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Introduction
Intertrochanteric fractures are common in elderly population and pose a significant financial burden to the society. Anatomically contoured proximal femur locking compression plate (PFLCP) is the latest addition in the surgeons’ armamentarium to deal with these fractures. It creates an angular stable construct, which will theoretically...
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... 3 The sliding hip screw was the gold standard for treatment in the past, but it had drawbacks such as prolonged surgical time, lateral wall blowout, lag screw cut out, and varus collapse. 4 The PFN was introduced as an intramedullary implant with advantages such as closer placement to the mechanical axis, shorter operating time, less blood loss, and early weight-bearing. However, it was not without complications such as jamming of the sliding mechanism, stress risers at the distal locking bolts, and the Z effect. ...
Background: In current practice, proximal femoral nail (PFN) and dynamic hip screw (DHS) with locking side plate are the implant of choice in stable trochanteric fractures. Most of the deficiencies of the standard DHS have been addressed by the introduction of the Locking side plate. There are plenty of studies comparing standard DHS and PFN. But studies comparing locking DHS and PFN are scarce in current literature. This study aimed to compare the outcomes of both implants in stable pertrochanteric fractures. Methods: The objective of this study was to assess and compare the clinical outcomes of using locking DHS and PFN for fixation in 40 patients who were admitted to SUT Academy of Medical Sciences between October 2017 and April 2019. The modified Harris hip score was used to evaluate the patients' progress, and regular follow-up was conducted to compare their outcomes. Results: Among the DHS group, the mean Harris hip score was 83.05, with excellent results observed in 2 patients (10%), good results in 12 patients (60%), fair results in 5 patients (25%), and poor results in 1 patient (5%). In comparison, the PFN group had a mean Harris hip score of 85.50, with excellent results seen in 6 patients (30%), good results in 10 patients (50%), fair results in 3 patients (5%), and poor results in 1 patient (5%). Conclusions: The DHS group had more patients with good and fair outcomes, while the PFN group had more patients with excellent and good outcomes. Based on these findings, we can conclude that both the PFN and DHS with locking side plate are similarly effective in treating stable intertrochanteric fractures.
... Accordingly, the application of DHS in unstable pertrochanteric fractures consequences in the retraction of screws that perhaps pinch the soft tissues accompanying pain and discomfort to the patient. 5 A proximal femoral plate (PFP) is a substitutive device that is anatomically contoured to precisely estimate the lateral facet of the proximal femur (left and right). Additionally, it stabilizes the femur by facilitating neck anteversion of the femur. ...
Objective: To determine the comparative and effective applicability of the Dynamic Hip Screw (DHS), and proximal femoral plate (PFP) in terms of the rapid bony union and complications for treating unstable pertrochanteric fractures. Methodology: This comparative study was conducted at the Department of Orthopedic surgery, Pakistan Institute of Medical Sciences, Islamabad during a period of 8 months from August 2016 to April 2017. Patients ages of 45 to 90 years, with close fresh unstable pertrochanteric fractures (one week) and of either gender were included. All the patients were divided into two groups. Patients in group A underwent PFP treatment and patients of group B underwent DHS treatment. Patients were followed up after 6 weeks and then every 2 weekly afterwards for a total period of 3 months for assessment of bony union both clinically and radiologically. The data was collected on a pre-structured Performa, and analysis was done using SPSS version 26. Results: A total of 84 patients were analysed, and average age of the patients in the PFP group was 66.57 ± 11.71 years and in the DHS group was 70.14 ± 9.03 years. Females were found in majority in both groups. No union was found till six weeks in both groups, while on 2nd month followup, union was found significantly high 19.0% in cases of the PFP group, compared to the 2.4% in the DHS group (p-0.014). On 2.5th months the union rate was significantly higher 59.5% in the PFP group, compared to the 7.1% DHS group (p-0.014), while on the 3rd month followup the union was almost in all cases in both groups (p-0.557) and the overall average union duration was significantly lower in PFP group compared to the DHS (p-0.001). Conclusion: The proximal femoral plate technique for treating unstable pertrochanteric fractures was observed to be more effective in terms of significant rapid bony union with minimum complications compared to the Dynamic Hip Screw (DHS).
... PFLCP is also associated with a lower risk of varus collapse and screw cut-out. 22 The mean age in our study was 57. 22 According to some studies the bone mineral density (BMD) decreases with age, which is associated with an increased risk of fractures. ...
... 22 The mean age in our study was 57. 22 According to some studies the bone mineral density (BMD) decreases with age, which is associated with an increased risk of fractures. 23,24 The risk of falls also increases with age thus causing an increased incidence of fractures in this age group. ...
... Whereas in the study by Agrawal et al most of the patients were males (65.38% in the DHS group and 57.69% in PFLCP group). 22 The risk of osteoporosis is increased four times in women aged 50 and above. 26 In our study, the most common cause of fractures was slips and falls (50%). ...
Background: Inter-trochanteric femoral fractures are associated with a high complication rate and mortality. This study aims to compare the proximal femoral locking compression plate (PFLCP) with dynamic hip screws (DHS) for inter-trochanteric femoral fractures in terms of mean bone union time.Methods: It was a prospective randomized study conducted at the department of orthopedics, Benazir Bhutto Hospital, Rawalpindi, Pakistan from June 2015 to December 2015. Sixty patients with a diagnosis of inter-trochanteric fractures, requiring orthopedic surgery, were included in the study. After randomization thirty patients underwent PFLCP fixation and the other thirty patients underwent DHS fixation. Patient information, demographic data, and functional level were assessed. Mean bone union time and implant complications were compared for the two treatment groups.Results: Patients who underwent PFLCP fixation demonstrated shorter bone union time (2.8±0.2 months) than those who underwent DHS fixation (3.2±0.1 months) (p<0.000). PFLCP group had 90% bone union whereas DHS group had 76.66% bone union at 12 weeks (p=0.16). Conclusions: PFLCP is better than DHS for intertrochanteric femoral fractures in terms of shorter mean bone union time and fewer complications.
... years against 55.3±17.9 years and 59.6 years according to Prabhat et al and Shah et al respectively. 28,29 Our study also showed a bimodal distribution of patients. The first peak occurred in young age where patients had high velocity trauma and the second peak occurred in older age group where there was osteoporosis and a simple fall could result in a fracture. ...
... days against 8.19±2.04 days in study by Agarwal et al. 29 The complications that we found were that one patient (3.31%) had superficial infection, two patients (6.66%) had varus collapse, one patient (3.31%) had screw cut-out and one patient (3.31%) had non-union. The patients who had superficial infection were given prolonged antibiotics and the infection healed completely. ...
... The patients who had superficial infection were given prolonged antibiotics and the infection healed completely. Lee 27,29 This study needed further evaluation with a larger number of patients and a longer follow up. ...
p class="abstract"> Background: The objective was to find out the clinical and functional outcome of intertrochanteric femur fractures treated with proximal femoral locking compression plate (PFLCP).
Methods: The study was conducted on patients who underwent fixation of intertrochanteric femur fractures with PFLCP in department of orthopedics, GMCH, Aurangabad from January 2020 to January 2021. The patients were assessed clinically and functionally using Harris hip score and radiological evaluation at three, six and nine months.
Results: At one year follow up, two patients had varus collapse, one had superficial infection and one had screw cut out. The mean Harris hip score at one month was 69.46 (52-76), at three months was 78.6 (58-88) and at nine months was 87.6 (64-96). The average operative time was 86.23 minutes (60-128 minutes), the average blood loss was 207.5 ml (170-250 ml) and the average time required for union was 15.16 weeks (10-24 weeks).
Conclusions: Intertrochanteric fractures treated with PFLCP provided a strong angular stable construct and showed satisfactory outcomes.</p
... In Ukraine, the frequency of such fractures is also disappointing. In Ukraine, every year the diagnosis of FPF is recorded in 100-150 patients per 100 thousand population with a steady upward trend [6,7]. There is a global trend of exponential increase in frequency of FPF among older people [8]. ...
The aim of the research: correlation levels of the psychological component of quality of life and medical-epidemiological characteristics of patients with fractures of the proximal thigh. Solved problem: to determine the possibility of predicting the impact of medical-epidemiological and anamnestic characteristics of patients with fractures of the proximal thigh on their quality of life after treatment of fractures of the proximal thigh. Main scientific results: natural increase in comorbidity in the presence of comorbidities, low functional status and an increase in age characteristics were established. The probable influence of comorbidity on the decrease of the functional state according to the ASA classification also stated. An increase in the duration of treatment of patients with surgical treatment and a longer period of injury marked. The decrease in the quality of life of patients with increasing age characteristics, increasing comorbidity and reducing the indicators of functional status according to the ASA classification have been established. Area of practical use of research results: medical institutions of traumatological profile. Innovative technological product: determining the ability to predict the quality of life of patients after treatment of fractures of the proximal thigh, which allows you to predict the results of treatment such patients. Scope of application of the innovative technological product: clinical medical traumatological practice of use of possibilities of forecasting of results of treatment of fractures of proximal hip department.
... % in the first year, and disability is estimated at 5964 DALI per 1000 people [10]. Caring for such patients is a serious global economic burden [11]. ...
The purpose of the study is to study the current global clinical and epidemiological features of proximal hip fractures and the risks of their development and spread. The paper identifies the main aspects of the spread and treatment of fractures of the proximal femur; main world modern epidemiological characteristics of hip fractures and levels of risks of their development and spread. The relationship between comorbidities in patients with proximal hip fractures and the risk of various treatment complications is shown. The main types of treatment tactics are identified, the groups of the most common comorbidities in such patients are given. As a result of the work it was established: the percentage of fractures of the proximal thigh is 9.00–45.00 % among all skeletal fractures in the older age group and among all age categories – 17.00–24.00 %; global annual morbidity is 1.7 million people, and mortality – 11.00–23.00 % in 6 months and 22.00–29.00 % in a year; increase in the frequency of these fractures with age with doubling after 50 years every ten years; average age of patients – 75–79 years; predominance of women over men in 2-3 times; the lowest annual age-standardized cases among women are in Nigeria, South Africa, Tunisia and Ecuador, and the highest are in Denmark, Norway, Sweden and Austria, which is also typical for men; significant economic burden of treatment and high levels of fractures with osteoporosis, cardiovascular disease, diabetes, chronic obstructive pulmonary disease and more; the advantage of surgical treatment over conservative.
... Another biomechanical experimental indicated that dynamic locking plate provided superior mechanical stability than other implants. [18,19] Brandt et al [20] further revealed that Targon FN enhances the mechanical strength of reconstructions in unstable/displaced ICHFs. Escheler et al [11] reported that complications in SHS group occurred earlier than in the dynamic locking plate group. ...
Background:
We studied the safety and efficacy of dynamic locking plate vs. other implants (cannulated cancellous screws [CCS] or sliding hip screw [SHS]) in patients undergoing intracapsular hip fracture (ICHF).
Methods:
We searched Pubmed, Embase, Web of Science, Cochrane library and Google database from inception to March 25, 2018. We selected any studies comparing dynamic locking plate for treatment ICHF. Non-union rate, osteonecrosis rate, cutout rate, revision rate, the replacement rate, and Harris hip scores were the outcomes. Stata 12.0 was used for meta-analysis.
Results:
Four studies involving 419 patients (143 patients in the dynamic locking plate group and 276 patients in the other implants group) were finally included. Compared with CCS or SHS, dynamic locking plate was associated with a reduction of nonunion rate, revision rate, replacement rate (P <.05). Furthermore, dynamic locking plate was also associated with an increase of the Harris hip scores (P <.05). There was no significant difference between the osteonecrosis rate and cutout rate (P >.05).
Conclusions:
Current meta-analysis revealed that dynamic locking plate has a benefit role in improving postoperative clinical outcome than CCS or SHS in ICHF patients. Further high quality and large-scale randomized controlled trials (RCTs) are needed to further identify the efficacy of dynamic locking plate for ICHF.
... The locking proximal femoral plate (LPFP) is one of the locking hip screw systems that is known to provide immediate angular stability in the proximal femur. However, pressure at the junction of the locking screws tends to cause hardware failure, including screw breakage, loosening, fracture, and nonunion [5,6]. This raises concerns about the clinical application of LPFP. ...
Background
The aim of this article is to introduce a novel technique of limited dynamic hip screw (LDHS) in the treatment of intertrochanteric fractures and to evaluate its biomechanical effects.
Material/Methods
Based on the principle of providing both dynamic and static pressure to stabilize the fracture, we improved the dynamic hip screw (DHS) and designed the LDHS. Six fresh cadavers were collected and intertrochanteric fracture models were established, including Evan’s type I fracture (n=3) and type II (n=3). We used the left-to-right comparison in this study. LDHS technique was performed on the left femoral head of each cadaver (LDHS group: n=6), while DHS was performed on the right side (DHS group: n=6). After fixation by either LDHS or DHS, compressive strength, rigidity, shear stress and strain, torsional properties, and ultimate loads were measured and compared in both groups.
Results
Under the 1200 N pressure, compressive strength, rigidity, shear stress and strain, and ultimate loads of LDHS were better than those of DHS in the 2 groups. All differences were statistically significant. Although LDHS enhanced the torsional properties, there was no significant difference.
Conclusions
Our study demonstrates that the biomechanical effects of LDHS are superior than those of DHS, and there was no screw failure after implantation. Armed with those better properties, LDHS, as a new internal fixation device, may be a good alternative option in the treatment of intertrochanteric fractures.
... Over the past decades, the dynamic hip screw (DHS) as an extra-medullary stabilization device has been the most widely used implant. However, complications such as hip varus deformity, delayed union and loosen screws have been frequently reported with DHS fixation particularly in unstable fractures 3,4 . Conventional intramedullary nails including gamma 3 locking nail and proximal femoral nail antirotation (PFNA) were designed for unstable intertrochanteric fractures 5 . ...
Intertrochanteric fractures are common injuries in the elderly. Conventional intramedullary nails including Gamma 3 locking nail and proximal femoral nail antirotation (PFNA) were designed for unstable intertrochanteric fractures. The InterTan (IT) nail system, introduced in 2005, has been reported superior biomechanical and clinical outcomes compared with 1-screw nailing system. However, some recent studies have reported that IT did not improve functional recovery in patients with intertrochanteric fractures. Randomized controlled trials (RCTs) or prospective cohort studies were included in our meta-analysis. We used the PRISMA guidelines and Cochrane Handbook to evaluate the quality of included studies to ensure that the pooled data of our meta-analysis were reliable and veritable. Our pooled data analysis demonstrated that IT was as effective as the control group in terms of Harris Hip Score (HHS), blood loss, total complications, union time, length of hospital stay, revision rate, and fluoroscopy time. IT shows less implant cut-out rate and femoral fractures when compared with control groups.
Objective To compare the clinical efficacy of PFNA combined with locking reconstruction plate and PFNA for femoral intertrochanteric fractures of lateral wall fractue.
Methods A retrospective study was conducted on 50 patients who received PFNA for femoral intertrochanteric fractures complicated with lateral wall fractures in our department from January 2017 to December 2021. According to the preoperative doctor-patient communication, 26 patients underwent PFNA and lateral wall reconstruction with a locking plate (group A), while the other 24 patients received PFNA alone (group B). The perioperative period, follow-up and imaging data of the two groups were compared.
Results All the patients were operated on smoothly without nerve and vascular injury. Although there were no significant differences in operation time, intraoperative blood loss, total incision length, intraoperative fluoroscopy times, success rate of the first nail placement, screw blade length, incision healing grade and hospital stay between the two groups (P>0.05), the group A resumed ambulation significantly earlier than the group B [((14.01±1.62) days vs (18.83±2.94) days, P< 0.05]. All patients in both groups were followed up for an average of (23.98±4.41) months, and the reconstruction group returned to full weight- bearing activity significantly earlier than the non-reconstructed group [(13.46±3.51) weeks vs (16.5±3.02) weeks, P<0.05]. The Harris score, hip extension-flexion range of motion (ROM) and adduction- abduction ROM significantly increased in both groups with postoperative time (P<0.05), which in the group A proved significantly better than those in group B at all time points accordingly (P<0.05). Radiologically, there was no significant difference in reduction quality between the two groups (P>0.05). At the last follow- up, the group A was also significantly superior to the group B in terms of neck-shaft angle (NSA) [(127.54±2.76)° vs (125.79±1.44)°, P<0.05] and extent of femoral head-neck shortening [(4.06±0.70) mm vs (5.04± 0.62) mm, P<0.05].
Conclusion The lateral wall reconstruction in PFNA fixation of femoral intertrochanteric fractures does enhance the stability of fixation, facilitate the functional recovery of hip joint and reduce complications in this study.
