# A Novel Combined Soft Tissue and Bony Repair of Trochanteric Fractures in Revision Hip and Periprosthetic Fractures—Greater Trochanteric Abductor Tendon Augmentation (GTATA)

## TL;DR

A new surgical technique for trochanteric fractures avoids bulky metalwork and shows promising results in mobility and reduced complications.

## Contribution

A novel combined soft tissue and bony repair technique for trochanteric fractures that avoids bulky metalwork.

## Key findings

- 17 patients showed no dislocations or reoperations for prominent metalwork.
- 8 patients were independently mobile and 7 were mobile with one walking aid.
- Only one case of non-union and three cases of GT displacement were observed.

## Abstract

Introduction: Management of trochanteric fractures in revision hip surgery has a high incidence of non-union and complications. Fixation devices are often bulky, prone to breakage, and necessitate reoperation. This study describes a novel soft tissue and bony abductor repair that reduces the forces on bony fragments without the need for prominent metalwork. Methods: This novel surgical technique involves fixation of the abductor mechanism with polyester and polyethylene sutures that are woven through the abductors and secured to the femoral shaft with a proprietary suture cerclage tape with cerclage wire supplementation in select cases. All patients undergoing fixation were retrospectively reviewed with a minimum follow-up period of 12 months. Outcomes relating to dislocation, reoperation, fracture union and the incidence of symptomatic Trendelenburg gait were recorded. Results: A total of 17 patients underwent this novel intervention. There were no dislocations or reoperations for prominent metalwork at the last follow-up. One patient had evidence of greater trochanter (GT) non-union, and three had GT displacement of over 3 mm. Eight (47.1%) patients were independently mobile and seven (41.2%) were mobile with only one walking aid. No patients required plate or bolt fixation. Conclusions: GT fractures and abductor deficiency are difficult to manage, with most reported methods utilising bulky metalwork to treat a soft tissue injury. We describe a novel combined soft tissue and bony fixation without the need for excessive metalwork. Our pilot study demonstrates satisfactory outcomes of this intervention that are technically reproducible and more appropriately addresses the deforming forces involved with a low complication profile.