Attempts have been made to reduce the incidence of complications in these fractures by using less extensile exposures and indirect reduction techniques and by supplementing lateral buttress
plate fixation with a medial two-pin external fixator or small antiglide plate rather than a second bulky medial buttress plate.
These fracture patterns include an unstable medial calcar and a deficient lateral buttress. They also found that when toggling was prevented no migration did occur .
Other mechanical reasons, include shearing and torsional muscle forces, failure to restore a stable medial cortical buttress, lateral buttress deficiency, unstable fracture patterns, or loss of posteromedial support.
If the fracture is extra-capsular and the lateral buttress is intact, the surgical choices are a dynamic hip screw (DHS) or intramedullary (IM) nailing.
Sometimes noticing a fractured lateral buttress is elusive on the preoperation X-rays.
This type of loading becomes more significant if the fracture is unstable (e.g., reverse obliquity) or if the plate does not act as a lateral buttress to the fracture.
If a four-holed Medoff plate is used for treatment of an unstable or reverse obliquity intertrochanteric fracture, the plate should serve as a lateral buttress for the proximal fragment or a stronger, six-holed plate (the four-hole plate does not have a horizontal strut for reinforcement, which the six-hole plate has) should be used.
Body rotund, small, spiny; with thickset, hollow, upright epidermal spicules, skeletal spicules lacking; cuticle and epidermis thick; radular teeth with a strong, lateral buttress beneath large, lateral denticles; long, spiral anteroventral radular pockets retaining initial, triangular teeth; with two pairs of pharyngeal salivary glands, the dorsalmost acinar; seminal receptacles paired, bibbed; lower gametoducts first uniting and then becoming bibbed before emptying into mantle cavity through a papilla; copulatory spicules single, paired; a dorsoterminal sense organ present.
17A, B); number of denticles on lateral buttress 4.
When a cortical gap was present, however, they found that the combination of an anatomically designed lateral buttress
Jplate and a medial reconstruction plate gave the greatest rigidity.