A prospective randomized trial of 100 patients using trochanteric support plates; worth their mettle?

BACKGROUND AND PURPOSE: To compare the radiological and clinical results of sliding hip screw (SHS) fixation with or without a Trochanteric Support Plate (TSP) on unstable three-or-more-part trochanteric fractures.

METHODS: A randomized prospective non blinded study of one hundred patients with trochanteric fractures; Evans-Jensen type 3, 4 and 5, reduced and fixed with SHS. Patients were randomized into two study groups; with or without TSP supplementation ('TSP' and 'NoTSP' groups). Radiologic measurements of the hip in the frontal plane (primary outcome), including fracture movement, nonunion and loss of fixation were measured, as well as pain, ambulation, mobility, institution residence, complications and death, twelve months post operatively (secondary outcomes).

RESULTS: At one-year follow-up four patients in the TSP and ten patients in the NoTSP group had either died or been lost in follow-up. Within this period, forty-three fractures healed and three had a loss of fixation in the TSP group; thirty-nine fractures healed and one had a loss of fixation in the NoTSP group. Frontal X-rays showed fracture subsidence on average 1 mm less in the TSP group compared to the NoTSP group. This difference was negligible, as was the difference in all subgroups, in fixation failure/cutout, modified Merle d'Aubigne Postel scores (measuring function and pain), institution residence, complications and death between the groups.

INTERPRETATION: This study cannot confirm that TSP has any beneficial effects on unstable three-or-more-part trochanteric fractures. If any effect at all, the difference is most likely slight and clinically irrelevant.