5791
document
RAB-plate versus sliding hip screw for unstable trochanteric hip fractures : stability of the fixation and modes of failure -- radiographic analysis of 218 fractures . BACKGROUND The sliding hip screw has gained considerable acceptance in the treatment of unstable trochanteric fractures . However , the new type of 120 degrees fixed angle blade-plate with a buttress rod ( RAB-plate ) showed encouraging clinical results . The purpose of this study was to assess stability of fixation and analyze modes of failure in unstable trochanteric hip fractures treated with these devices . METHODS A retrospective radiographic review of 218 unstable fractures was performed . Linear and angular displacements of the major fragments and implant migration into the femoral head during healing were assessed . Additionally , adequacy of the reduction and the location of the implant within the femoral head as predictors of fixation failure were evaluated . RESULTS The postreduction neck-shaft angle was maintained in the majority of the fractures in both groups . However , there was a significantly higher incidence of varus angulation by 10 degrees or more by the completion of healing among fractures treated with the sliding hip screw ( p = 0.04 ) . There was no statistically significant difference in vertical migration of the device into the femoral head between the implants used ( p = 0.3 ) . There was a significant relationship between failure of the fixation and varus reduction ( p = 0.04 ) as well as screw/neck angle deviation more than 20 degrees in the lateral projection ( p = 0.005 ) or if the implant was in a superior or posterior position ( p = 0.02 ) . CONCLUSION The RAB-plate provided a more stable fixation , especially with regard to maintained postoperative alignment . However , positive predictors for fixation failure were identical for both devices . Here , the screw/neck angle deviation has had the strongest significance for prediction of fixation failure .
5792
Intervention_Surgical
RAB-plate
5793
Intervention_Surgical
sliding hip screw
5794
Intervention_Surgical
sliding hip screw
5795
Intervention_Surgical
120 degrees fixed angle blade-plate with a buttress rod
5796
Intervention_Surgical
sliding hip screw
5797
Intervention_Surgical
RAB-plate
5798
Outcome_Physical
implant migration into the femoral head
5799
Outcome_Physical
vertical migration of the device into the femoral head
5800
Outcome_Physical
fixation failure