Fixation of AO-OTA 31-A1 and A2 trochanteric femur fractures using a sliding hip screw system: can we trust a two-hole side plate construct? A review of the literature

Abstract

Trochanteric femur fractures are frequently fixed with a four-hole side plate sliding hip screw device, but in recent decades two-hole side plates have been used in an attempt to minimize operative time, surgical dissection, blood loss and post-operative pain.The aim of this review was to determine whether two-hole sliding hip screw constructs are an acceptable option for fixation of AO-OTA 31-A1 and A2 trochanteric femur fractures.An electronic MEDLINE® database search was performed using PubMed®, and articles were included in this review if they were reporting historical, biomechanical, clinical or outcome data on trochanteric fracture fixation using a two-hole sliding hip screw device.A two-hole dynamic hip screw with a minimally invasive muscle-splitting approach is recommended for fixation of AO-OTA 31-A1 simple trochanteric fractures; this implant is biomechanically safe, and allows the use of a minimally invasive muscle-splitting approach which potentially provides better clinical outcome, such as decreased surgical trauma, shorter operative time, less blood loss, decreased analgesics use, and shorter incision length. As the majority of reviewed publications relate to the dynamic hip screw, it is not clear whether the above recommendations can be extended to any other sliding hip screw device.An intramedullary device is recommended for all other extra-capsular proximal femoral fractures. Cite this article: EFORT Open Rev 2020;5:118-125. DOI: 10.1302/2058-5241.5.190020.

Keywords: dynamic hip screw; four holes; gliding hip screw; sliding hip screw; trochanteric femur fracture; two holes.

Fig. 1

Radiographs of an 82-year-old female with a left AO-OTA 31-A1 simple trochanteric fracture. (A) and (B) antero-posterior and axial views prior to fixation. (C) and (D) antero-posterior and axial views on day 0 after surgical fixation with a two-hole DHS. (E) and (F) final follow-up antero-posterior and axial views six months after surgery; the patient was able to walk with one crutch and minimal discomfort from three months after surgery. At six months, the crutch was used only for security reasons, as the patient was afraid of falling again. Note. DHS, dynamic hip screw.

Fig. 2

Radiographs of a 94-year-old female with a right AO-OTA 31-A2 multi-fragmentary trochanteric fracture. (A) and (B) antero-posterior and axial views prior to fixation. (C) and (D) antero-posterior and axial views on day 0 after surgical fixation with a cephalo-medullary nail (Gamma nail). (E) and (F) final follow-up antero-posterior and axial views one year after surgery; the patient was able to walk with one crutch and no pain or discomfort from three months after surgery, and kept the crutch from then only for security reasons.

Fig. 3

Radiographs of a 90-year-old female with a right AO-OTA 31-A3 reverse obliquity trochanteric fracture. (A) and (B) antero-posterior and axial views prior to fixation. (C) and (D) antero-posterior and axial views on day 0 after surgical fixation with a cephalo-medullary nail (Gamma nail). (E) and (F) final follow-up antero-posterior and axial views 18 months after surgery; the patient was able to walk with no crutch and no pain or discomfort from two months after surgery.