Extramedullary fixation of 569 unstable intertrochanteric fractures: a randomized multicenter trial of the Medoff sliding plate versus three other screw-plate systems

Research output: Contribution to journalArticle

Abstract

We compared the efficacy of the Medoff sliding plate (MSP) with 3 other screw-plate systems for fixation of unstable intertrochanteric fractures in a randomized multicenter trial of 569 elderly patients. The MSP has biaxial dynamic capacity along both the neck and the shaft of the femur unlike the other systems, which lack dynamic capacity along the shaft. 268 fractures were operated on with the MSP, and 301 with the dynamic hip screw (DHS), with or without a trochanteric stabilizing plate (DHS/TSP) or with the dynamic condylar screw (DCS). The MSP had recently been shown to the surgeons.The patients in the groups were similar as regards age, domestic situation, preinjury walking ability and type of fracture. We followed the patients clinically and radiographically for at least 1 year. There was no significant difference in walking ability at follow-up or rate of return to home. Fixation failure occurred in 18/268 fractures operated on with the MSP, in 8/238 with the DHS, in 3/49 with the DHS/TSP and in 1/14 with the DCS. The difference in the rate of fixation failure was not statistically significant when the MSP group was compared to the 3 other groups. In 14 of the 18 fixation failures in the MSP group, the biaxial dynamic capacity of the MSP had not been used due to technical errors by surgeons, unfamiliar with the new method. No selection bias was found regarding fracture types in the 2 subgroups of patients with correct or inadequate biaxial dynamization. Extramedullary fixation of unstable intertrochanteric fractures with these implants showed a low failure rate. When using the MSP, biaxial dynamization must be correctly performed.

Details

Authors
  • Karl Lunsjö
  • Leif Ceder
  • Karl-Göran Thorngren
  • Björn Skytting
  • Jan Tidermark
  • Per-Olof Berntson
  • Ingemar Allvin
  • Sigge Norberg
  • Krister Hjalmars
  • Sune Larsson
  • Richard Knebel
  • Anders Hauggaard
  • Leif Stigsson
Organisations
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Surgery
  • Orthopedics
Original languageEnglish
Pages (from-to)133-140
JournalActa Orthopaedica Scandinavica
Volume72
Issue number2
Publication statusPublished - 2001
Publication categoryResearch
Peer-reviewedYes

Bibliographic note

The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Department of Orthopaedics (Lund) (013028000), Reconstructive Surgery (013240300)