Comparison of the clinical effectiveness and intraoperative and postoperative complications of proximal femur locking compression plate (PFLCP) with dynamic hip screw (DHS) in the management of inter-trochanteric fracture

Abstract

Background: Intertrochanteric femur fractures are a very common injury seen in the elderly. Understanding the pathophysiology as well as the proper treatment options will significantly decrease the risk of mortality and morbidity of this injury. Anatomically contoured proximal femur locking compression plate (PFLCP) is the latest addition to deal with these fractures, which creates an angular stable construct. It will theoretically lessen the risk of failure by screw cut-out and varus collapse, the common mode of DHS failure. Hence here we intended to study these two implants in inter-trochanteric fracture management regarding its clinical effectiveness and intraoperative and postoperative complications. Materials & Methods: This study was done to prospectively compare, the rate of union, complications, operative risks and functional outcomes in inter-trochanteric fractures treated with dynamic hip screw (DHS) and Proximal femur locking compression plate (PFLCP). It also determined the effectiveness of PF-LCP in comparison to DHS in treatment of inter-trochanteric fractures. The data collected during the study of 30 cases of inter-trochanteric fractures, 15 cases were treated using PFLCP and other 15 group of cases were treated using DHS in the Department of Orthopaedics in Rajendra Institute of Medical Sciences, Ranchi from December 2012 to December 2014. Results: The functional outcome was measured with Harris Hip Score. In PFLCP group 7 (46.67%) cases had excellent result, 5 (33.33%) cases had good result, and 3 (20%) cases had fair result with no poor result. The mean score in PFLCP group was 86.4. In DHS group 7 (46.67%) cases had excellent result, 4 (26.67%) cases had good result, 2 (13.33%) cases had fair result and 2 (13.33%) cases had poor result. The mean score in DHS group was 83.4, although the PFLCP had better results but the difference between the two groups was not statistically significant P-value >0.05. In PFLCP group there was varus malunion in 3 (20%) cases, shortening >2cm in 2 (13.33%) cases. Delayed union was seen in 2 (13.33%) cases. No case of non union was seen. No case had Infection, bed sore, deep venous thrombosis and death. In 5 (33.33%) cases we failed to accommodate all three screws. There was no incidence of plate breakage or screw cut out. In DHS study group there were 4 (26.67%) cases with improper placement of the lag screw, shortening in 4(26.67%) cases and rotational deformity in 2(13.33%) case. Post operative superficial infection was seen in 2(13.33%) case. No case had deep venous thrombosis or death. Varus malunion was seen in 3(20%) cases and delayed union in 2(13.33%) cases, no case of non union was seen. Implant failure was seen in 1 case with screw breakage. Conclusion: PFLCP is a good option for the management of inter-trochanteric fracture with high union rate and low rate of complication with high functional outcome and with a possibility that it can be done without C-Arm.