Percutaneous Compression Plate Research Articles

PROSPECTIVE RANDOMIZED CONTROLLED STUDY ON TREATMENT OF DISPLACED FEMORAL NECK FRACTURES WITH PERCUTANEOUS COMPRESSION PLATE

To compare the effectiveness of percutaneous compression plate (PCCP) and hollow compression screw in the treatment of displaced femoral neck fractures. Between January 2010 and June 2014, 70 patients with displaced femoral neck fractures were randomly divided into 2 groups. After reduction, fracture was fixed with PCCP in 35 cases (group A) and with hollow compression screw in 35 cases (group B). There was no significant difference in the gender, age, cause, side and type of fractures, time from injury to operation, associated disease, pre-operative Harris score and visual analogue scale (VAS) score between 2 groups (P>0.05). The operation time, intra-operative blood loss, fracture healing time, fracture reduction quality, time of rehabilitation and weightloading; complication, post-operative Harris score and post-operative VAS score were compared between 2 groups. The incisions healed by first intention. All patients were followed up 13-34 months (mean, 23.7 months). There were significant differences in operation time, intra-operative blood loss, and fracture healing time between 2 groups (P<0.05). There was no significant in the fracture reduction quality between 2 groups (P>0.05). Avascular necrosis of the femoral head occurred in 2 cases of group A after operation (fracture reduction quality: grade IV); and avascular necrosis of the femoral head occurred in 4 cases of group B after operation (fracture reduction quality: grade I in 2 cases, grade Ⅱ in 1 case, grade Ⅲ in 1 case, and grade IV in 1 case), nonunion in 1 case, and screw loosening in 3 cases; and there was significant difference in the incidence of bone nonunion and avascular necrosis of the femoral head between 2 groups (χ2=-3.997, P=0.046). Difference was significant in fracture reduction quality in the patients with avascular necrosis of the femoral head and nonunion between 2 groups (χ2=1.991, P=0.047）. The time of rehabilitation and weight-loading of group A was significantly earlier than that of group B (P<0.05); the Harris and VAS scores of group A were significantly better than those of group B at 12 months after operation (P<0.05). PCCP for treatment of displaced femoral neck fractures has better static stability and better sliding dynamic pressure effect than hollow compression screw, and it can provide earlier rehabilitation and weight-loading postoperatively and obviously decrease the incidence of bone nonunion and avascular necrosis of the femoral head, but avascular necrosis of the femoral head still occur in patients with poor reduction or comminuted fracture.

Long-term results after treatment of pertrochanteric femoral fractures with percutaneous compression plate (PCCP).

This study sought to evaluate the long-term osteosynthesis results for AO/OTA 31.A1-A2 pertrochanteric fractures treated with the percutaneous compression plate (PCCP). This investigation was a retrospective observational descriptive study of 335 patients, with a minimum follow-up of 2years and a maximum follow-up of 8years (2004-2011). The average post-operative hospital stay was 6.2days, and the average decrease in haemoglobin levels after the intervention was 2.7mg/dL, with transfusion required for one-third of the patients. Complications related to the implant were observed in 4.2% of patients; the most notable complication was cut-out (2.4% of patients), and 3 cases involved pseudarthrosis with breakage of the implant (0.9% of patients). From the results obtained in this study and an analysis of previously published work, we believe that the PCCP may be the implant of choice for AO/OTA 31.A1-A2 fractures.

Comparison of Outcomes of Intertrochanteric Fracture Fixation Using Percutaneous Compression Plate Between Stable and Unstable Fractures in the Elderly

To evaluate the outcomes of treatment with a percutaneous compression plate (PCCP) in stable and unstable intertrochanteric hip fractures. Clinical prospective nonrandomized cohort study. San Cecilio University Hospital, Granada (Spain). A tertiary-care hospital. Patients older than 65 years undergoing surgery for an intertrochanteric hip fracture (n = 657) were divided according to the OTA/AO classification, into stable (31-A1) (group A, n = 363) and unstable fractures (31-A2) (group B, n = 294). Osteosynthesis with a PCCP (Orthofix Inc). Blood loss, wound complications, postoperative pain, operative and fluoroscopy time, functional outcomes, device-related complications, consolidation time, and mortality. Patients with unstable fractures were significantly worse with respect to postoperative pain, immediately (P = 0.020), at 6 weeks (P = 0.0001), and at 3 months (P = 0.009), and with respect to independent walking ability at 6 weeks. No other significant differences were observed. The outcomes of osteosynthesis with PCCP seem to be equally satisfactory in stable and unstable intertrochanteric fractures, with stable fractures having less pain and a greater ability to walk earlier. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Comparison of Outcomes of Intertrochanteric Fracture Fixation Using Percutaneous Compression Plate Between Stable and Unstable Fractures in the Elderly

Objectives: To evaluate the outcomes of treatment with a percutaneous compression plate (PCCP) in stable and unstable intertrochanteric hip fractures. Design: Clinical prospective nonrandomized cohort study. Setting: San Cecilio University Hospital, Granada (Spain). A tertiary-care hospital. Patients: Patients older than 65 years undergoing surgery for an intertrochanteric hip fracture (n = 657) were divided according to the OTA/AO classification, into stable (31-A1) (group A, n = 363) and unstable fractures (31-A2) (group B, n = 294). Intervention: Osteosynthesis with a PCCP (Orthofix Inc). Main Outcome Measurements: Blood loss, wound complications, postoperative pain, operative and fluoroscopy time, functional outcomes, device-related complications, consolidation time, and mortality. Results: Patients with unstable fractures were significantly worse with respect to postoperative pain, immediately (P = 0.020), at 6 weeks (P = 0.0001), and at 3 months (P = 0.009), and with respect to independent walking ability at 6 weeks. No other significant differences were observed. Conclusions: The outcomes of osteosynthesis with PCCP seem to be equally satisfactory in stable and unstable intertrochanteric fractures, with stable fractures having less pain and a greater ability to walk earlier. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Effect of the area of paries medialis defect on the stability of fracture ends after percutaneous compression plating for femoral intertrochanteric fracture

Objective To analyze the effect of different areas of paries medialis defect of femoral trochanter on the stability of fracture ends after percutaneous compression plating for femoral intertrochanteric fracture. Methods Thirteen preserved cadaveric specimens of adult femur were used in this experiment. The age of death ranged from 30 to 50 years. Oblique osteotomy was conducted under the same condition using a wire saw to create experimental models of fracture of Evans-Jensen type Ⅳ. The ratios of the area of paries medialis defect to the projected area of lesser trochanter in the specimens 1 to 13 were set respectively as 0, 10.0% , 14.5% , 20.2% , 23.4% , 30.6% , 45.8% , 56.8% , 76.8% , 88.7% , 99.8% , 121.3% and 149.4% . All the fractures were fixated by standard percutaneous compression plating. Cyclic load was applied on each specimen using Instron 2000 universal material tester. A vertical load of 600 N was applied for respectively 1, 10, 100 and 1,000 times to measure the displacements of proximal and distal fracture ends. Results When the ratio of the area of paries medialis defect to the projected area of lesser trochanter was 30.6% , the average displacements of the proximal and distal ends were 0.14 cm and 0.10 cm. When the ratio was 45.8% , the average displacement of the proximal end was 0.53 cm, 278.6% greater than that for 30.6% ; the average displacement of the distal end was 0.41 cm, 310.0% greater than that for 30.6% . When the ratio was 149.4% , the average displacement of the proximal end was 0.93 cm, 564.3% greater than that for 30.6% ; the average displacement of the distal end was 0.65 cm, 550.0% greater than that for 30.6% . Conclusions When the ratio of the area of paries medialis defect to the projected area of lesser trochanter reaches >45.8% , the area of paries medialis defect will have a significant effect on the stability of fracture ends after percutaneous compression plating for femoral intertrochanteric fracture. The displacement will increase linearly under the same compression with the increase in defect area. Key words: Hip fractures; Fracture fixation, internal; Bone plates; Biomechanics

Minimally invasive percutaneous compression plating versus dynamic hip screw for intertrochanteric fractures: a randomized control trial

ObjectiveIntertrochanteric femur fracture is a common injury in elderly patients. The dynamic hip screw (DHS) has served as the standard choice for fixation; however it has several drawbacks. Studies of the percutaneous compression plate (PCCP) are still inconclusive in regards to its efficacy and safety. By comparing the two methods, we assessed their clinical therapeutic outcome. MethodsA total of 121 elderly patients with intertrochanteric femur fractures (type AO/OTA 31.A1-A2, Evans type 1) were divided randomly into two groups undergoing either a minimally invasive PCCP procedure or a conventional DHS fixation. ResultsThe mean operation duration was significantly shorter in the PCCP group (55.2min versus 88.5min, P<0.01). The blood loss was 156.5ml±18.3ml in the PCCP group and 513.2ml±66.2ml in the DHS group (P<0.01). Among the patients treated with PCCP, 3.1% needed blood transfusions, compared with 44.6% of those that had DHS surgery (P<0.01). The PCCP group displayed less postoperative complications (P<0.05). The mean American Society of Anesthesiologists score and Harris hip score in the PCCP group were better than those in the DHS group. There were no significant differences in the mean hospital stay, mortality rates, or fracture healing. ConclusionDue to several advantages, PCCP has the potential to become the ideal choice for treating intertrochanteric fractures (type AO/OTA 31.A1-A2, Evans type 1), particularly in the elderly.

Internal fixation of intertrochanteric fractures using the percutaneous compression plate: the event of cutting out and its prediction by the tip-apex-distance

In a recent study, the analyzed percutaneous compression plate (PCCP) data identified the tip-apex-distance (TAD) as the most valuable risk factor for the reoperation rate and in particular for the event of cutting out of the cephalic screws after internal fixation of intertrochanteric fractures. However, it is unknown which potential distance between the tip of the screws and the apex of the femoral head is most valuable in predicting the event of cutting out. As the PCCP device has two cephalic screws, there are at least three different distances which can be measured, including the distance between the tip of the lower screw and the apex of the femoral head, the distance between the center of the line between the two cephalic screws and the apex, and finally between the tip of the upper screw and the apex. Our study was motivated by the question which measurement can provide the best results for the prediction of the event of cutting out of the cephalic screws. The digitalized postoperative X-ray films of 174 patients with 174 PCCP implants were analyzed, and we obtained three different measurements for every patient. The primary outcome was the proportion of those patients with a cutting out of the screws. A univariate logistic regression was performed to assess the impact of the TAD on the event of cutting out. To describe the degree of consistency among measurements, we calculated an intra-class correlation coefficient (ICC) and the corresponding 95 % confidence limits. For each of the different measurements, we performed a receiver operating characteristic (ROC) curve analysis and calculated the area under the curve (AUC) and the corresponding 95 % confidence limits. In order to identify the most valuable distance measure, we added pairwise comparisons of the AUCs. Out of 174 patients, six patients (3.4 %) were reoperated due to cutting out of the cephalic screws. In the univariate logistic regression model, the p value was 0.0012 (OR 0.874; 95 % CI 0.806 to 0.948). The ROC curve analysis showed similar results for the different measurements; however, the highest AUC value was obtained for the center position. In conclusion, all three measurements provide similar results and are suitable to predict the risk of cutting out of the cephalic screws.

Locked minimally invasive plating versus fourth generation nailing in the treatment of AO/OTA 31A2.2 fractures: A biomechanical comparison of PCCP® and Intertan nail®

IntroductionLocked minimally invasive plating and fourth generation nailing potentially could reduce the complication rate in the treatment of trochanteric femur fractures by its rotational stability and providing better lateral cortical support. The purpose of this study was (1) to compare the biomechanical properties of the Percutaneous compression plate (PCCP) and the Intertan nail (IT) with regards to implant failure and (2) to assess dynamic stability coefficients in an unstable AO/OTA 31A2.2 fracture model. MethodsIn paired femurs, a standardised unstable trochanteric femur fracture was induced by an oscillating saw. The fractures were stabilised by either the PCCP (Orthofix, McKinney, TX, USA) or the IT (Smith & Nephew, Memphis, TN, USA). All femurs were loaded with 300N, followed by an increase in load until failure using 300N each time (2000 cycles each, 0.5Hz). After every load step the samples were assessed visually and radiographically. We measured migration and performed a survival analysis. Results16 fractures were induced in 8 paired human specimens (mean age: 84 years, 61–100 years). The mean stiffness (PCCP vs. IT: 249±124N/mm vs. 273±153N/mm; p=0.737) was comparable. The IT proved superior to the PCCP with regard to the number of cycles reached before failure occurred (PCCP vs. IT: 12,691±4733 vs. 15,313±4875 cycles; p=0.023). Except for a higher axial migration of the IT at failure point (PCCP vs. IT: 1.3mm vs. 4.3mm; p=0.028) there were no differences between the intra- and extramedullary implants, not even in terms of rotational stability along the femoral neck axis. A fracture of the femoral neck caused test abortion in both implants in most cases. ConclusionThis study showed a superiority of the IT compared with the PCCP with regards to number of cycles achieved under sequential load increases for unstable trochanteric femur fractures. The stiffness was comparable. Both implants showed a high rotational stability and a support of the lateral wall. Study typeBiomechanical study.

Perioperative nursing of percutaneous compression plating for aged patients with intertrochanteric hip fracture

Objective To investigate the perioperative nursing experience of percutaneous compression plating for aged patients with intertrochanteric hip fracture. Methods The clinical nursing data of 24 aged patients with intertroehanteric hip fracture were ana- lyzed. Based on the pathological, physical, and psychological characteristics of elderly people, corresponding measures were provided to pre- vent complications and let them have functional exercise. Results Among of them 24 eases were followed up for 6 - 28 months （ average 16 months）. According to the scoring systems of Harris, the results were excellent in 14 cases, good in 8, fair in I, poor in 1. The rate of ex- cellent and good was 91. 6%. Conclusions Proper perioperative nursing and postoperative rehabilitation guidance can improve success rate, decrease complications, promote functional recovery and improve life quality of patients. Key words: Intertrochanteric fracture; PCCP; The aged; Perioperative nursing

Mid-term results after treatment of intertrochanteric femoral fractures with percutaneous compression plate (PCCP)

BackgroundWith the ageing of the population, intertrochanteric femoral fracture is associated with increased morbidity. There is continuing controversy over the best treatment for the injury, and the choice of internal fixation method has been a focus of dispute. The purpose of this study was to evaluate the results of these fractures being treated with the percutaneous compression plate (PCCP) technique. MethodsFrom March 2009 to May 2012, 154 patients with intertrochanteric femoral fractures were treated using the PCCP method. Forty-one patients were excluded from the study. According to the AO classification, the remaining 113 fractures were classified as 35 cases of 31A1 fractures, 59 cases of 31A2 fractures, and 19 cases of 31A3 fractures. The clinical data and imaging results were retrospectively analysed. ResultsThe mean operation time was 42.0 (range, 25–82) min, the mean intraoperative blood loss was 40.5 (range, 10–100) ml, and the mean hospital stay was 8.6 (range, 3–18) days. One patient died of renal failure in the perioperative period. Twelve patients died during the 12 months after surgery. The remaining 100 patients were followed-up for 12–36 months and healed their fractures except one, whose neck screw cut out from the femoral neck after 1 postoperative month and resulting in a revision to a hemiarthroplasty. The mean time to bone healing was 12.6 (range, 6–23) weeks. Sixteen patients had pain. There were 13 major device-related complications, including 5 cases of coxa vara, 4 cases of fracture collapse, 2 cases of head penetration, and 2 cases of fracture collapse combined with head penetration. At the time of the last follow-up, 81 patients had regained a pre-injury level of function. The median Harris hip score was 89 points. The median Parker-Palmer score was 7 points. Patients with poor quality of reduction and bad positioning of neck screw were more likely to suffer complications (p<0.05). ConclusionThe results suggest that the PCCP is an effective and safe method in the treatment of all types of intertrochanteric femoral fractures, but good fracture reduction and ideal positioning of the neck screw are prerequisites for the success of the device.

Gotfried percutaneous compression plating (PCCP) versus dynamic hip screw (DHS) in hip fractures: blood loss and 1-year mortality

Intertrochanteric fractures are among the most common fracture in elderly and are correlated with an average 1-year mortality of 25%. Increased mortality after hip fracture could be related to blood loss and comorbidities. We compared two groups of patients treated with percutaneous compression plating (PCCP) and dynamic hip screw (DHS) with the hypothesis that treatment with PCCP can reduce blood loss and 1-year mortality. We furthermore investigated the role of several surgical-related and patient-related factors on mortality of all the enrolled patients. We performed a comparative retrospective study of 280 patients with type 31A1 or 31A2 hip fractures treated in our department from January 2004 to May 2008. Exclusion criteria were age <60years, multiple injuries and pathological fractures. A total of 194 patients were treated with DHS, and 86 patients were treated with PCCP. No statistical differences were found in term of blood loss, blood transfusion and 1-year mortality between the two groups, whereas we found a significant incidence of gender, age, American Society of Anaesthesiologists score and preoperative haemoglobin on mortality. Both plates seem to be comparable in terms of blood loss and blood transfusion rate, and mortality was rather correlated with some patient-related factors reflecting the global health status. Emerging mortality in this kind of patient should encourage us to improve preventative orthogeriatric health care.

Treatment of AO/OTA 31-A3 intertrochanteric femoral fractures with a percutaneous compression plate

OBJECTIVE:AO/OTA 31-A3 intertrochanteric femoral fractures have completely different fracture line directions and biomechanical characteristics compared with other types of intertrochanteric fractures. The choice of the fixation method has been a focus of dispute among orthopedic trauma surgeons. The purpose of this study was to review the outcomes of these fractures treated with a percutaneous compression plate at our institute.METHOD:Seventeen patients with AO/OTA 31-A3 intertrochanteric femoral fractures were treated with a percutaneous compression plate at our institute from January 2010 to December 2011. The clinical data and imaging results were retrospectively analyzed.RESULTS:The medical complication of popliteal vein thrombosis occurred in one patient. Sixteen patients were followed up for 12 to 21 months. Two patients had malunion and mild pain. Fracture collapse occurred in two patients, with one having head penetration. These two patients had moderate pain. There were no occurrences of nonunion or reoperation. The mean Harris hip score obtained during the last follow-up was 84.1 (61-97). Patients with a poor quality of reduction were more likely to have pain results (p = 0.001). A trend existed toward the presence of a poor quality of reduction (p = 0.05) in patients with a collapse of fracture. Patients with poor preoperative mobility were more likely to have a lower Harris hip score (p = 0.000).CONCLUSION:The percutaneous compression plate is an alternative device for the treatment of AO/OTA 31-A3 intertrochanteric femoral fractures. Good fracture reduction and an ideal placement position of the neck screw are important in the success of the device.

Percutaneous compression plate versus proximal femoral nail anti-rotation in treating elderly patients with intertrochanteric fractures: a prospective randomized study

BackgroundThe treatment and management of hip fracture poses a great challenge for clinicians in osteology and surgery. The aim of this study is to compare the clinical effectiveness of the percutaneous compression plate (PCCP) versus proximal femoral nail anti-rotation (PFNA) in the treatment of intertrochanteric fractures in elderly patients. MethodsA prospective randomized study was carried out from January 2008 to October 2011 involving 90 elderly patients with intertrochanteric fractures (90 hips) who underwent minimally invasive surgery using the PCCP or PFNA. Evaluation variables, including operation time, intra- and perioperative blood loss, duration of hospital stay, incidence of postoperative complications, and final clinical outcomes by the end of follow-up, were used to compare the benefits of these two implants. ResultsAmong 90 subjects, 45 received PCCPs and 45 received PFNAs. The baseline characteristics of the two groups were comparable. The median follow-up time was 16.9months (12–24months). In the PCCP group, the mean operative time was 53min (40–75min), and the mean intra- and perioperative blood losses were 100.7ml (60–150ml) and 916ml (433–1339ml), respectively, which were significantly lower than those in the PFNA group. Nevertheless, there was no statistical difference in the incidence of postoperative complications and final clinical outcomes including pain complaints, range of motion of the hip, postoperative hip function at 12months, and the recovery of walking ability to pre-injury status between these two implants. ConclusionsOverall, the PCCP and PFNA appear to have similar clinical effects in treating elderly patients with intertrochanteric fractures, although the PCCP provided shorter operation times and less blood loss than PFNA. Both implants discussed were demonstrated to be ideal for the treatment of femoral intertrochanteric fractures in elderly patients.

Reoperation Rate After Internal Fixation of Intertrochanteric Femur Fractures With the Percutaneous Compression Plate

The aim was this study was to analyze the risk factors for reoperation after internal fixation of intertrochanteric fractures of the femur using the percutaneous compression plate (PCCP). This was a retrospective cohort study. The study was conducted at the University Hospital. Patients with intertrochanteric femur fractures who underwent internal fixation with a PCCP were included in this study. We investigated potential risk factors such as age, gender, body mass index, comorbidities of the patients (American Society of Anesthetist classification), type of fracture (AO/OTA classification), experience of the surgeons (in terms of the number of surgical procedures with the PCCP device), tip-apex distance (TAD), and operation time. The procedures were performed by 10 surgeons. Logistic regression was used to assess potential predictors for the need of reoperation. Of the 96 patients with 96 intertrochanteric fractures, 8 underwent reoperation due to local complications (8.3%). The most frequent complication was complete or imminent cutting out of the upper cervical screw (N = 5; 5.2%). Five of the 8 risk factors that were associated with reoperation in the initial univariable analyses with a P value of <0.20 were retained in a multivariable logistic regression model, including, age, body mass index, TAD, experience of the surgeons, and operation time. Of these, only the factor TAD proved to be a significant predictor for reoperation (P = 0.027, odds ratio = 1.089, 95% confidence interval 1.01-1.175). Our data show that the surgeon-related risk factors (number of operations, operation time, TAD) seem to be more relevant for the reoperation rate after internal fixation with the PCCP device when compared with the patient-related risk factors. This finding indicates a substantial learning curve for this technically demanding procedure. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Clinical and functional outcomes of the PCCP study: a multi-center prospective study in Italy.

The standard surgical management of hip fractures is associated with tissue trauma and bleeding which are added to the fracture injury. The percutaneous compression plate (PCCP) is a minimally invasive device that has been demonstrated in previous studies to reduce postoperative complications and blood loss. This prospective, multi-center, observational study assessed clinical and functional outcomes with PCCP as treatment for trochanteric fractures. Patients with a stable or unstable proximal femoral fracture of type AO 31.A1 or 31.A2 were enrolled in eight hospitals in Italy. The primary outcome of interest was the recovery of the pre-fracture functional status at 1-year follow-up; secondary outcomes of interest included blood transfusions, surgical time, complications, and mortality. A total of 273 patients were enrolled. The ASA score was 3 or 4 in 72.5 % of patients. The mean surgical time was 44.1 min; the mean post-surgery blood transfusions was 0.9 units. At 1 year, 48 patients (17.6 %) died, 28 (10.2 %) were lost to follow-up, 4 patients (1.5 %) were excluded, hence 193 patients (70.3 %) were available for final evaluation. At the 1-year follow-up visit, 51.9 % of patients recovered or improved their pre-fracture modified Harris Hip Score, 49.1 % of patients improved or maintained their walking abilities, and 66.6 % of patients residing at home pre-surgery maintained their domicile. The overall mortality rate was 17.6 %. Major complications included two fracture collapses, one excessive sliding of the cephalic screw leading to a partial fracture collapse and one back-out of the diaphyseal screw. This study demonstrates that treatment of trochanteric fractures with PCCP gives good outcomes and significant advantages such as low blood loss, short surgical time, low risk of complications, and good functional recovery in the majority of the patients.

Extramedullary fixation implants and external fixators for extracapsular hip fractures in adults.

Extramedullary fixation of hip fractures involves the application of a plate and screws to the lateral side of the proximal femur. In external fixators, the stabilising component is held outside the thigh by pins or screws driven into the bone. ThisisanupdateofaCochranereviewfirstpublishedin1998, and last updated in 2005. To assess the relative effects of different types of extramedullary fixation implant, as well as external fixators, for treating extracapsular proximal femoral (hip) fractures in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (July 2011), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2011, Issue 2), MEDLINE (1966 to June Week 4 2011), EMBASE (1988 to 2011 Week 25), various other databases, conference proceedings and reference lists. Randomised or quasi-randomised controlled trials comparing extramedullary implants or external fixators for fixing extracapsular hip fracture in adults were included. Two review authors independently selected trials, assessed risk of bias and extracted data. Data were pooled where appropriate. The 18 included trials tested seven comparisons in a total of 2615 mainly female and older participants with a total of 2619 fractures. All trials had methodological flaws that may affect the validity of their results.Three trials of 355 participants comparing a fixed nail plate (Jewett or McLaughlin) with the sliding hip screw (SHS) found an increased risk of fixation failure for fixed nail plates.The two trials of 433 participants comparing the Resistance Augmented Bateaux (RAB) plate with the SHS had contrasting results, notably in terms of operative complications, fixation failure and anatomical restoration.One trial of 100 participants comparing the Pugh nail and the SHS found no significant difference between implants.Three trials of 458 participants compared the Medoff plate with the SHS. There was a trend to higher blood losses and longer operation times for the Medoff plate along with a trend to a lower risk of fixation failure with the Medoff plate for unstable trochanteric fractures.Two trials of 676 participants compared the Medoff plate with three different screw-plate systems. There were no statistically significant differences in outcome for trochanteric fractures. For subtrochanteric fractures, there was a lower fixation failure rate for the Medoff plate but no evidence for differences in longer-term outcomes.Four trials of 396 participants comparing the Gotfried percutaneous compression plate (PCCP) with a SHS found a trend to lower blood loss and transfusion requirements for the PCCP but no other confirmed differences in outcomes between implants. Three of the trials reported intra-operative problems with the PCCP, some of which precluded its use.Three trials of 200 participants comparing external fixation with a SHS found less operative trauma for the external fixation. Final outcome appeared similar. The markedly increased fixation failure rate of fixed nail plates compared with the SHS is a major consideration and thus the SHS appears preferable.There was insufficient evidence from other comparisons of extramedullary implants or on the use of external fixators to draw definite conclusions.

Ostéosynthèse par plaque percutanée en compression versus vis plaque dynamique dans le traitement des fractures trochantériennes de hanche : revue systématique et méta-analyse des études comparatives disponibles

Summary Background The use of a percutaneous compression plate (PCCP) provides a minimally invasive technique for the fixation of stable intertrochanteric femoral fractures. It has several theoretically potential advantages over the dynamic hip screw (DHS) such as shorten incision and lower incidence of wound infection. Hypothesis PCCP have several advantages than DHS, such as reduced blood loss, transfusion, mortality, shorter operative time, and lower incidence of complications. This systematic review and meta-analysis was performed to identify the clinical outcomes and safety of patients with stable intertrochanteric hip fractures operated on using PCCP compared with DHS. Materials and methods A systematic search of all studies published through April 2012 was conducted using the Medline, Embase, Sciencedirect, OVID and the Cochrane Central database. The randomised controlled trials (RCT) and quasi-randomised control trials (qRCT) that compared PCCP with DHS in treating adult patients with stable intertrochanteric hip fractures and provided data on safety and clinical effects were identified. Demographic characteristics, adverse events and clinical outcomes were manually extracted from all of the selected studies. Results Nine studies encompassing 914 patients met the inclusion criteria. Overall, the result of meta-analysis indicated that over DHS, PCCP allowed significantly shorter operative time, reduced blood loss as well as transfusion, diminished incidence of cardiovascular events. However, there were no significant differences in length of hospitalization, rate of walking without help, early mortality and other complications. Discussion Significant differences favoring PCCP were found with regard to operative time, blood loss, transfusion and lower incidence of cardiovascular events. However, owing to the limitations of this systematic review, future RCT are still needed to confirm this data and the clinical efficiency of PCCP. Level of evidence Level II: low-powered prospective randomised trial.

The percutaneous compression plate versus the dynamic hip screw for treatment of intertrochanteric hip fractures: A systematic review and meta-analysis of comparative studies

The use of a percutaneous compression plate (PCCP) provides a minimally invasive technique for the fixation of stable intertrochanteric femoral fractures. It has several theoretically potential advantages over the dynamic hip screw (DHS) such as shorten incision and lower incidence of wound infection. PCCP have several advantages than DHS, such as reduced blood loss, transfusion, mortality, shorter operative time, and lower incidence of complications. This systematic review and meta-analysis was performed to identify the clinical outcomes and safety of patients with stable intertrochanteric hip fractures operated on using PCCP compared with DHS. A systematic search of all studies published through April 2012 was conducted using the Medline, Embase, Sciencedirect, OVID and the Cochrane Central database. The randomized controlled trials (RCTs) and quasi-randomised control trials (qRCTs) that compared PCCP with DHS in treating adult patients with stable intertrochanteric hip fractures and provided data on safety and clinical effects were identified. Demographic characteristics, adverse events and clinical outcomes were manually extracted from all of the selected studies. Nine studies encompassing 914 patients met the inclusion criteria. Overall, the result of meta-analysis indicated that over DHS, PCCP allowed significantly shorter operative time, reduced blood loss as well as transfusion, diminished incidence of cardiovascular events. However, there were no significant differences in length of hospitalization, rate of walking without help, early mortality and other complications. Significant differences favoring PCCP were found with regard to operative time, blood loss, transfusion and lower incidence of cardiovascular events. However, owing to the limitations of this systematic review, future RCTs are still needed to confirm this data and the clinical efficiency of PCCP. Level II: low-powered prospective randomized trial.

Percutaneous Locking Compression Plate(LCP) Internal Fixation for Distal Tibial Comminuted Fracture

Objective To explore the effect of percutaneous locking compression plate(LCP) internal fixation for distal tibial comminuted fracture.Methods 35 patients of distal tibial Comminuted fracture were treated with percutaneous locking compression plate(LCP) internal fixation.Results All patients were followed up for average 1.8 years(ranging from 1 to 2.5 years).All of cases have healed well,and the average bone healing was 14.6 weeks (ranging from 8 to 28 weeks ).All of them have no infection and no loosening or breakage of internal fixation.According to Mazur criterion,excellent effect 17 cases,good effect 16 cases,fair effect 1 case poor effect 1 case,94.3％ was excellent or good.Conclusion The LCP internal fixation for distal tibial comminuted fracture have the advantage of less invasive,good internal fixation and bone union fastly and little complications. Key words: Tibial and fibula fracture; Locking compression plate; Fracture Fixation, Internal

A meta-analysis of percutaneous compression plate versus sliding hip screw for the management of intertrochanteric fractures of the hip

Intertrochanteric hip fractures are associated with high morbidity and mortality rates. Percutaneous compression plating (PCCP) is a minimally invasive technique for fracture fixation that has been advocated to reduce blood loss, relieve pain, and lead to faster rehabilitation. The present systematic review and meta-analysis was performed to evaluate PCCP in patients with intertrochanteric hip fractures compared with patients with sliding hip screw (SHS). A comprehensive review of related literature was conducted to identify all articles in PubMed, EMBASE, Springer, Ovid, China National Knowledge Infrastructure (CNKI), and the Cochrane Central Register of Controlled Trials published on or before July 26th, 2011. Only prospective or retrospective comparative studies reporting clinical and radiographic outcomes of PCCP for intertrochanteric hip fractures were included. The methodological qualities of the included studies were assessed using the Coleman methodology score, and the reported data of individual studies were extracted. Meta-analytic pooling of group outcomes across studies was performed for both the PCCP and SHS techniques. Fourteen studies met the inclusion criteria. Minimally invasive PCCP was associated with a decrease in surgical time, blood loss, transfusion rate, and systematic complications. No significant differences between PCCP and SHS were observed in other parameters, including hospital stay, mortality, reoperation, implant-related complications. Based on these finding, PCCP appeared similar to SHS in terms of mechanical stability in the clinical setting, but had obvious advantages in terms of blood loss, transfusion need, and systematic complications, which may be attributed to reduced soft tissue and bone damage. Although orthopedic surgeons are advised to consider PCCP fixation as an additional alternative treatment for intertrochanteric fractures, high-quality randomized trials are still needed to assess the benefits of this minimally invasive technique. III, systematic review.