) under image intensifier control. The proximal femur is dissected only laterally and only in so far as in necessary to place the DCS. We never use cancellous bone grafting. From 1988 to 1990 this technique was used in 12 patients. All fractures had healed uneventfully after 4 months.