Outcome of SHS-Plate in Treatment of Proximal Femoral Fracture Prospective Study Conducted In KTH, Ibnkhaldoon And Sahiroon Hospitals

Abstract

This is a prospective clinical study carried on 69 patients with proximal femoral fractures treated with SHS at KTH,Sahiroon and Ibnkhaldoon hospitals during the period between May2002- June2003. Only fortyeight patients were followed for six months and included in the analysis of the final results. The mean age of the 48 patients was 57.27years. The purpose of this study was to evaluate the functional outcome and to study the complications and their risk factors in patients with PFF treated with SHS. patients were males and 24were females. Out of the 48 patients high-energy injury (RTA, fall from a height and gun shot) was the cause of fracture in twenty six patients while low-energy injury (fall at home) was the cause in twenty two patients. All of the fractures in female patients were intertrochanteric or basicevical and 16 of them aged above 60 years sustained a low-energy injury (fall at home). From the 29 male patients high-energy injury in 23 patients, of whom 18 patients were aged below 50 years. Thirty three fractures were Intertrochanteric, eight were basicervical, two were intracapsular and five were subtrochanteric.By the end of the first - 4 - postoperative week weight-bearing as tolerated was initiated by 36 of the 48 patients, and most of the patients who had delayed postoperative ambulation had an associated injury. The overall failure of fracture healing or fixation at six months was 14.6% (7 cases); cutting-out of the lag screw from the femoral head was the cause in 57% of the instances. Superior position of the lag screw and instability of the fracture were found to be highly significant determinant factors that the implant will cut-out, but the age and walking ability had no significant influence. Penetration of the screw into the hip was seen in one patient, another patient showed extrusion of the screw (>25mm) and the third patient presented with refracture distal to the implant. Three out of the four patients with the cut-out screw had not united at six months, with one patient with intracapsular fracture further complicated by avascular necrosis. 40 (83.3%) patients had excellent to satisfactory functional results and eight patients showed poor functional results. At six months only few patients retuned to their prefracture functional status. Male patients showed better functional outcome than female patients at six months follow-up.