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

A New Postoperative Stability Score to Predict Loss of Reduction in Intertrochanteric Fractures in Elderly Patients

The study aimed to validate a newly developed postoperative stability score for evaluating clinical follow-up in elderly patients with low-energy hip fractures. From 1 January 2020 to 31 December 2021, we enrolled patients aged over 65 who underwent cephalomedullary nail fixation using proximal femoral nail antirotation II (PFNAII) and had at least 6 months of follow-up; excluding multiple fractures, pathological fractures, and periprosthetic fractures. We collected general patient data. Parameters such as TAD, Parker's ratio (AP and lateral), and the new postoperative stability score were recorded. A loss of reduction was defined using the decline in the Chang reduction quality criteria (CRQC) score within one month. Among the 108 enrolled patients, 23 (21.3%) experienced a loss of reduction, with a mean age of 82.1 years and a mean follow-up time of 7.4 months. Univariate analysis showed no significant association between loss of reduction and general data. However, the new postoperative stability score correlated significantly with loss of reduction (mean scores: 6.68 vs. 4.83, p = 0.045). Multivariate analysis confirmed this association (odds ratio: 0.076, 95% confidence interval: 0.022-0.263, p < 0.05). The newly developed postoperative stability score, incorporating surgical technique assessment, improves prediction accuracy for loss of reduction in elderly intertrochanteric fracture (ITF) patients.

Comparison of Cephalomedullary Nails with Sliding Hip Screws in Surgical Treatment of Intertrochanteric Fractures: A Cumulative Meta-Analysis of Randomized Controlled Trials

Background

The primary objective of the present study was to compare surgical failures of intertrochanteric fractures of the femur through a meta-analysis of randomized controlled trials and to assess the change in surgical outcomes over time in a cumulative meta-analysis.

Methods

To identify studies evaluating the surgical outcomes of internal fixation using sliding hip screws (SHS) or cephalomedullary (CM) nails for the treatment of intertrochanteric fractures of the femur, all records until August 2021 in the PubMed, Embase, and Cochrane Library databases were searched. Studies with the following characteristics were considered eligible: patients who had an intertrochanteric fracture of the femur (population); patients who received surgical treatment using a CM nail (intervention); patients who received surgical treatment using SHS (comparator); surgical failures that required reoperation, including cut-out or cut-through of lag screws, varus collapse or posterior angulation of proximal fragments, loosening of lag screws or helical blades, and fracture nonunion (outcomes); and two reviewers independently reviewed the titles and abstracts of the randomized controlled trials and selected relevant studies for a full-text review (study design).

Results

Twenty-one studies were included in the final analysis consisting of 1,777 cases in the SHS group and 1,804 cases in the CM nail group. The cumulative standard mean difference was 0.87, indicating that CM nails had no significant effect in improving the surgical outcomes. There was no significant difference in surgical failure between SHS and CM nails for all intertrochanteric fractures (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.76-1.49). Pooled data showed no significant difference between the two groups in terms of surgical failure in unstable intertrochanteric fractures (OR, 0.80; 95% CI, 0.42-1.54).

Conclusions

Although the use of CM nails has become a current trend in the treatment of intertrochanteric fractures, there is no literature supporting their clinical superiority when compared with SHS.

Optimal surgical methods to treat intertrochanteric fracture: a Bayesian network meta-analysis based on 36 randomized controlled trials

Background

There are several surgical methods to treat intertrochanteric fracture: dynamic hip screw (DHS), compression hip screw (CHS), percutaneous compression plate (PCCP), Medoff sliding plate, less invasive stabilization system (LISS), Gamma nail, proximal femoral nail (PFN), and proximal femoral nail anti-rotating (PFNA). We therefore conducted a network meta-analysis to compare eight surgical interventions, including DHS, CHS, PCCP, Medoff sliding plate, LISS, Gamma nail, PFN, and PFNA, to provide the optimal surgical intervention for intertrochanteric fracture.

Methods

An electronic search of 4 databases (PubMed, Embase, Cochrane library, and Web of Science) from inception to July 2020. Two or more of the eight surgical interventions, including the DHS, CHS, PCCP, Medoff sliding plate, LISS, Gamma nail, PFN, and PFNA, for intertrochanteric fracture were included. The methodological quality of the included studies was assessed using the Cochrane Collaboration risk of bias (ROB) tool. Network meta-analysis was conducted by using R-3.5.1 software with the help of package “gemtc”. The odd ratios (ORs) with 95% credibility interval (CrI) were used to assess complications and standard mean difference (SMD) with 95% CrI to calculate the continuous outcomes (operative time, intraoperative blood loss, and Harris hip score). Surfaces under the cumulative ranking curves (SUCRA) were used to rank the intervention.

Results

A total of 36 RCTs were included in this study. The results of this network meta-analysis showed that, compared with the CHS and DHS group, PFNA exhibited a beneficial role in reducing the blood loss (SMD, 152.50; 95% CrI, 72.93 to 232.45; and SMD, 184.40; 95% CrI, 132.99 to 235.90, respectively). PFNA achieved the lowest value for the surface under the cumulative ranking curve (SUCRA) for the blood loss (SURCA = 0.072) and highest of Harris hip score (SURCA = 0.912). PCCP may have the lowest probability of the operative time (SURCA = 0.095). There were no significant differences among the eight surgical procedures in complications.

Conclusion

PFNA technique is the optimal treatment method for intertrochanteric fracture. Larger, longitudinal RCTs addressing current limitations, including sources of bias, inconsistency, and imprecision, are needed to provide more robust and consistent evidence.

Mortality and cardiorespiratory complications in trochanteric femoral fractures: a ten year retrospective analysis

PURPOSE

Despite intense research and innovations in peri-operative management, a high mortality rate and frequent systemic complications in trochanteric femoral fractures persist. The aim of the present study was to identify predictive factors for mortality and cardio-respiratory complications after different treatment methods in a ten year period at a level I trauma centre.

METHODS

Retrospectively, all patients above 60 years of age with trochanteric femoral fracture between January 2000 and May 2011 were analyzed at a level I trauma centre. Demographic variables, comorbidities, and data regarding the surgical procedures, including required transfusions and post-operative complications, were evaluated, and the in-hospital mortality was recorded. The grade of osteoporosis was classified radiographically using the Singh index.

RESULTS

The in-hospital mortality rate was 8.2% among 437 patients (male/female ratio = 110/327, mean age = 81 years) with extramedullary open (n = 144), intramedullary (n = 166), and extramedullary minimally invasive (n = 125) procedures. Significant influential factors on in-hospital mortality were identified with binary logistic regression analysis: an age of ≥90 years (P = 0.011), male sex (P = 0.003), a high American Society of Anesthesiologists (ASA) grade (3-5, P = 0.042), and a high osteoporosis grade (Singh index 3-1, P = 0.011). A total of 21.5% of the study population suffered cardio-respiratory complications post-operatively. The specific mortality was 28.7% (P < 0.001), which was influenced by a high ASA grade (3-5, P = 0.002) and a high transfusion rate (P = 0.004). Minimally invasive locked plating was associated with increased cardio-respiratory complications (P = 0.031).

CONCLUSIONS

This study identified high patient age, distinctive comorbidities, male sex, and high osteoporosis grade as significant risk factors for increased in-hospital mortality in the treatment of trochanteric femoral fractures. Furthermore, high ASA grade and a liberal transfusion regime led to an increased incidence of cardio-respiratory complications. Patient-specific characteristics, especially osteoporosis grade and pre-existing medical conditions, may assist in the identification of high-risk patients and allow a patient-specific geriatric co-management plan.

Effect of comorbidities on the association between age and hospital mortality after fall-related hip fracture in elderly patients

The relation between age and mortality after hip fracture was analyzed in elderly patients. 5.5% of the 31,884 patients died. Compared to those 65-74 years old, the multivariate OR for mortality for those 75-84 and ≥85 were 2.11 (95% CI: 1.61-2.77) and 4.10 (95% CI: 3.14-5.35).

PURPOSE

To analyze the impact of Elixhauser comorbidities on the relation between age and mortality after hip fracture in elderly patients.

METHODS

Cross-sectional study of the population ≥65 years old hospitalized in Spain in 2013 with a diagnosis of fall-related hip fracture in the Basic Minimum Set Data (BMSD). The impact of Elixhauser comorbidities on the association between mortality and age groups (65-74, 75-84, ≥85) was analyzed by logistic regression models with progressive adjustment for demographic variables and comorbidities introduced individually.

RESULTS

We identified 31,884 patients, 5.5% of which died during hospitalization. Compared with those 65-74 years old, the multivariate OR of mortality for those 75-84 and ≥85 years old decreased from 2.23 (95% CI: 1.71-2.90) and 4.57 (95% CI: 3.54-5.90) to 2.11 (95% CI: 1.61-2.77) and 4.10 (95% CI: 3.14-5.35), respectively after adjustment for comorbidities. The OR of mortality for men was 1.77 (95% CI: 1.58-1.98) compared to women. The comorbidities with higher OR for mortality were congestive heart failure (OR: 3.88; 95% CI: 3.42-4.41), metastasis (OR: 3.44; 95% CI: 2.27-5.20), fluid and electrolyte disorders (OR: 2.95; 95% CI: 2.47-3.52), coagulation deficiencies (OR: 2.87; 95% CI: 2.08-3.96), and liver disease (OR: 2.40; 95% CI: 1.82-3.17).

CONCLUSIONS

The association between age and mortality after hip fracture remains after adjusting for numerous comorbidities. However, some potentially controllable disorders are associated with an increased risk for mortality, thus, improving their management could benefit survival.

Anchorage strategies in geriatric hip fracture management

There is an enormous humanitarian and socioeconomic need to improve the quality and effectiveness of care for patients with hip fracture. To reduce mechanical complications in the osteosynthesis of proximal femoral fractures, improved fixation techniques have been developed including blade or screw-anchor devices, locked minimally invasive or cement augmentation strategies. However, despite numerous innovations and advances regarding implant design and surgical techniques, systemic and mechanical complication rates remain high. Treatment success depends on secure implant fixation in often-osteoporotic bone as well as on patient-specific factors (fracture stability, bone quality, comorbidity, and gender) and surgeon-related factors (experience, correct reduction, and optimal screw placement in the head/neck fragment). For fracture fixation, the anchorage of the lag screw within the femoral head plays a crucial role depending on the implant's design. Meta-analyses and randomized controlled studies demonstrate that there is a strong trend towards arthroplasty treating geriatric femoral neck fractures. However, for young adults as well as older patients with less compromised bone quality, or in undisplaced fractures, head-preserving therapy is preferred as it is less invasive and associated with good functional results. This review summarizes the evidence for the internal fixation of femoral neck fractures and trochanteric femoral fractures in elderly patients. In addition, biomechanical considerations regarding implant anchorage in the femoral head including rotation, migration, and femoral neck shortening are made. Finally, cement augmentation strategies for hip fracture implants are evaluated critically.

Percutaneous compression plate versus dynamic hip screw for treatment of intertrochanteric hip fractures: A overview of systematic reviews and update meta-analysis of randomized controlled trials

PURPOSE

Intertrochanteric hip fractures lead to high morbidity and mortality rates. As a minimally invasive technique, many studies reported the efficacy of PCCP for the treatment of intertrochanteric fractures, but the controversy still existed in some outcomes. The purpose of this study was to evaluate the efficacy of PCCP and DHS by a overview of systematic reviews and well-designed, comprehensive update meta-analysis.

METHODS

PUBMED, SCOPUS, CCRCT, WANFANG and CNKI database were searched in all languages published up to April 2016. Systematic reviews and randomized controlled trials reporting outcomes of PCCP and DHS for intertrochanteric fractures were included. Meta-analyses comparing the two techniques were performed according to the Cochrane Handbook.

RESULTS

Five original trials and four systematic reviews met the inclusion criteria. Meta-analyses showed that the blood loss [SMD = -2.35, 95%CI(-4.26--0.44)], transfusion volume [SMD = -0.26, 95%CI(-0.47--0.06)] and complications [RR = 0.33, 95%CI(0.14-0.77)] was statistically less in PCCP group than DHS group while there was no significant difference between two groups in mortality rate, transfusion rate and length of hospital day.

CONCLUSIONS

PCCP is recommended to treat intertrochanteric hip fractures as an alternative minimally invasive method. More high-quality, randomized controlled trials that are adequately powered are needed to further evaluate the efficacy of PCCP and DHS.

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.

Thirty-day mortality after hip fractures: has anything changed?

Bone density insufficiency is the main cause for significant musculoskeletal trauma in the elderly population following low-energy falls. Hip fractures, in particular, represent an important public health concern taking into account the complicated needs of the patients due to their medical comorbidities as well as their rehabilitation and social demands. The annual cost for the care of these patients is estimated at around 2 billion pounds (£) in the UK and is ever growing. An increased early and late mortality rate is also recognised in these injuries together with significant adversities for the patients. Lately, in order to improve the outcomes of this special cohort of patients, fast-track care pathways and government initiatives have been implemented. It appears that these measures have contributed in a steady year-by-year reduction of the 30-day mortality rates. Whether we have currently reached a plateau or whether an ongoing reduction in mortality rates will continue to be observed is yet to be seen.

Interpretation of hip fracture patterns using areal bone mineral density in the proximal femur

INTRODUCTION

Bone mineral density scans are currently interpreted based on an average score of the entire proximal femur. Improvements in technology now allow us to measure bone density in specific regions of the proximal femur. The study attempts to explain the pathophysiology of neck of femur (NOF) and intertrochanteric/basi-cervical (IT) fractures by correlating areal BMD (aBMD) scores with fracture patterns, and explore possible predictors for these fracture patterns.

MATERIALS AND METHODS

This is a single institution retrospective study on all patients who underwent hip surgeries from June 2010 to August 2012. A total of 106 patients (44 IT/basi-cervical, 62 NOF fractures) were studied. The data retrieved include patient characteristics and aBMD scores measured at different regions of the contralateral hip within 1 month of the injury. Demographic and clinical characteristic differences between IT and NOF fractures were analyzed using Fisher's Exact test and two-sample t test. Relationship between aBMD scores and fracture patterns was assessed using multivariable regression modeling.

RESULTS

After adjusted multivariable analysis, T-Troc and T-inter scores were significantly lower in intertrochanteric/basi-cervical fractures compared to neck of femur fractures (P = 0.022 and P = 0.026, respectively). Both intertrochanteric/basi-cervical fractures (mean T.Tot -1.99) and neck of femur fractures (mean T.Tot -1.64) were not found to be associated with a mean T.tot less than -2.5. However, the mean aBMD scores were consistently less than -2.5 for both intertrochanteric/basi-cervical fractures and neck of femur fractures. Gender and calcium intake at the time of injury were associated with specific hip fracture patterns (P = 0.002 and P = 0.011, respectively).

CONCLUSIONS

Hip fracture patterns following low energy trauma may be influenced by the pattern of reduced bone density in different areas of the hip. Intertrochanteric/basi-cervical fractures were associated with significantly lower T-Troc and T-Inter scores compared to neck of femur fractures, suggesting that the fracture traversed through the areas with the lowest bone density in the proximal femur. In the absence of reduced T.Troc and T.Inter, neck of femur fractures occurred more commonly. T-Total scores may underestimate the severity of osteoporosis/osteopenia and measuring T-score at the neck of femur may better reflect the severity of osteoporosis and likelihood of a fragility fracture.

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

BACKGROUND

With 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.

METHODS

From 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.

RESULTS

The 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).

CONCLUSION

The 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.

Accuracy of the lesser trochanter for guiding lag screw insertion in hip fracture management

The goal of this study was to evaluate the accuracy of the lesser trochanter for entry of lag screw placement in the fixation of hip fractures. Radiographs of the pelvis with both hips in 50 Chinese patients were analyzed to determine the accuracy of using the lesser trochanter as a reference landmark for inserting lag screws. The femoral neck was divided into 4 parts, and the second distal part was classified as the safe zone. Cobb angles of 125° and 130° were used as representative lag screw insertion angles, referencing the lateral cortex of the lesser trochanter for measurement, and insertion tracks were drawn on the neck of the femur. The accuracy of lag screw placement in the defined safe zone was evaluated. Accuracy of placement in the safe zone for entry points at the superior tip, apex, and inferior tip of the lesser trochanter were 78%, 39%, and 0%, respectively, for the 125° Cobb angle. Rates for the superior tip, apex, and inferior tip of the lesser trochanter were 31%, 74%, and 6%, respectively, for the 130° Cobb angle. The entry point at the level of the inferior tip of the lesser trochanter had incidence rates of 95% and 71% for cutout for 125° and 130° screws, respectively. The authors found that the superior tip of the lesser trochanter was a good reference point for 125° lag screw insertion and that the apex of the lesser trochanter was a good reference point for 130° lag screw insertion. Entry at the level of the inferior tip of the lesser trochanter has a very high rate of cutout and should be avoided.

Percutaneous compression plate versus dynamic hip screw for treatment of intertrochanteric Hip fractures: a meta-analyse of five randomized controlled trials

BACKGROUND

Percutaneous compression plating (PCCP) has been advocated to reduce blood loss, relieve pain, and lead to faster rehabilitation for the treatment of intertrochanteric fractures. The purpose of this meta-analysis was to estimate the outcomes and complications of the PCCP versus dynamic hip screw (DHS) fixation for intertrochanteric fractures.

METHODS

All randomized controlled trials (RCT) that compared PCCP with DHS in treating adult patients with intertrochanteric fractures were included. Main outcomes were collected and analysed using the RevMan 5.1 version.

RESULTS

Five trials met the inclusion criteria. Compared with DHS, PCCP had similar operation time (95% CI: -26.01~4.05, P = 0.15), length of hospitalization (95% CI: -1.79~1.25, P = 0.73), mortality (95% CI: 0.37~1.02, P = 0.06), incidence of implant-related complications (95% CI: 0.29~1.82, P = 0.49), and reoperation rate (95% CI: 0.41~3.05, P = 0.83). But blood loss (95% CI: -173.84~-4.81, P = 0.04) and transfusion need (95% CI: -0.53~-0.07, P = 0.01) significantly favored the PCCP.

CONCLUSIONS

The PCCP was associated with reduced blood loss and less transfusion need, but similar to DHS in other respects. Owing to the limitations of this systematic review, more high-quality RCTs are still needed to assess the clinical efficiency of PCCP.

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.

Reoperation rate after internal fixation of intertrochanteric femur fractures with the percutaneous compression plate: what are the risk factors?

OBJECTIVE

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).

DESIGN

This was a retrospective cohort study.

SETTING

The study was conducted at the University Hospital.

PATIENTS AND METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

LEVEL OF EVIDENCE

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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

BACKGROUND

The 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.

METHODS

A 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.

RESULTS

Among 90 subjects, 45 received PCCPs and 45 received PFNAs. The baseline characteristics of the two groups were comparable. The median follow-up time was 16.9 months (12-24 months). In the PCCP group, the mean operative time was 53 min (40-75 min), and the mean intra- and perioperative blood losses were 100.7 ml (60-150 ml) and 916 ml (433-1339 ml), 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 12 months, and the recovery of walking ability to pre-injury status between these two implants.

CONCLUSIONS

Overall, 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.