Dynamic Hip Screw Fixation Research Articles

15THE MORTALITY OF PATIENTS ADMITTED WITH HIP FRACTURE AND CONSOLIDATION ON CHEST RADIOGRAPH

s / International Journal of Surgery 23 (2015) S15eS134 S83 supervision given. We will make a simple teaching video addressing these issues to improve clinical skills and maintain standards of care. 0306: THE MORTALITY OF PATIENTS ADMITTED WITH HIP FRACTURE AND CONSOLIDATION ON CHEST RADIOGRAPH T. Paavana , M. Lee , H. Elphick . Northern General Hospital, UK; 2 Scunthorpe General Hospital, UK Aim: To ascertain the mortality of patients admitted with hip fracture and consolidation on chest radiograph Methods: Patients over 70 admitted with fractured neck of femur (NOF) during December 2013eApril 2014 were identified from the National Hip Fracture Database (NHFD). Inpatient falls and pathological fractures were excluded. Admission chest radiographs were reviewed to identify those with radiological evidence of possible community acquired pneumonia (CAP). Nottingham Hip Fracture Scores (NHFS) and in-hospital mortality were identified from the NHFD. Results: From a total of 171 patients, 13 (7.6%) died during admission, of which 6 (46%) were found to have consolidation suggestive of CAP on admission radiograph, as opposed to only 13 (8.2%) in the surviving group. There was a highly significant difference between the two groups (Fishers exact p 1⁄4 0.0027). Further analysis showed that as predictor of mortality, consolidation on admission radiograph had a sensitivity of 0.26 (0.11e0.48), and specificity of 0.95 (0.9e0.97). Positive likelihood ratio of death was 5.55 (2.04e15.06). Conclusion: For the elderly NOF population, a radiograph suggesting CAP at admission is a highly specific but poorly sensitive predictor of mortality. This may aid clinicians in estimating patient outcomes. Prompt orthogeriatric assessment and treatment of these patients is recommended. 0307: TIP-APEX DISTANCE IN DHS FIXATION: THIRD AUDIT CYCLE J. Hornsby, S. Borland. University Hospital of North Durham, UK Aim: The tip-apex distance (TAD) in dynamic hip screw (DHS) fixation has been shown to predict failure of the procedure by “cut out” of the lag screw. The standard is for TAD to be less than 25 mm in all cases. This standard was used to audit practice at this centre in 2007 and 2011, with educational interventions following each cycle. This is a re-audit to ensure improvement in practice. Methods: The antero-posterior and lateral intraoperative radiographs of all dynamic hip screws in a single centre between January and June 2014 were reviewed. A minimum follow up of three months was used to record any failure of the procedure. The results were compared to the previous audit cycles. Results: Sixty one patients underwent dynamic hip screw fixation in the study period. The mean TAD was 15.6 mm (range 6.2 mme26 mm). Three cases (4.9 per cent) had a TAD > 25 mm. Fifty one cases (83.6 per cent) had a TAD 65 years admitted between April & May 2014. Data was collected from notes, EDMS, and Sigma. Adherence protocols from an audit completed in 2007 were used as audit standards as well as timelines of fluid prescription and administration. Results: Forty patients presented with NOF fractures in this study. Mean age was 81 (range: 65e92). Mean Nottingham Hip Fracture Score was 6 (range: 2e8). There was significant improvement in commencing intravenous (iv) fluids in A&E (82% vs 53%) compared with the previous study, however only 39% of iv fluids prescribed were according to protocol and of those, 83% were administered. None were administered correctly, mainly attributed to poor documentation. 20% of patients developed AKI postoperatively. Conclusion: Whilst progress has been made towards commencing iv fluids in A&E, there is room for improving accuracy of prescription and administration. This can be achieved through staff education and revision of the current NOF protocol.

Training safer orthopedic surgeons

Background and purpose — Virtual-reality (VR) simulation in orthopedic training is still in its infancy, and much of the work has been focused on arthroscopy. We evaluated the construct validity of a new VR trauma simulator for performing dynamic hip screw (DHS) fixation of a trochanteric femoral fracture.Patients and methods — 30 volunteers were divided into 3 groups according to the number of postgraduate (PG) years and the amount of clinical experience: novice (1–4 PG years; less than 10 DHS procedures); intermediate (5–12 PG years; 10–100 procedures); expert (> 12 PG years; > 100 procedures). Each participant performed a DHS procedure and objective performance metrics were recorded. These data were analyzed with each performance metric taken as the dependent variable in 3 regression models.Results — There were statistically significant differences in performance between groups for (1) number of attempts at guide-wire insertion, (2) total fluoroscopy time, (3) tip-apex distance, (4) probability of screw cutout, and (5) overall simulator score. The intermediate group performed the procedure most quickly, with the lowest fluoroscopy time, the lowest tip-apex distance, the lowest probability of cutout, and the highest simulator score, which correlated with their frequency of exposure to running the trauma lists for hip fracture surgery.Interpretation — This study demonstrates the construct validity of a haptic VR trauma simulator with surgeons undertaking the procedure most frequently performing best on the simulator. VR simulation may be a means of addressing restrictions on working hours and allows trainees to practice technical tasks without putting patients at risk. The VR DHS simulator evaluated in this study may provide valid assessment of technical skill.

Retrograde Intramedullary Nailing for Femoral Shaft Fractures in Elderly Patients with Previous Ipsilateral Dynamic Hip Screw Fixation

Purpose: We present our experience in managing femoral shaft fractures in elderly patients with previous ipsilateral dynamic hip screw fixation for extracapsular neck of femur fractures using retrograde intramedullary nailing implants. Methods: This was a prospective consecutive study of patients presenting with a femoral shaft fracture and an ipsilateral dynamic hip screw fixation treated with unreamed retrograde femoral nailing. The Wilde modification of the Neer knee score was used as a primary outcome measure. Results: A total of 16 patients were included (5 males, 11 females), with a mean age of 82 years (range 74-101). All fractures were closed and were due to low-energy trauma. There were 7 patients with 32-A1 fractures, 5 patients with 32-A2 fractures and 4 patients with 32-B1 fractures. All patients had an ipsilateral 4-hole plate dynamic hip screw implant. Minor surgical complications were recorded in 5 patients. Two patients died due to medical complications and were excluded from the final analysis. All remaining 14 patients achieved satisfactory outcomes at 12 months of follow-up with a mean Wilde modification of the Neer knee score of 15.5 (SD 2.53; range 13-20). Conclusions: Unreamed retrograde femoral nailing can achieve good functional recovery in elderly patients with a femoral shaft fracture and a previous ipsilateral dynamic hip screw fixation.

Osteoporotic hip fractures: 10-year review in a Singaporean hospital.

To review records of 2702 patients with osteoporotic hip fractures in a Singaporean hospital. Medical records of 1905 women and 797 men, aged 50 to 112 (median, 78) years, who were admitted to a Singaporean hospital with an osteoporotic hip fracture (ICD9 820) between January 2000 and December 2010 were reviewed. Female patients were significantly older than male patients (p<0.0005). The trend for the median patient age over the 10-year period has increased significantly in women (r=0.826, p=0.002) but not in men. Of the hip fractures, 49.4% were femoral neck fractures and 50.6% were intertrochanteric/ basicervical fractures. The rate of intertrochanteric/ basicervical fractures was higher in men than women (61.2% vs. 46.1%, p<0.0005). Increased age, ischaemic heart disease, Parkinson's disease, and being Malay or Caucasian or Sikh were more likely to have intertrochanteric/basicervical fractures than femoral neck fractures. Femoral neck fractures were usually treated with hemiarthroplasty (68.8%), cancellous screw fixation (20.6%), and conservative methods (20.5%), whereas intertrochanteric/basicervical fractures were usually treated with dynamic hip screw fixation (76.3%) and conservative methods (15.6%). 84 women and 26 men sustained a subsequent osteoporotic hip fracture on the contralateral side after a median interval of 2 (range, 0-8) years. 11 of these 110 patients were already on osteoporosis medication. The rate of osteoporotic hip fractures has increased, particularly among women, over the 10- year period. The rate of intertrochanteric/basicervical fractures was higher in men than women.

Implant failure in a proximal femoral fracture treated with dynamic hip screw fixation

Dynamic hip screw fixation is a common orthopaedic procedure and to date, still can cause difficulties to the senior trauma surgeon. We present a case where an extra-capsular fracture of the proximal femur was managed with a dynamic hip screw (DHS) fixation. She proceeded to the operating theatre, where the fracture was stabilized with a 75-mm DHS and short-barrelled plate. The implant position was checked with intraoperative screening and the position accepted. Following attempted mobilization at 11 days post-operatively, the patient developed a recurrence of her preoperative pain. X-ray showed that the implant screw had separated from the barrel. Later scrutiny of the intraoperative screening films revealed that the barrel and screw were not engaged at the time of surgery. Intraoperative screening films should be carefully checked to ensure congruity of implant components.

A biomechanical comparison of proximal femoral nails and locking proximal anatomic femoral plates in femoral fracture fixation: A study on synthetic bones.

Background:The incidence of fractures in the trochanteric area has risen with the increasing numbers of elderly people with osteoporosis. Although dynamic hip screw fixation is the gold standard for the treatment of stable intertrochanteric femur fractures, treatment of unstable intertrochanteric femur fractures still remains controversial. Intramedullary devices such as Gamma nail or proximal femoral nail and proximal anatomic femur plates are in use for the treatment of intertrochanteric femur fractures. There are still many investigations to find the optimal implant to treat these fractures with minimum complications. For this reason, we aimed to perform a biomechanical comparison of the proximal femoral nail and the locking proximal anatomic femoral plate in the treatment of unstable intertrochanteric fractures.Materials and Methods:Twenty synthetic, third generation human femur models, obtained for this purpose, were divided into two groups of 10 bones each. Femurs were provided as a standard representation of AO/Orthopedic Trauma Associationtype 31-A2 unstable fractures. Two types of implantations were inserted: the proximal femoral intramedullary nail in the first group and the locking anatomic femoral plate in the second group. Axial load was applied to the fracture models through the femoral head using a material testing machine, and the biomechanical properties of the implant types were compared.Result:Nail and plate models were locked distally at the same level. Axial steady load with a 5 mm/m velocity was applied through the mechanical axis of femur bone models. Axial loading in the proximal femoral intramedullary nail group was 1.78-fold greater compared to the plate group. All bones that had the plate applied were fractured in the portion containing the distal locking screw.Conclusion:The proximal femoral intramedullary nail provides more stability and allows for earlier weight bearing than the locking plate when used for the treatment of unstable intertrochanteric fractures of the femur. Clinicians should be cautious for early weight bearing with locking plate for unstable intertrochanteric femur fractures.

Accuracy of the surgeon's eye: Use of the tip–apex distance in clinical practice

Tip–apex distance is a well described method for assessment of screw placement in dynamic hip screw fixation of proximal femoral fracture. A distance of <25mm is associated with a significantly lower rate of cut out of the fixation device. Measurement is frequently performed retrospectively, although there has been no demonstration as to what accuracy the surgeon has of estimating tip–apex distance from image intensifier images, whilst scrubbed in theatre.Thirty-one clinicians working within orthopaedic departments were tested in their ability to identify adequacy of tip–apex distance on a series of image intensifier images. Level of seniority, awareness of the concept of tip–apex distance and use of the concept in clinical practice were each assessed.The accuracy in identifying the correct TAD was 82.5% in consultants, 83.8% in registrars and 71.1% in Senior house officers (SHO). The method was used in clinical practice by 50% of consultants, 89% of registrars and none of the SHOs.

Comparative study of proximal nailing versus dynamic hip screw device in the surgical management of intertrochanteric fractures

Background: The intertrochanteric fractures are most common injuries in patients over sixty years of age. Earlier,they were managed conservatively which usually resulted in malunion. Internal fixation is now being done with sliding devices like Dynamic Hip Screw (DHS) or with intramedullary devices like Proximal Femoral Nail (PFN). PFN placement allows the implant to lie closer to the mechanical axis of the extremity, thereby decreases the lever arm and bending moment on the implant. Purpose of the present study is to verify the functional outcome of the patient and the theoretical advantages of PFN over the DHS device. Materials and methods: Forty adult patients with intertrochanteric fracture were randomly selected for DHS fixation or PFN. The study period was from June 2013 to August 2014. The patients were evaluated for the mode of injury and necessary radiological investigations were done. Type of surgery and details were noted. All the cases were evaluated postoperatively, at 3 months and 6 months interval for any morbidity as to the ability to bear weight, rate of union, degree of deformity, any limb length discrepancy. Results: The PFN required significantly shorter incisions, less blood loss, less operative times and less complications such as malunion and wound infections. The DHS group required 16sec less fluoroscopy time however more associated with limb length shortening. Patients treated with PFN had a significantly lower pain score at follow up. Conclusion: PFN has better function outcome and it is better fixation device especially in unstable intertrochanteric fracture.

Pyoderma Gangrenosum Mimicking an Infected Wound following Dynamic Hip Screw Fixation.

Pyoderma gangrenosum (PG) is an inflammatory ulcerative neutrophilic dermatosis that can occur following skin trauma. The correct diagnosis is not often made immediately as the condition can mimic an infective appearance. This leads to delays in the appropriate management of high dose steroids. Although debridement can offer aid in resolving lesions, this is contraindicated in the acute phase as this can cause acceleration of the pathogenic process. Biopsy of the lesion does not offer a definitive diagnosis; therefore suspicion must be maintained as the diagnosis is ultimately a clinical one. Any postoperative pustular ulcerative lesion not improving despite antibiotic therapy that also yields negative bacteriological and fungal studies should lead to consideration of this diagnosis. We document the first case of PG developing following intertrochanteric femur fracture fixation using dynamic hip screw.

Effect of teriparatide on unstable pertrochanteric fractures.

We retrospectively analyzed the radiographic and clinical outcomes of unstable pertrochanteric fractures (AO/OTA 31-A2) in 44 patients who underwent dynamic hip screw (DHS) fixation and compared the results with 29 patients who received teriparatide in addition to DHS fixation. A significantly shorter time for fracture healing was recorded in the teriparatide-treated group than in the control group. Rates of lag screw sliding, femoral shortening, and varus collapse were all significantly reduced in the teriparatide-treated group. There were no significant differences with regard to superficial wound infection, pneumonia, urinary tract infection, mortality, malunion, and cutting of the lag screw. The mean overall mobility scores were significantly better in the teriparatide-treated group at 3 and 6 months (P < 0.001 and P < 0.001, resp.) but not at 12 months or the last follow-up. The pain scores were also significantly better in the teriparatide-treated group at 3 and 6 months (P = 0.040 and P = 0.041, resp.) but not at 12 months or the last follow-up. Teriparatide improves radiographic outcomes and yields better clinical outcomes at 3 and 6 months postoperatively. The improvement in union time may be important for elderly populations with unstable pertrochanteric fractures to enable them to return to daily activities and reduce morbidity and mortality.

A prospective comparative evaluation for the use of an intramedullary hip-screw versus a compression hip-screw with a plate for intertrochanteric femoral fractures

Background Combining the advantages of intramedullary fixation with those of a sliding screw theoretically overcomes the usual complications of dynamic hip-screw fixation. A comparative study was conducted to evaluate the credibility of the use of intramedullary screw over the conventional dynamic hip-screw. Patients and methods A total of 100 elderly patients who had an intertrochanteric femoral fracture were randomized to treatment with a compression hip-screw with a plate (50 patients) or intramedullary hip-screw (50 patients). All patients were followed up prospectively for 1 year. A detailed assessment of the functional status and the plain radiographs of the hip was performed at 1, 3, 6, and 12 months postoperatively. The two treatment groups were strictly comparable. Results The operative time needed to insert the intramedullary hip-screw was significantly greater than that needed to insert the compression hip-screw with the plate, but use of the intramedullary hip-screw was associated with less estimated intraoperative blood loss. There were one intraoperative fracture of the femoral shaft and two intraoperative fractures of the greater trochanter in the group managed with the intramedullary hip-screw. One patient had pulling-out of the compression hip-screw on the seventh postoperative day. Four patients had a wound hematoma after insertion of an intramedullary hip-screw. All but one of the fractures healed. The one nonunion, which was in a patient who had a compression hip-screw, was treated with a hemiarthroplasty. Fourteen patients who had an intramedullary hip-screw had cortical hypertrophy at the level of the tip of the nail at 12 months postoperatively. Six of these patients also had pain in the mid-portion of the thigh; three of the six patients had the hardware removed because of the pain, and the symptoms resolved. Conclusion Routine use of intramedullary hip-screws cannot be recommended for the treatment of intertrochanteric femoral fractures because of the reported complications. However, the intramedullary device is a promising alternative, especially for a comminuted fracture with subtrochanteric extension or a reverse oblique pattern.

Minimally Invasive Dynamic Hip Screw Fixation for the treatment of stable Intertrochanteric Fractures of femur

Background: Trochanteric fracture is the commonest fracture in elderly people. These fractures carry risks associated with prolonged immobility. Early fracture fixation allowing early mobilization of the patients is the aim of the treatment. Dynamic hip screw and plate remains the most common method for treating stable intertrochanteric fractures. Minimal invasive technique has advantages of less blood loss, minimal soft tissue dissection, early mobilization, lesser requirement of analgesics and shorter hospital stay.Objectives: The study was done to evaluate the amount of intraoperative blood loss, reduction of post operative haemoglobin, requirement of post-operative analgesics and days of postoperative hospital stay in the patients of stable intertrochanteric femur fracture treated with minimal invasive dynamic hip screw (MIDHS).Methods: Twenty-five cases of stable intertrochanteric fractures of femur were treated with minimal invasive Dynamichip screw technique. Average blood loss during surgery, reduction of postoperative haemoglobin, requirement of post-operative analgesics and total days of postoperative hospital stay were studied.Results: Mean intraoperative blood loss was 53 ml, mean reduction of postoperative haemoglobin was 0.9 gm/dl. Average wound size was of five cm. Postoperative analgesic requirement was twice a day in an average and for five days. Mean hospital stay after surgery was five days.Conclusion: Minimal invasive Dynamic hip screw is a safe technique having advantages of less blood loss, minimal soft tissue dissection, lesser requirement of post-operative analgesics and shorter hospital stay in treating stable intertrochanteric fractures.DOI: http://dx.doi.org/10.3126/jkmc.v2i4.11739 Journal of Kathmandu Medical CollegeVol. 2, No. 4, Issue 6, Oct.-Dec., 2013Page: 170-174

Minimally Invasive Dynamic Hip Screw (MIDHS) Fixation

Use of a dynamic hip screw is the preferred mode of treatment for intertrochanteric fractures. Minimally invasive and small incision surgeries are routinely performed in orthopedics. The authors describe here the minimally invasive dynamic hip screw fixation technique for intertrochanteric fractures of the femur.

Dynamic hip screw fixation: Is the tip-apex distance the most important predictor for lag screw cutout?

Dynamic hip screw fixation: Is the tip-apex distance the most important predictor for lag screw cutout?

Use of an expanded lateral hip view to assist guidewire placement during dynamic hip screw fixation.

Use of an expanded lateral hip view to assist guidewire placement during dynamic hip screw fixation.

Functional recovery of elderly patients with surgically-treated intertrochanteric fractures: preliminary results of a randomised trial comparing the dynamic hip screw and proximal femoral nail techniques

IntroductionIntertrochanteric fractures of the femur are prevalent in the elderly, and leave patients with functional restrictions after surgical treatment. The aim of this study was to compare the functional recovery at 1-year follow-up of elderly patients with intertrochanteric fractures treated surgically with the dynamic hip screw (DHS) or proximal femoral nail (PFN) fixation techniques. Material and methodsThis prospective, randomised, blinded trial included patients aged over 65 years with intertrochanteric fractures classified as AO group 31.A1 or 31.A2. The patients were allocated into one of two treatment groups: one treated with DHS and the other with PFN. Data on functional recovery were obtained using the Functional Recovery Score developed by Zuckerman for elderly patients with hip fracture. Variables were described as means and standard deviations, and the non-parametric Kolmogorov–Smirnov test was used to verify the normality of data distribution. Non-normally distributed variables were compared using the non-parametric Friedman and Mann–Whitney U tests. Data processing and analysis were carried out in SPSS 10.0. Results were deemed significant at the 5% level (p≤0.05). ResultsThere were no significant between-group differences in age (p=0.152), sex (p=0.363), or American Society of Anaesthesiologists (ASA) score (p=0.579). Functional recovery scores in the DHS group at 3 and 6 months after surgery were significantly reduced from preoperative baseline scores (p=0.007) compared with in the PFN group. However, there were no statistically significant differences between the two groups in functional recovery scores at baseline (p=0.346) or at 3 months (p=0.880), 6 months (p=0.699), and 12 months (p=0.468) after surgery. There was no between-group difference in mortality (p=0.140). ConclusionAt 1-year follow-up, functional recovery scores were similar in elderly patients treated with the DHS and PFN techniques. However, DHS-treated patients exhibited significant loss of function in the first 6 months after surgery, which did not occur in the PFN-treated group.

Insight into performance on virtual reality simulation of dynamic hip screw fixation

Insight into performance on virtual reality simulation of dynamic hip screw fixation

Factors affecting transfusion requirement after hip fracture: can we reduce the need for blood?

Hip fractures are common injuries that result in blood loss and frequently require the transfusion of blood products. We sought to identify risk factors leading to increased blood transfusion in patients presenting with hip fractures, especially those factors that are modifiable. We retrospectively reviewed the cases of all patients who had fixation of their hip fractures between October 2005 and February 2010. The need for transfusion was correlated with potential risk factors, including age, sex, preoperative hemoglobin, fracture type, fixation method and more. A total of 835 patients had fixation of their hip fractures during the study period; 631 met the inclusion criteria and 249 of them (39.5%) were transfused. We found an association between need for blood transfusion and female sex (p = 0.018), lower preoperative hemoglobin (p < 0.001), fracture type (p < 0.001) and fixation method (p < 0.001). Compared with femoral neck fractures, there was a 2.37 times greater risk of blood transfusion in patients with intertrochanteric fractures (p < 0.001) and a 4.03 times greater risk in those with subtrochanteric fractures (p < 0.001). Dynamic hip screw (DHS) fixation decreased the risk of transfusion by about half compared with intramedullary nail or hemiarthroplasty. We found no association with age, delay to operation (p = 0.17) or duration of surgery (p = 0.30). The only modifiable risk factor identified was fixation method. When considering blood transfusion requirements in isolation, we suggest a potential benefit in using a DHS for intertrochanteric and femoral neck fractures amenable to DHS fixation.

Étude comparative des plaques verrouillées à compression de fémur proximal avec les vis plaques dynamiques de hanche (DHS) dans le traitement des fractures fémorales proximales extracapsulaires

IntroductionThe potential value of proximal femoral locking compression plate (PFLCP) for extracapsular femoral fractures has been discussed in several case reports; however, clinical control studies are lacking. Therefore, we performed a case control study to assess: 1) If PFLCP offers better functional results and fewer complications than dynamic hip screws (DHS)? 2) Which kind of extracapsular femoral fractures would benefit from PFLCP fixation? HypothesisThe PFLCP fixation offers better functional results and fewer complications than the DHS for the treatment of extracapsular fractures. Patients and methodsA total of 83 patients with extracapsular femoral fractures were recruited. Forty-one patients underwent PFLCP fixation, and 42 patients underwent DHS fixation. Patient information, operative time, blood loss, functional level (as assessed by Sanders’ traumatic hip rating scale), bone union, and implant complications were compared for the two treatment groups. ResultsPatients with stable intertrochanteric fractures who underwent PFLCP fixation demonstrated shorter bone union time than the DHS fixation group (3.3±0.2 vs. 4.3±0.1 month; P<0.0001); however, both groups had 100% bone union and good to excellent scores on Sanders’ traumatic hip rating scale (P=1.000). Patients with unstable intertrochanteric fractures who underwent PFLCP fixation experienced greater blood loss (619.0±23.9 vs. 474.1±19.8ml; P<0.0001), which was mainly due to the need for open reduction (64.3% vs. 12.5%; P=0.003), compared to the DHS fixation group. No differences were identified with respect to bony union, functional level, or complications. Patients with subtrochanteric fractures who underwent PFLCP fixation demonstrated significantly shorter operative times (82.1±4.3 vs 102.2±2.2min; P<0.0001), less blood loss (751.8±25.4 vs. 987.6±32.0ml; P<0.0001), shorter bone union times (5.2±0.4 vs. 8.8±1.0 month; P=0.006), more good to excellent Sanders’ traumatic hip rating scale scores (92.9% vs. 55.5%; P=0.009), and fewer complications (14.2% vs. 66.6%; P=0.005) than the DHS fixation group. ConclusionPFLCP fixation offers better functional outcomes and fewer complications for subtrochanteric femoral fractures but not for intertrochanteric femoral fractures. Levels of evidenceCase control study, level III.

A comparison of proximal femoral locking compression plates with dynamic hip screws in extracapsular femoral fractures

IntroductionThe potential value of proximal femoral locking compression plate (PFLCP) for extracapsular femoral fractures has been discussed in several case reports; however, clinical control studies are lacking. Therefore, we performed a case control study to assess: (1) If PFLCP offers better functional results and fewer complications than dynamic hip screws (DHS)? (2) Which kind of extracapsular femoral fractures would benefit from PFLCP fixation? HypothesisThe PFLCP fixation offers better functional results and fewer complications than the DHS for the treatment of extracapsular fractures. Patients and methodsA total of 83 patients with extracapsular femoral fractures were recruited. Forty-one patients underwent PFLCP fixation, and 42 patients underwent DHS fixation. Patient information, operative time, blood loss, functional level (as assessed by Sanders’ traumatic hip rating scale), bone union, and implant complications were compared for the two treatment groups. ResultsPatients with stable intertrochanteric fractures who underwent PFLCP fixation demonstrated shorter bone union time than the DHS fixation group (3.3±0.2 vs. 4.3±0.1 month; P<0.0001); however, both groups had 100% bone union and good to excellent scores on Sanders’ traumatic hip rating scale (P=1.000). Patients with unstable intertrochanteric fractures who underwent PFLCP fixation experienced greater blood loss (619.0±23.9 vs. 474.1±19.8ml; P<0.0001), which was mainly due to the need for open reduction (64.3% vs. 12.5%; P=0.003), compared to the DHS fixation group. No differences were identified with respect to bony union, functional level, or complications. Patients with subtrochanteric fractures who underwent PFLCP fixation demonstrated significantly shorter operative times (82.1±4.3 vs. 102.2±2.2minutes; P<0.0001), less blood loss (751.8±25.4 vs. 987.6±32.0ml; P<0.0001), shorter bone union times (5.2±0.4 vs. 8.8±1.0 month; P=0.006), more good to excellent Sanders’ traumatic hip rating scale scores (92.9% vs. 55.5%; P=0.009), and fewer complications (14.2% vs. 66.6%; P=0.005) than the DHS fixation group. ConclusionPFLCP fixation offers better functional outcomes and fewer complications for subtrochanteric femoral fractures but not for intertrochanteric femoral fractures. Levels of evidenceCase control study, level III.