Özet:

Objective Pertrochanteric fractures consist 50% of the hip fractures with a high rate of morbidity. The primary aim in treatment is anatomic reduction, preserving of the reduction with stable fixation and early mobilization with rehabilitation. Dynamic hip screws (DHS) are accepted as the golden standard in treatment of the these fractures. On the other hand, fixed angle plates, intramedullary nails and external fixators are also used. However, there is no consensus on the implant choice in the management of intertrochanteric fractures particularly for the unstable fractures. The aim of the present study is to discuss the functional results of the extramedullary stabilization of intertrochanteric fractures in the light of the current literature. Materials and Methods In the present study, the patients over 18 years of age who had Evans type 1 and type 2 intertrochanteric fractures that were managed by open reduction and internal fixation and, completed post-operative 1year retrospectively evaluated. Varus, valgus angulation and loss of reduction evaluated in the anteriorposterior radiographs. Harris Hip Score (HHS) and Traumatic Hip Scale (THS) were used to assess functional evaluation. Results Eighteen patients were included in the study. Mean age of the patients was 52,5 years old, mean stay in the hospital was 7 days and mean follow-up time was 22 months. Cause of the admission to the hospital was traffic accident in 4 patients and was falling in 14 patients. Seventeen of the fractures were type 1 and one was type 2. Ten of the type 1 fractures were stable and, 7 were unstable. DHS was used in 13 of the patients and, DCS was used in 5 of the patients. Functional results according to HHS; 14 excellent, 3 good, 1 poor and according to THS; 9 excellent, 7 good, 1 poor and 1unsuccessful.Varus angulation occurred in 12 patients with a mean angle of 8,25°and, valgus angulation occurred in 3 patients with a mean angle of 4,6°. In 3 patients (Evans type 1 unstable) no change occurred in neck-shaft angle. Mean sliding was 5,34 mm in unstable fractures and, was 1,76 mm in stable fractures.Non-union, cutout and femoral shaft medialization, infection, deep venous thrombosis, pulmoner emboli and myositis ossificans was seen in none of the patients. Conclusion Type of the fracture is one of the important factors affecting mortality. Mechanically stable reduction and preserving of the reduction is the main effect that provides success. The increased revision incidence also increases mortality. The present literature is far away from describing the ideal implant. But, every implant has own advantages and disadvantages. Proximal femoral nails seem more advantageous than DHS considering implant failure, bleeding amount and shorter hospitalization time. And also, proximal anatomic plates must be kept in mind for the certain types of the fractures.

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