Percutaneous Compression Plate Research Articles

Comparison of percutaneous compression plate to parallel screws in the treatment of nondisplaced femoral neck fractures in elderly patients: a prospective, randomized study.

The optimal internal fixation for non-displaced femoral neck fractures remains controversial. This study aimed to compare the clinical results of the percutaneous compression plate (PCCP) with parallel screws (PS) in treating femoral neck fractures in elderly patients. A total of 218 patients who underwent internal fixation were randomized to receive either a percutaneous compression plate (PCCP group) or parallel screws (PS group) using a computerized random sequence generator which was used to assign the order of randomization. Patients were assessed by the operating time, intraoperative blood loss, hemoglobin level drop, postoperative hospital stay, the time to full weight-bearing, reduction quality, fracture healing time, Harris hip score, and postoperative complications. There was no significant difference between PCCP and PS groups regarding operative time, intraoperative blood loss, hemoglobin level drop, postoperative hospital stays, reduction quality, and Harris hip score (p > 0.05). The time to full weight-bearing and the fracture healing time in the PCCP group were shorter than those in the PS group (p < 0.05). The overall complication rates were slightly lower in the PCCP compared to the PS patients, but there was no significant difference (p > 0.05). However, the implant failure rate was significantly higher in the PS group compared to the PCCP group (p < 0.05). The present study suggests that the PCCP is superior to the parallel screws fixation in the treatment of non-displaced elderly femoral neck fractures in terms of earlier full weight-bearing, shorter fracture healing time, and lower implant failure rate. Therefore, it may be a better therapeutic strategy for non-displaced femoral neck fractures in elderly patients.

Comparison of curative effect between percutaneous compression plate and cannulated compression screw in the treatment of displaced femoral neck fractures in young and middle-aged patients

To compare the efficacy of percutaneous compression plate and cannulated compression screw in the treatment of displaced femoral neck fractures in young and middle-aged patients. From January 2015 to July 2020, 68 young and middle-aged patients with displaced femoral neck fracture were retrospectively analyzed. Among them, 31 cases were fixed by percutaneous compression plate (PCCP), and 37 cases were fixed by cannulated compression screw (CCS). General data such as gender, age, cause of injury, comorbidities, fracture classification and cause of injury of two groups were collected. The operation time, intraoperative blood loss, hospital stay, full weight bearing time, fracture healing time, visual analogue scale(VAS), Harris hip score and complications were compared between two groups. Patients in both groups were followed up for more than 2 years. There were no significant differences in operation time, intraoperative blood loss, fracture reduction quality, hospital stay and VAS between two groups. The fracture healing time in PCCP group was significantly shorter than that in CCS group (t=-4.404, P=0.000). The complete weight bearing time of PCCP group was significantly shorter than that of CCS group (t=-9.011, P=0.000). Harris score of hip joint in PCCP group was better than that in CCS group 2 years after operation (P=0.002). Complications occurred in 3 cases (9.68%) in PCCP group, while 11 cases (29.72%) in CCS group, with a statistically significant difference (P=0.042). Both PCCP and CCS can be used for the treatment of displaced femoral neck fractures in young and middle-aged people. Compared with CCS, PCCP fixation can achieve shorter fracture healing time and create conditions for early full weight bearing. PCCP results in higher hip score and lower complications.

Comparison of Curative Effect between PFNA and PCCP in the Treatment of Femoral Intertrochanteric Fractures.

Objective To compare and analyze the clinical efficacy of proximal femoral nail anti-rotation (PFNA) and percutaneous compression plate (PCCP) for minimally invasive treatment of femoral intertrochanteric fractures. Methods A retrospective analysis of 98 patients with femoral intertrochanteric fractures admitted to our hospital from January 2019 to December 2020 was used as the research object, and they were divided into PFNA group and PCCP group according to different treatment methods, with 51 cases and 47 cases. The intraoperative and postoperative indicators were compared between the two groups of patients. Results There was no significant difference in the operative time, postoperative fracture healing time, and Harris score of hip joint function between the two groups (t = −1.43, 1.86, 1.63; P > 0.05). Compared with the PFNA group, the intraoperative blood loss and postoperative drainage volume in the PCCP group were lower than those in the PFNA group (t = 11.38, 9.66; P < 0.05). Compared with the PFNA group, the time of weight-bearing in the PCCP group was longer than that in the PFNA group (t = −2.23, P < 0.05). The total incidence of postoperative complications was 7.84% in the PFNA group and 10.64% in the PCCP group, and there was no significant difference between the two groups (P > 0.05). Conclusion The PFNA and PCCP are both effective measures for the clinical treatment of intertrochanteric fractures, and internal fixation should be reasonably selected according to the specific conditions of the patients.

Midterm effectiveness of percutaneous compression plate for femoral neck fractures in young and middle-aged patients

To analyze midterm effectiveness of percutaneous compression plate (PCCP) for femoral neck fractures in young and middle-aged patients. The clinical data of 173 young and middle-aged patients with femoral neck fractures who met the selection criteria and were treated with PCCP internal fixation between January 2011 and March 2019 were retrospectively analyzed. Among them, there were 102 males and 71 females; the age ranged from 18 to 59 years, with an average age of 44.9 years. The injury causes included falling in 112 cases, traffic accident in 32 cases, falling from height in 21 cases, struck in 7 cases, and sprain in 1 case. According to Garden classification, there were 90 cases without displacement (51 cases of type Ⅰ and 39 cases of type Ⅱ) and 83 cases with displacement (51 cases of type Ⅲ and 39 cases of type Ⅳ). According to Pauwels classification, there were 10 cases of type Ⅰ, 88 cases of type Ⅱ, and 75 cases of type Ⅲ. The time from injury to operation was 1-14 days, with an average of 4.5 days. The operation time, intraoperative blood loss, perioperative blood transfusion, and hospitalization stay were recorded; the fracture reduction was evaluated by Garden alignment index at 1 day after operation; fracture healing and complications were observed, and Harris score was used to evaluate the effectiveness at last follow-up. The operation time was 34-130 minutes (mean, 78.6 minutes); the intraoperative blood loss was 10-250 mL (mean, 93.2 mL); 171 cases did not receive blood transfusion during perioperative period, 2 patients received blood transfusion of 400 mL and 800 mL respectively; the hospitalization stay was 3-19 days (mean, 11.3 days). All 173 cases were followed up 11-103 months, with an average of 42.6 months. Postoperative reduction quality was satisfactory in 170 cases and unsatisfactory in 3 cases. There were 13 cases of osteonecrosis of femoral head, 1 case of screw cutting out, 2 cases of screw withdrawal, 5 cases of femoral neck shortening, and no deep vein thrombosis in the lower extremity requiring surgical intervention. Fractures healed in 172 patients, and the healing time ranged from 3.0 to 7.5 months, with an average of 3.6 months; 1 case of nonunion occurred. Internal fixation was removed after fracture healing in 51 patients. At last follow-up, Harris score was excellent in 156 cases, good in 11 cases, fair in 3 cases, and poor in 3 cases, with an excellent and good rate of 96.5%. The treatment of femoral neck fractures with PCCP has advantages of rigid fixation, immediate weight-bearing, and sliding compression, reducing the incidences of osteonecrosis of femoral head and nonunion.

Outcome of percutaneous compression plate for treatment of femoral neck fractures: mean follow-up of 4.4years.

Percutaneous compression plate (PCCP) provides superior anti-rotational abilities and mechanical strength in femoral neck fractures (FNFs). The first series reporting its utilization of FNFs was promising. Since the long-term outcome regarding the implant has not been reported, the purpose of this study was to evaluate the long-term functional outcomes and complications after fixation using PCCP in FNFs. From 2010 to 2019, 51 patients aged from 18 to 87years were evaluated; 11 patients were excluded from this study. Demographic data, fracture classification, and complications were analyzed. Besides plain radiographs and CT, uptake ratios using bone scintigraphy and/or SPECT were also collected and analyzed. At a mean follow-up of 4.4 ± 2.0years (range, 2-10years), the mean Harris hip score was 88, with 44 patients (86.3%) achieving excellent or good outcomes. The rate of complication was 13.7% (7/51), with five cases of osteonecrosis of the femoral head (OFNH). Hip replacements were performed in four (7.8%) cases. After confirmation of normal transfusion status, 11 patients underwent elective removal of the implant without further complications. Closed reduction and internal fixation using PCCP in FNFs resulted in satisfactory outcomes with low complication rates. Longer follow-up (3-5years) and sequential bone scintigraphy or SPECT after surgery are recommended after internal fixation using PCCP.

Analysis of the Therapeutic Effects of Percutaneous Compression Plate for Femoral Neck Fractures in Young and Middle-Aged Patients: A Retrospective Multicenter and 2-Year Follow-Up Study

Introduction: Traditional internal fixators include hollow compression screw (HCS) and sliding hip screw for femoral neck fractures have a high incidence of complications, and are not conducive to postoperative early rehabilitation and weight-loading of patients. Therefore, femoral neck fractures are referred to as ‘unresolved fractures’. However, single-center results of percutaneous compression plate (PCCP) have showed a significant improvement in efficacy. We retrospectively analyzed the therapeutic effects of PCCP for femoral neck fractures in young and middle-aged patients in a multi-center and &gt;2-year follow-up.&#x0D; Materials and Methods: Between January 2010 and December 2017, 331 patients with femoral neck fractures in young and middle-aged patients fixed with HCS and PCCP in four hospitals were studied retrospectively.&#x0D; Results: There were 182 men and 149 women, with an average age of 47.69 years (age range, 20-65 years). HCS group vs. PCCP group (170 vs. 161). There was no significant difference in the baseline data between the two groups (P&gt;0.05). All patients were followed-up for 24-60 months (mean, 36 months). The operative time and intraoperative bleeding were significantly decreased, whereas the hospital stay significantly longer in HCS group than those in PCCP group (P&lt;0.05). Nonunion in 17 cases and fixation failure in 14 cases in HCS group, whereas 3 and 0 cases, respectively, in PCCP group, showing significant difference (P&lt;0.05). Avascular necrosis (AVN) in 17 cases in HCS group while 15 cases in PCCP group, showing no significant difference (P&gt;0.05). The overall complications in HCS group were greater than that in PCCP group (P&lt;0.05). The Harris hip scores at 6- and 12-month follow-up in group PCCP were significantly improved than those in group HCS (P&lt;0.05), but not significant at 18-, 24- month and last follow-up between the two groups (P&gt;0.05).&#x0D; Conclusion: Our results suggest that PCCP is a stable and reliable internal fixation device with sliding compression effect for femoral neck fractures, which has satisfactory short and mid-term therapeutic effects, but AVN remains unsolved.

Short- and medium-term effectiveness of percutaneous compression plate internal fixation in the treatment of femoral neck fractures in the elderly

To investigate the short- and medium-term effectiveness of percutaneous compression plate (PCCP) internal fixation for femoral neck fractures in the elderly. The clinical data of 32 elderly patients with femoral neck fracture treated with PCCP internal fixation between January 2012 and January 2019 were retrospectively analyzed. All of them were traumatic fractures. The causes of injury were falling in 20 cases, traffic accident in 7 cases, and falling from height in 5 cases. According to Garden classification, there were 7 cases of type Ⅱ, 15 cases of type Ⅲ, and 10 cases of type Ⅳ; there were 12 cases with Singh index level Ⅳ, 14 cases with level Ⅴ, and 6 cases with level Ⅵ; the bone mineral density of femoral neck was 0.610-0.860 g/cm 2 (mean, 0.713 g/cm 2). The time from injury to operation was 3-14 days, with an average of 5.8 days. Patients began to weight-bear gradually within 3 days postoperatively. The operation time, intraoperative blood loss, hospitalization stay, fracture reduction (Garden alignment index), fracture healing, failure of internal fixation, femoral neck shortening, and osteonecrosis of the femoral head were observed; hip function recovery was evaluated by Harris score. The operation time was 35-135 minutes (mean, 73.4 minutes), the intraoperative blood loss was 75-385 mL (mean, 116.4 mL), the hospitalization stay was 3-15 days (mean, 8.3 days). At 1 week after operation, the Garden alignment index of fracture reduction was grade Ⅰ in 25 cases, grade Ⅱ in 6 cases, and grade Ⅲ in 1 case. One case of superficial infection of the incision occurred after operation, and no early complications such as deep vein thrombosis in the lower extremities, pulmonary embolism, or bedsores occurred. All the patients were followed up 2.1-4.0 years, with an average of 2.7 years. Except for 2 cases of delayed union (displaced trans-neck and subhead fractures), no nonunion of fracture and failure of internal fixation occurred, the fracture healing time was 4-8 months, with an average of 4.9 months. Femoral neck shortening occurred in 12 cases (37.5%); osteonecrosis of the femoral head occurred in 3 cases (9.4%), all of which were displaced trans-neck and subhead fractures, of which 2 cases received total hip arthroplasty and the other received conservative treatment. The Harris scores of the hip joint at 3 months, 2 years after operation and at last follow-up were significantly improved when compared with those before operation ( P<0.05); there was no significant difference between each time point after operation ( P>0.05). At last follow-up, the hip joint function was evaluated according to Harris score, the results were excellent in 15 cases, good in 12 cases, and fair in 5 cases, with an excellent and good rate of 84.4%. There was no significant difference in postoperative hip function composition among patients with different ages, Garden classification, Singh index, and Garden alignment index ( P>0.05). For elderly patients with femoral neck fractures without severe osteoporosis and with relatively good physical conditions, PCCP internal fixation can achieve satisfactory short- and medium-term effectiveness, but there is a certain risk of osteonecrosis of the femoral head.

Imaging observation of percutaneous compression plate use in promoting femoral neck fracture healing

ObjectiveTo examine the imaging evidence of the use of percutaneous compression plate (PCCP) in promoting femoral neck fracture healing compared with cannulated screws (CS).MethodsThis retrospective study enrolled patients with femoral neck fractures undergoing internal fixation procedures. The patients were divided into a PCCP group and a CS group with imaging as the primary outcome and Harris hip score (HHS) as the secondary outcome.ResultsThis study included 162 patients: 80 in the PCCP group and 82 in the CS group. There were no significant differences between the patients in their preoperative baseline characteristics. Patient follow-up ranged from 24–56 months (mean 30.7 months). Differences in reduction quality, screw slipping, neck shortening and avascular necrosis (AVN) were not significant between the two groups. There were significant differences between the treatment groups in bone absorption, nonunion, healing time, screw withdrawal and fixation failure in favour of the PCCP group. Postoperative HHS at 6 and 12 months were significantly better for the PCCP group than the CS group, but the differences were not significant at 24 months and last follow-up.ConclusionStable internal fixation with dynamic compression was the key to PCCP promoting femoral neck fracture healing.

Outcomes of basicervical femoral neck fracture treated with percutaneous compression plate (PCCP)

IntroductionBasicervical femoral neck fracture is associated with high rates of failure due instability patterns, mainly collapse and rotational instability.The purpose of this study was to evaluate the clinical-radiological results of a group of patients with a bascervical proximal femoral fractures treated with Percutaneous Compression Plate (PCCP). Material and methodsAmong 5817 patients with a hip fracture who were admitted in our hospital from January 2005 to December 2017, 234 factures (4%) were diagnosed of basicervical femoral fracture. 30 of them were treated with a PCCP, 22 women and 8 men, mean age was 81.2 years (63-94). Demographic and perioperative variables were collected. The patients were followed up at 1, 3 and 6 months clinically and radiologically. ResultsThere were no intra-operative complications and no conversions to open surgery. There was no early implant failure. No surgical wound infection was diagnosed. Crude mortality was 13% the first year and 87% were able to walk at the 6 months. The last follow-up x-rays revealed 97% fracture healing and the collapse at fracture site occurred in 4 hips.No instances of cut-out were observed. In one case, a fatigue failure of the lag screws of a PCCP plate was observed at 3 months from osteosynthesis. ConclusionPCCP is an appropriated implant for basicervical femoral neck fractures.

Effectiveness of percutaneous compression plate fixation for femoral neck fractures

To investigate the effectiveness of percutaneous compression plate (PCCP) fixation for femoral neck fracture. A clinical data of 100 patients with femoral neck fractures who were treated with internal fixation were analyzed retrospectively. The fractures were fixed with the cannulated screws (CS) in 55 patients (CS group) and with the PCCP in 45 patients (PCCP group). There was no significant difference in gender, age, the cause of injury, the fracture type, complications, and disease duration between the two groups ( P>0.05). The quality of fracture reduction, bone resorption, screw slipping, femoral neck shortening, complications (nonunion, failure of fixation, and osteonecrosis of femoral head), and functional recovery of hip (Harris score) were compared between the two groups. All incisions healed by first intention. All patients were followed up 24-56 months, with an average of 30.7 months. The quality of fracture reduction was excellent in 26 cases, good in 18 cases, fair in 9 cases, and poor in 2 cases in CS group and excellent in 21 cases, good in 17 cases, fair in 4 cases, and poor in 3 cases in PCCP group, showing no significant difference between the two groups ( Z=-0.283， P=0.773). The incidence of nonunion in PCCP group was significantly lower than that in CS group ( P=0.046), and the fracture healing time in PCCP group was shorter than that in CS group ( t=2.155, P=0.034). There was no significant difference in the incidences of bone resorption, screw slipping, femoral neck shortening, failure of fixation, and osteonecrosis of femoral head between the two groups ( P>0.05). The overall complication rates were 27.27% (15/55) in CS group and 8.89% (4/45) in PCCP group, showing significant difference ( χ 2=5.435, P=0.020). The Harris score in PCCP group at 6 months after operation was significantly higher than that in CS group ( t=-2.073, P=0.041). However, there was no significant difference in the Harris score at 12, 18, and 24 months after operation between the two groups ( P>0.05). Stable sliding compression of PCCP is benefit for the femoral neck fracture healing, especially shortening union.

Examining implant superiority in the treatment of simple pertrochanteric fractures of the proximal femur in elderly patients.

The aim of this study was to compare the clinical and radiological results of the proximal femoral nail antirotation (PFNA) with those of the dynamic hip screw (DHS) and percutaneous compression plate (PCCP) in the treatment of simple pertrochanteric fractures. A total of 203 patients were included in the study. PFNA fixations were performed in 73 patients (PFNA group), DHS in 68 patients (DHS group), and PCCP in 62 patients (PCCP group). The main outcome measurements were perioperative properties, the Harris hip score, changes in the neck-shaft angle, and loss of the abductor muscle strength. Data were compared between the groups. The mean estimated total blood loss and the number of patients receiving the blood transfusion rate in the PFNA group were statistically significantly lower. The mean operation and fluoroscopy times in the PCCP group were statistically significantly higher. The mean loss of the abductor muscle strength and changes in the neck-shaft angle in the PFNA group were statistically significantly higher. The mean Harris hip scores were similar. Our findings demonstrated that although PFNA was superior with regard to the perioperative data, DHS and PCCP were superior in maintaining the reduction and the abductor muscle strenght. All three implants were similar and had satisfactory functional outcomes.

Comparison of fixations with dynamic hip screw, percutaneous compression plate and proximal femoral nail anti-rotation for intertrochanteric femoral fractures with paries medialis defect

Objective To compare the effects of fixations with dynamic hip screw (DHS), percutaneous compression plate (PCCP) and proximal femoral nail anti-rotation (PFNA) for treatment of intertrochanteric femoral fractures with paries medialis defect. Methods We reviewed the 82 patients with femoral intertrochanteric fracture and paries medialis defect who had been treated at our department from January 2011 to July 2016. They were 42 men and 40 women, aged from 27 to 91 years (average, 73.0 years). According to the AO classification, 72 cases belonged to type 31-A2.2, 10 to type 31-A2.3. Of them, 9 cases were treated with DHS, 17 cases with PCCP and 56 cases with PFNA-Ⅱ. The 3 groups were compared in terms of intraoperative blood loss, blood infusion, fluid infusion, operation duration, time for fracture union, postoperative complications and Functional Recovery Score (FRS) of the hip 12 months after operation. Results The fluid infusion [1,100 (850, 1,100) mL] and intraoperative blood loss [60 (5, 100) mL] in the PCCP group were significantly less than in the PFNA group [1,100 (1,000, 1,700) mL and 150 (50, 300) mL] and the operation duration (91.4±29.2 min) in the former was significantly shorter than in the latter [121 (85, 185) min] (P 0.05). Of the patients, 57 (8 DHS, 12 PCCP and 37 PFNA ones) were followed up for an average of 47 months (from 15 to 85 months). There were no statistically significant differences between the 3 groups in time for fracture union, complications, or average FRS score of the hip 12 months after operation (P>0.05). Conclusions For unstable intertrochanteric fractures with paries medialis defect, it is not clear that intramedullary nails are superior to extramedullary fixation. Intramedullary nails like PFNA may be suggested for patients with better preoperative conditions while extramedullary fixation like PCCP suggested for those with poor general conditions. Key words: Hip fractures; Fracture fixation, internal; Bone plates; Bone nails

Clinical observation of surgical treatment of limb fractures with locking and compression plate

Objective To observe the clinical effect of locking and compression plate in the treatment of limb fractures. Methods 80 patients with limb fractures were selected.According to the internal fixation method, the patients were divided into observation group and control group, 40 cases in each group.The observation group was treated with percutaneous compression and compression plate fixation.The control group was treated with plain plate fixation.The operation time, length of stay, postoperative bleeding and bone healing time, the clinical efficacy, joint function recovery and postoperative complications of the two groups were observed. Results In the observation group, the operation time was (94.61±3.84)min, which was significantly lower than (117.45±4.72)min in the control group(t=10.64, P<0.05), the hospitalization time was (13.91±4.82)d, which was significantly lower than (18.97±5.26)d in the control group(t=5.23, P<0.05), the postoperative bleeding volume was (91.48±14.52)mL, which was significantly less than (265.95±32.17)mL in the control group(t=17.49, P<0.05), the bone healing time was (14.64±3.91)d, which was significantly lower than (24.16±5.73)d in the control group(t=11.36, P<0.05). The excellent rate of clinical curative effect in the observation group was 92.5%, which was significantly higher than 82.5% in the control group(χ2=9.64, P<0.05). The excellent and good rate of joint function in the observation group was 95.0%, which was significantly higher than 80.0% in the control group(χ2=11.45, P<0.05). The incidence rate of complication in the observation group was 2.5%, which was significantly lower than 12.5% in the control group(χ2=10.57, P<0.05). Conclusion Locking compression plate internal fixation is effective in the treatment of limb fractures.It can shorten the time of bone healing, reduce postoperative complications and improve the safety of treatment.It is worthy of clinical application. Key words: Fractures, bone; Extremities; Fracture fixation, internal

Treatment of Pauwels type III femoral neck fractures with modified percutaneous compression plate

To investigate the preliminary effects of modified percutaneous compression plate in treating femoral neck fractures of Pauwels type III. From March 2012 to March 2016, 35 patients with femoral neck fracture were treated by closed reduction and internal fixation with a modified percutaneous compression plate, including 21 males and 14 females with an average age of 45 years old ranging from 23 to 62 years old. The anatomical position of fracture was divided into 8 cases of lower head type, 27 cases of head and neck. According to the Garden classification, there were 8 cases of type II, 18 of type III, and 9 of type IV fractures. All patients were closed injury. The general information, reduction quality, fracture healing time, postoperative complications were recorded and evaluated. Harris scoring was used to evaluate the hip joint function. All patients were followed up for 15 to 24 months with an average of 20 months. All the incisions were primary healing. The reduction quality of the femoral neck fracture was evaluated according to the Garden's alignment Index, and the quality of reduction was grade I reduction in 29 cases and grade II reduction in 6 cases. No nonunion, femoral avascular necrosis, implant failure and hip varus was observed during follow-up. Harris score was(92.70±4.60) points at final follow-up, the results of the treatment was evaluated as excellent in 26 cases, good in 8 cases, fair in 1 case. No complications such as internal fixation loosening, nail breaking, and heterotopic ossification occurred. Internal fixation with modified percutaneous compression plate has an advantages of decreased trauma, simple operation, rigid fixation, good function outcome, and low risk of complications.

Comparison of percutaneous compression plate and cannulated compression screw in treatment of undisplaced femoral neck fracture in the elderly

Objective To compare the efficacy between percutaneous compression plate (PCCP) and cannulated compression screw for undisplaced femoral neck fracture among the elderly. Methods A retrospective case-control study was made on 46 elderly patients with undisplaced femoral neck fracture between August 2011 and September 2015. There were 14 males and 32 females, with the age of(76.9±12.1) years (range, 60-85 years). The fracture types included GardenⅠ in 12 patients and GardenⅡ in 34. These patients were divided into PCCP group (PCCP for undisplaced femoral neck fracture in 23 patients) and cannulated screw group (three cannulated compression screws for undisplaced femoral neck fracture in 23 patients), according to different surgical fixations. The following data were compared between two groups, namely, operation time, intraoperative blood loss, postoperative hemoglobin decline, postoperative length of hospital stay, postoperative partial time of weight-bearing and full weight-bearing, fracture healing time, Harris hip score (HHS) as well as postoperative complications. Results All 46 patients were followed up, with follow-up duration for (34.6±15.3)months (range, 12-60 months) in PCCP group and for (32.9±17.3) months (range, 12-60 months) in cannulated screw group (P>0.05). There were no statistically significant difference between two groups in terms of operation time, intraoperative blood loss, postoperative hemoglobin decline, postoperative length of hospital stay, fracture healing time, and postoperative full weight-bearing time (P>0.05). The partial weight-bearing time of patients in PCCP group was earlier than that in cannulated screw group (P 0.05). There was no statistically significant difference in the incidence of postoperative complications between PCCP group (9%) and the cannulated screw group (13%) (P>0.05). Conclusions Usage of PCCP or cannulated compression screw can obtain satisfactory clinical results for the undisplaced femoral neck fracture among the elderly. But PCCP has the advantages of earlier partial weight-bearing time and faster recovery. Key words: Femoral neck fractures; Fracture fixation, internal; Bone plates

Is There Evidence that the Percutaneous Compression Plate Method of Internal Fixation for Intertrochanteric Hip Fractures Leads to Better Intraoperative and Postoperative Outcomes than the Dynamic Hip Screw?

Background:Hip fractures are common, expensive and lead to considerable morbidity and mortality. An ageing population in the United Kingdom means that rates of this injury are increasing, making them a pressing public health issue. The National Institute of Health and Care Excellence (NICE) recommends that extramedullary implants are used over intramedullary nails to fix intertrochanteric fractures, which make up half of all hip fractures. However, there is currently no guidance on the preferred type of extramedullary device whether this be the commonly used dynamic hip screw (DHS) or another newer device. It has been suggested that a percutaneous compression plate (PCCP) can reduce complications and improve functional outcome compared with the traditional DHS.Review Question:In patients with intertrochanteric hip fractures, is the PCCP more effective than the DHS in terms of relevant intraoperative and postoperative outcomes such as blood loss, implant failure, and mortality?Literature Search:We first searched for relevant information in the NICE Clinical Guideline on Hip Fracture Management (CG124), then National Health Service (NHS) evidence for Clinical Knowledge Summaries, then the Cochrane library for systematic reviews. Finally, we conducted an electronic search of the PubMed database.Review Findings:We selected five systematic reviews and eight primary studies for review. The main findings were that the PCCP was associated with significantly less blood loss, fewer blood transfusions, and shorter operating times compared with the DHS. However, no significant differences were found in postoperative pain, orthopaedic performance, and mortality rates between the two methods. There was no comparison of cost-effectiveness between the two methods.Conclusions:The PCCP is superior to the DHS in terms of intraoperative blood loss and, potentially, non-orthopaedic postoperative complications such as deep vein thrombosis and nosocomial infection. However, there was no significant difference in mortality rates between the two methods. Current studies on this topic have several methodological issues and some are of relatively poor quality. Further higher quality research and cost-effectiveness are necessary to further evaluate the efficacy of these methods.

Comparison of the effects of closed reduction and interlocking intramedullary nail and percutaneous minimally invasive locking compression plate in treatment of tibial fractures

Objective To compare the effects of closed reduction and interlocking intramedullary nail and percutaneous minimally invasive locking compression plate in treatment of tibial fractures. Methods 70 patients with tibial fractures were selected as research subjects, and they were randomly divided into the control group and the observation group according to the digital table, each group in 35cases.The control group was treated with closed reduction and interlocking intramedullary nail, while the observation group was treated with percutaneous minimally invasive locking compression plate.Then, the operation index, postoperative complications, treatment effect after treatment between two groups were compared. Results The operation time, fracture healing time, length of stay in the observation group were less than those in the control group[(70.37±11.06)min vs.(82.13±12.15)min, (3.02±0.61)month vs.(4.21±0.70)month, (13.39±3.02)d vs.(16.26±3.21)d](t=4.234, 3.852, 7.582, all P<0.05). The incidence rate of complication in the observation group was lower than that in the control group[14.28%(5/35) vs.51.42%(18/35)](χ2=10.943, P<0.05). The excellent rate in the observation group was statistically higher than that in the control group[94.28%(33/35) vs.74.28%(26/35)](χ2=5.285, P<0.05). Conclusion Closed reduction and interlocking intramedullary nail and minimally invasive percutaneous locking compression plate are successful in the treatment of tibial fracture, but interlocking intramedullary nail easily leads to delayed healing, complications and higher rate of surgery two times, while minimally invasive percutaneous locking compression plate can promote healing, curative effect is better. Key words: Tibial fractures; Fracture fixation, intramedullary; Bone nails; Surgical procedures, minimally invasive

Comparative outcome of PFNA, Gamma nails, PCCP, Medoff plate, LISS and dynamic hip screws for fixation in elderly trochanteric fractures: a systematic review and network meta-analysis of randomized controlled trials.

The ideal implant for the treatment of an unstable intertrochanteric femoral fracture is still a matter of discussion. The aim of this systematic review is to conduct a network meta-analysis of randomized controlled trials (RCTs) comparing clinical outcomes between dynamic hip screws (DHS), Medoff sliding plating, percutaneous compression plating (PCCP), proximal femoral nails (PFN), Gamma nails and less invasive stabilization system fixation in femoral trochanteric fractures in the elderly. These clinical outcomes consist of total intra-operative time, intra-operative fluoroscopy time, intra-operative blood loss, blood component transfusion, length of hospital stay, postoperative general complications, wound complications, late complications and reoperation rates. This systematic review was conducted using PubMed and Scopus search engines for RCTs comparing clinical outcomes between treatments from inception to February 22, 2015. Thirty-six of 785 studies identified were eligible. Compared to the other implants, PCCP showed the lowest total operative time and units of blood transfusion with an unstandardized mean difference (UMD) of 29.27min (95% CI 5.24, 53.50) and 0.89 units (95% CI 0.52, 1.25). The lowest incidence of general complications, wound complications and late complications of PCCP was 0.09 (95% CI 0.04, 0.18), 0.01 (95% CI 0.01, 0.04) and 0.05 (95% CI 0.02, 0.11), respectively, when compared to others. The lowest fluoroscopic time was with DHS with an UMD of 0.24min (95% CI 0.16, 0.32), whereas the lowest blood loss and shortest hospital stay were with PFN with an UMD of 233.61ml of blood loss (95% CI 153.17, 314.04) and 7.23days of hospital stay (95% CI 7.15, 7.31) when compared to all other fixation methods. Reoperation rates of all implants had no statistically significant difference. The network meta-analysis suggested that fixation with PCCP significantly shortens operative time and decreases the units of blood transfusion required, while also lowering risks of general complications, wound complications and late complications when compared to fixation. Use of PFN showed the least intra-operative blood loss and shortest hospital stay. Multiple active treatment comparisons indicate that PCCP fixation in trochanteric fractures in the elderly is the treatment of choice in terms of intra-operative outcomes and postoperative complications.

Early Clinical Efficacy Comparison Study of Gamma3 Nail, Percutaneous Compression Plate (PCCP) and Femoral Head Replacement (FHR) Treatment on Senile Unstable Intertrochanteric Fractures

ABSTRACTPurpose: This study aimed to analyze the early clinical efficacy of Gamma 3 nail, percutaneous compression plate (PCCP) and femoral head replacement (FHR) treatments on senile unstable intertrochanteric fractures. Materials and Methods: Totally 116 patients were included to perform an retrospective study, which involved analysis of the operation time, intraoperative blood loss, and hemoglobin reduction on the first postoperative day compared with preoperative levels, fracture gap, neck shaft angle and tip apex distance on the first postoperative X-ray, hospital stay, time from surgery to mobilization, Harris hip scores and Barthel index six months after operation, and complications postoperative meanwhile were evaluated respectively among three groups. Results: The Harris hip score and Barthel index and time from surgery to mobilization after FHR treatment were superior to another two surgical methods, but had more blood loss and greater hemoglobin reduction. The mean PCCP hemoglobin reduction was notably shorter than that of the other two groups. Gamma 3 treatment had a lower operation time and blood loss than those treated with PCCP and FHR. Conclusions: Gamma 3 and PCCP treatments are a priority for senile unstable intertrochanteric fractures if patients are in good health and perform fair activities of daily living prior to the operation, but had a significantly longer mobilization time than that in FHR. Therefore, considering the senile patients who unable to tolerate long immobilization time, FHR treatment is a considerable choice for faster recovery of independent function and achieve a good clinical efficacy as well as improve quality of life.

Treatment of displaced femoral neck fractures with percutaneous compression plate in young and middle-aged patients

Objective To explore the operative treatment of displaced femoral neck fractures with percutaneous compression plate (PCCP) in young and middle-aged patients. Methods Forty-three young and middle-aged patients with displaced femoral neck fracture were treated with PCCP from May 2011 to May 2015. They were 24 males and 19 females, aged from 21 to 55 years (mean, 38.2 years). According to the Garden classification, 29 cases were type Ⅲ and 14 type Ⅳ. According to the Pauwels classification, 18 cases were type Ⅱ and 25 type Ⅲ. After reduction was conducted manually or using percutaneous joystick technique, nailing was carried out under the guidance of the three-dimensional position sticker which had been invented by ourselves for minimally invasive treatment of hip fractures. Clinical and radiographic outcomes were recorded after operation and postoperative hip function was evaluated using Harris score. Results Manual reduction succeeded in 38 cases and the other 5 cases experienced reduction by percutaneous joystick technique after failure of manual reduction. For this series, the operation time ranged from 35 to 60 minutes (mean, 53.2 minutes), explicit blood loss from 20 to 80 mL (mean, 65.3 mL), frequency of X-ray exposure from 6 to 20 times (mean, 11.8 times) during operation, the partial weight-bearing time from 14 to 30 days (mean, 22.5 days), and the full weight-bearing time from 2.5 to 4.0 months (mean, 3.2 months). The 43 cases were followed up for 12 to 46 months (mean, 28.5 months). Bone union was achieved in all after 3 to 7 months (mean, 4.3 months). The Harris hip scores at the final follow-ups ranged from 71 to 98 points (mean, 92.7 points). The excellent to good rate was 95.3%, with 26 excellent cases, 15 good ones and 2 fair ones. Two cases developed femoral avascular necrosis. No nonunion, implant failure or hip varus was observed during follow-ups. Conclusion Although it is difficult to treat displaced femoral neck fractures in young and middle-aged patients using PCCP, the surgery can be simplified with the aid of certain surgical techniques so that the advantages of PCCP can be realized, like minimal invasion, rigid fixation, low risk of complications and satisfactory therapeutic effect. Key words: Femoral neck fractures; Fracture fixation, internal; Bone plates; Surgical technique