Influence of Dynamization of Trochanteric Fracture Osteosynthesis on Bone Union.

Abstract

BACKGROUND Ineffectively treated trochanteric fractures lead to disability and thus constitute a significant social problem. The aim of the study was to analyze the effect of dynamization of the fixation of trochanteric fractures on bone union. MATERIAL AND METHODS We conducted a retrospective study involving 149 patients operated on for trochan-teric fractures in 2015-2017. The fractures were anastomosed with a DHS extramedullary device or a Gamma 3 intramedullary nail. RESULTS Bone union was achieved at an average of 11 weeks after the surgery (8-20 weeks). In the extra-me-dullary stabilization (DHS) group, union was achieved after 12 weeks (8 to 16 weeks) (N = 47). In in-tramedullary stabilization, union was achieved after 10 weeks (8 to 20 weeks) (N = 96). The intramedullary nails were locked statically or dynamically. The time to union in static stabilization was 12.3 weeks (8 to 20 weeks) (N = 31), while in dynamic stabilization it was 9.4 weeks (8 to 16 weeks) (N = 64). CONCLUSIONS 1. This study revealed a measurable biologically beneficial effect of dynamization of the fixation of trochanteric fractures on the time of bone union. 2. Conventional radiographs and CT imaging according to indications significantly facilitate the classification of fractures and selection of the method of stabilization with dynamization. 3. Due to the considerable comminution of the trochanteric massif, double dynamization (cervical-trochanteric and femoral-trochanteric) of fracture fragments is essential, ensuring reduction of fracture gaps and self-reduction of inter-fracture resorptive gaps, which is a prerequisite for optimal union. 4. Allowing early, full weight-bearing of the operated limb within the painless range is an important element of effective dynamization.