Bridge-plating osteosynthesis of 20 comminuted subtrochanteric fractures with dynamic hip screw.

BACKGROUND A prospective clinical trial was conducted to evaluate the conjunctive use of an extramedullary device and the bridge-plating technique in the treatment of comminuted subtrochanteric fractures with major extension into the femoral shaft. METHODS A Winquist criteria was used to classify 3 fracture patterns. The type 3 fractures were excluded from this study because of great extent of the fracture zone for which the bridge-plating technique is not indicated. There were 14 men and 6 women, with a mean age of 49 (range, 17-76) years. A dynamic hip screw (DHS) with a long side plate was chosen as the fixation device because of the small learning curve. RESULTS The fractures united at a mean of 7.6 (range, 3-15) months postoperatively. Mobility was scored at 9 points in 18 patients and 6 points in 2 patients (Mobility score of Parker & Palmer). Pain was absent in 14, mild in 3, and moderate in 3 patients. Two limbs were shortened by 1 and 1.5 cm, respectively. CONCLUSION Our results indicate that DHS fixation using the bridge-plating technique leads to union of all comminuted Winquist types 1 and 2 fractures without major complications, and it is a valuable alternative to new intramedullary devices. This procedure offers the significant advantage of being less technically demanding.