M.E.Müller: Atlas: Fracture 31-A1

Femur, Proximal, extra-articular fracture, trochanteric area, pertrochanteric simple 9,55% of the total
15,80% of the femur
22,59% of the segment

2677 fractures
51,6% group
30%M, 70%F

1992 fractures
38,4% group
24%M, 76%F

517 fractures
10,0% group
30%M, 70%F

Along the intertrochanteric line Through the greater trochanter +Q Below the lesser trochanter +Q

These are simple pertrochanteric fractures without displacement. Medial cortex contact is preserved and there is no postero-medial bone loss. Ref. Manual of Internal Fixation :
262 - 265. 272 - 275. 528 - 531.
Surgeon. RO, MS.

Dynamic internal fixation allows fragment impaction guided by the implant. The basic implant is the 130º angled blade-plate with the “U” profile blade. It can be complemented with a proximal cancellous screw performing compression, tension band and anti-rotational effects. Currently, most surgeons prefer to use the DHS implant because of its easier insertion, helped by an X-Ray guided threaded pin that facilitates the exact positioning of the sliding screw threads into the hard core of the femoral head.

Both the DHS and the 130º angled blade-plate allow dynamic compression between the proximal and distal fragments when load is applied to the fracture. In the fracture type 31-A1.1 the fragment impaction is minimal since there is no bone loss between the two main fragments. This is why, under load, there is no penetration of the tip of the 130º blade-plate, neither is there sliding of the DHS screw. Both implants are equally effective but greater surgical skill is required for a precise implantation of the 130º blade-plate.

preoperative + 4 months

preoperative + 4 months

preoperative preoperative

+ 2 years + 2 years

preoperative preoperative

+ 0 months + 0 months

+ 4 months + 4 months

These are pertrochanteric fractures with varus displacement in which medial cortex contact is restored by adequate reduction. The displacement carries with it crushing of the cancellous bone, undiscernible small fragments or collapse weakness of the postero-medial wall. Ref. Manual of Internal Fixation:
262 - 265. 272 - 275. 528 - 531.
Surgeon. RO, RO.

There are two possibilities: Dynamic internal fixation with a DHS, its easier application being appreciated by the majotity of the surgeons, or internal fixation with a 95º condylar plate protected by one or two lag screws into the calcar. If a fracture line through the lesser trochanter is suspected, it must be fixed with a lag screw in order to prevent the fracture from evolving to an A2 type when placed under load.

The condylar plate should be reserved only for young non-osteoporotic bone. It requires anatomic reduction with perfect medial cortex contact and it is mandatory to complement its buttress effect with interfragmentary compression by lag screws. Therefore, it requires greater surgical experience and is less forgiving of technical errors than the dynamic internal fixation. The use of a 130º angled blade-plate, with or without an added screw, would also be adequate.

preoperative + 4 months

preoperative + 4 months

preoperative + 6 months + 6 months

preoperative preoperative

+ 0 months + 0 months

+ 9 months + 9 months

.. Surgeon. RO, RO.

.

.

preoperative preoperative

+ 4 months + 4 months




						Femur, Proximal, extra-articular fracture, trochanteric area, pertrochanteric simple	9,55% of the total 15,80% of the femur 22,59% of the segment






These are simple pertrochanteric fractures without displacement. Medial cortex contact is preserved and there is no postero-medial bone loss.		Ref. Manual of Internal Fixation : 262 - 265. 272 - 275. 528 - 531. Surgeon. RO, MS.

Dynamic internal fixation allows fragment impaction guided by the implant. The basic implant is the 130º angled blade-plate with the “U” profile blade. It can be complemented with a proximal cancellous screw performing compression, tension band and anti-rotational effects. Currently, most surgeons prefer to use the DHS implant because of its easier insertion, helped by an X-Ray guided threaded pin that facilitates the exact positioning of the sliding screw threads into the hard core of the femoral head.	Both the DHS and the 130º angled blade-plate allow dynamic compression between the proximal and distal fragments when load is applied to the fracture. In the fracture type 31-A1.1 the fragment impaction is minimal since there is no bone loss between the two main fragments. This is why, under load, there is no penetration of the tip of the 130º blade-plate, neither is there sliding of the DHS screw. Both implants are equally effective but greater surgical skill is required for a precise implantation of the 130º blade-plate.






These are pertrochanteric fractures with varus displacement in which medial cortex contact is restored by adequate reduction. The displacement carries with it crushing of the cancellous bone, undiscernible small fragments or collapse weakness of the postero-medial wall.		Ref. Manual of Internal Fixation: 262 - 265. 272 - 275. 528 - 531. Surgeon. RO, RO.

There are two possibilities: Dynamic internal fixation with a DHS, its easier application being appreciated by the majotity of the surgeons, or internal fixation with a 95º condylar plate protected by one or two lag screws into the calcar. If a fracture line through the lesser trochanter is suspected, it must be fixed with a lag screw in order to prevent the fracture from evolving to an A2 type when placed under load.	The condylar plate should be reserved only for young non-osteoporotic bone. It requires anatomic reduction with perfect medial cortex contact and it is mandatory to complement its buttress effect with interfragmentary compression by lag screws. Therefore, it requires greater surgical experience and is less forgiving of technical errors than the dynamic internal fixation. The use of a 130º angled blade-plate, with or without an added screw, would also be adequate.