Dynamic helical blade plate fixation of intertrochanteric fractures

Abstract

Proximal femoral fractures are commonly encountered in our daily practice. However, significant complications still occur and most fractures heal with significant collapse, resulting in limb shortening and limping gait. The fixation over the femoral head region is still not satisfactory and lag screw cut-out occurs 6-19%.The helical blade plate fixation was devised as an attempt to improve the fixation of the femoral head. The theoretical advantage includes an increased cross section area to resist cut-out and a decreased amount of bone removed from the femoral head during insertion. An anti-rotation mechanism was also devised, which potentially decreased the amount of rotational displacement during fracture collapse. A total of 104 dynamic helical blade plate fixations were performed in Queen Mary Hospital, Hong Kong. The average age was 82. The indications include AO/OTA 31 A1 and A2 fractures. Cut-out of the helical blade occurred in two patients (1.9%). All other fractures united with different degrees of shortening.The theoretical advantages of the helical blade fixation of the osteoporotic femoral head appear to be valid. However, the fracture of the lateral wall of the proximal femoral shaft can still occur and may compromise the result of this method of fixation. Larger randomized studies are needed to further evaluate the usefulness of this method of fixation.