Unstable Intertrochanteric Fracture Fixation – Is Proximal Femoral Locked Compression Plate Better Than Dynamic Hip Screw
Background: Intertrochanteric fractures are one of the most common fractures encountered in our practice. Most of them need operative intervention and union is achieved. As per the literature dynamic hip screw (DHS) is the gold standard for the treatment of these fractures, however problem arise...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2016-01-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/7084/11179_CE(Ra1)_F(GH)_PF1(PAK)_PFA(AK)_PF2(PAG).pdf |
| Summary: | Background: Intertrochanteric fractures are one of the most
common fractures encountered in our practice. Most of them
need operative intervention and union is achieved. As per
the literature dynamic hip screw (DHS) is the gold standard
for the treatment of these fractures, however problem arises
with maintenance of neck shaft angle and proper reduction
in unstable intertrochanteric fractures. The situation gets
more complex when “cut out” of femoral head screw occurs
either alone or in combination with varus collapse when they
are treated with DHS. Here we are giving results of unstable
intertrochanteric fractures treated with Proximal Femoral
Locked Compression Plate (PFLCP) as compared with similar
patients treated with Dynamic Hip Screw (DHS).
Materials and Methods: The study included a total of 27
patients (17 males, 10 females) with unstable intertrochanteric
fractures who were subjected to PFLCP treatment from March
2011 to November 2012 in one group. Another was a similar
group of 35 patients treated with DHS from March 2008 to
February 2010. Results of group 1 were compared with group
2. Detailed clinical conditions of all patients, duration of surgery,
blood loss, length of incision and duration of image intensifier
use were recorded. Patients were revisited at 6 weeks, 3 months,
6 months and 1 year after operation. Results were evaluated
clinically by Harris hip Score and radiologically for fracture
union. Progress of union and complications (limb shortening,
varus collapse, cut out of femoral head screw and medialization
of distal fragment) were recorded.
Results: Among 27 patients treated with PFLCP, one patient
expired 6 week postoperatively and one patient lost to follow
up, so 25 patients were evaluated for final outcome of which
23 (92%) showed union at follow up of 12 months. One patient
developed bending of proximal screws and three developed
varus collapse. Among the group treated with DHS, eight patients
developed varus collapse, seven developed medialization and
three had femoral head screw cut out. According to Harris
hip Score 88% cases had good to excellent result in PFLCP
group whereas only 60% cases in the DHS group had good to
excellent result.
Conclusion: Treatment of unstable intertrochanteric fractures
with proximal femoral locked plate (PFLCP) can give good
healing, with a limited occurrence of complication. |
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| ISSN: | 2249-782X 0973-709X |