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Kinast et al. compared their results of open reduction and blade plate fixation of

subtrochanteric fractures with indirect reduction and fixation. They found that delayed union

or nonunion resulted in 16.6% of fractures fixed with open reduction and in none fixed with

indirect reduction; infection rates were 20.8% and 0%. iebenroc!" #uller" and $an

reported indirect reduction and internal fixation with a condylar blade plate of 1&

subtrochanteric fractures. 'ourteen of 1& fractures healed ()*%+ after an a,era-e of * months.

They emphasied the importance of not disturbin- the ,ascular supply to the fracturefra-ments.

TECHNIQUE 52-5

Kinast et al.

osition the patient supine on a standard operatin- table" and ma!e a standard lateral

approach to the hip /oint (see hapter 1+.

'ree the fascia of the ,astus lateralis laterally and trans,ersely at the inferior aspect

of the -reater trochanter. arefully retract the ,astus lateralis to expose only the

lateral aspect of the femur.

nsert the blade of the plate into the proximal fra-ment at the le,el determined bypreoperati,e radio-raphs ('i-. &2*03+. 3pply the shaft of the plate to the main

distal fra-ment with selfcenterin- boneholdin- forceps" and reduce the fracture to

the shaft of the plate. f shortenin- is si-nificant" apply the femoral distractor

laterally and distract the fracture ('i-. &2*04+.

f shortenin- is minimal" place an outri--er screw in the cortical bone distal to the

plate" and use the plate tension de,ice as a distractor to o,erdistract the fracture

sli-htly. The medial fra-ments often reduce spontaneously (indirectly+ because of

their softtissue attachments. f further reduction is necessary" manipulate the

fra-ments with a small pestle; to pre,ent softtissue strippin-" do not manipulate the

fra-ments from the cortical surfaces. 3ttempt to obtain anatomical reduction if

possible; howe,er" anatomical reduction and restoration of the medial buttress arenot absolutely necessary.

5hen the medial fra-ments ha,e been ali-ned" use the tensionin- de,ice to

compress the fracture axially ('i-. &2*13+" loc!in- the fra-ments and holdin-

them. The fracture must accept axial compression" and the fra-ments should be

trapped medially if possible. f the medial fra-ments are not loc!ed" they are

considered ,ascularied bone -rafts and are left in place" but the plate is still loaded

with the tension de,ice.

5hen the fracture is stable and accepts the applied load" fix the plate to the femoral

shaft with enou-h screws to ensure stability ('i-. &2*14+.

btain interfra-mentary fixation throu-h the plate or outside it" but a,oid further

periosteal strippin-.

lose the wound in the usual manner.

Fig. 52-30 ndirect reduction techni7ue of Kinast et al. A,4lade is inserted into proximal fra-ment. B,ateral application of femoral distractor.

(From Kinast C, Bolhofner BR, Mast JW, et al: Subtrochanteric fractures of the femur: results of treatment with the 95!e"ree con!#lar bla!e$late,

Clin %rtho$ Relat Res &':)&&, )99*+

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Fig. 52-31 A,9se of tensionin- de,ice. B,late is fixed to shaft with screws.

(From Kinast C, Bolhofner BR, Mast JW, et al: Subtrochanteric fractures of the femur: results of treatment with the 95!e"ree con!#lar bla!e$late,

Clin %rtho$ Relat Res &':)&&, )99*+

AFTERTREATENT

3ftertreatment is similar to that for hip compression screw fixation of intertrochanteric

fractures. $enerally" the medial buttress is not completely restored" and only touchdown

wei-ht bearin- is allowed until si-ns of early fracture healin- are present at 6 to 8 wee!s. 'ull

wei-ht bearin- usually is delayed for up to * months after sur-ery.