Abstract
Unstable intertrochanteric fractures present a difficult problem with a high incidence of complications such as mechanical failure of the implants or cut-out. The use of bone cement (PMMA) has been suggested in the past but the application with hand to fill the existing voids has not given good results and also has high incidence of pseudarthrosis and infection.
A new technique is presented in which the PMMA is injected with syringe through the hole opened for the compression screws. The aim is to augment mechanical stability and also to replace the compressed spongiosa.
The study population of 105 patients with unstable intertrochanteric fractures was separated in 2 groups, hi group A (51 patients, 4 male/47 female, mean age 72.3) a conventional sliding nail was performed, while in group B (54 patients, 3 male/51 female, mean age 78.9) the new technique was applied. The two were similar regarding age and gender.
Post-operatively in group A 95% of the patients remain in bed for 1–2 weeks according to the surgeon opinion regarding the stability of osteosynthesis. 45% of them remain in a regime of bed to chair existence for 6 weeks. 72% return to its previous domicile and activity. In group B all patients were sat out the bed in the 1st day post-op and walked in the 2nd day post-op with partial weight bearing where that ability preexisted. 91% return to its previous domicile and activity.
In group A ll cases of cut-out were noted while in group B only 1 cut-out and also 2 cases, where we had screw failure, but fracture went on to union. All the difference are in favor in group B and statistical significant (p< 0,0 5). No infection was noted.
The suggested method appears to give a satisfactory solution to the problem of unstable intertrochanteric fractures, allowing fast and safe mobilization of the patient, reducing thus morbidity. Technically it is simple, easy to apply and does not require instrumentation while the extra cost is only that of a butch of PMMA.
Correspondence should be addressed to 8 Martiou Str. Panorama, Thessaloniki PC:55236, Greece.
