Minimally invasive plate osteosynthesis of subtrochanteric femur fractures with a locking plate: a prospective series of 20 fractures

Intramedullary nailing is a mainstay in the treatment of subtrochanteric femoral fractures. But nailing is often unsuitable for difficult fracture patterns with comminution or when the medullary canal is narrow. The purpose of this study was to clarify the efficacy of minimally invasive plate osteosynthesis (MIPO) with locking compression plate in the treatment of subtrochanteric fractures. Twenty patients with subtrochanteric fractures (mean age 49.6 years) were prospectively treated using the MIPO technique using a locking plate. Indications of procedure were fractures with the greater trochanter or medial comminution, and multiple injured patients with a narrow femoral canal. According to the AO/OTA classification, there were three of type A, eight of type B, and nine of type C. All healed without bone graft, at an average of 20.1 weeks (range 16-32). With the exception of two patients with minor internal rotation deformity and one patient with 1 cm of shortening, most achieved acceptable alignment. All patients were able to walk with no or only a slight limp, and median Merle d'Aubigne score was 17.3 (15-18). Four patients complained of a slight pain in the trochanteric area due to plate prominence. The MIPO technique with a locking plate provides an alternative method for fixing subtrochanteric femur fractures, when IM nailing is inappropriate. This technique provides stable fixation, with a high union rate and a minimal complication rate.