Treatment of reverse obliquity intertrochanteric fractures.

BACKGROUND: Unstable intertrochanteric fractures of the hip, especially reverse oblique fractures are a serious problem in traumatology, as there is no standard method of treatment and inadequate treatment carries a significant complication rate. To assess the surgical treatment results of reverse oblique trochanteric fractures.

MATERIAL/METHODS: Between 1997-2010, 389 patients with intertrochanteric fractures were treated. 28 (7.1%) of these fractures classified as reverse oblique. This group of patients consisted of 10 men and 18 women, aged 24 to 98 years. All patients underwent surgery. Following treatment options were used; dynamic hip screw (DHS)--10 patients, proximal femoral nail (PFN)--13 patients, dynamic condylar screw (DCS)--2 patients, angular plate--4 patients, UFN spiral blade--1 patient, bone plate--1 patient. Since 2000, all patients with reverse oblique fractures were treated with a PFN.

RESULTS: Seventeen (60.7%) hips healed without complications. In three patients fixation was unsuccessful. The first patient, who was unhealed because of non-union, underwent three types of fixation (DHS, DCS and PFN) before finally receiving a total revision cement prosthesis. The second patient suffered a re-fracture following angular plate procedure and fixation was changed into a DHS. The third patient, treated with DCS, healed with a varus deformity. Twelve out of thirteen PFN-treated hips healed without complications. Six patients died a few years after surgery due to unrelated causes.

CONCLUSIONS: The operative treatment of reverse oblique fractures using intramedullary fixation carries fewer complications than internal extramedullary fixation.