Treatment of pertrochanteric fractures with a proximal femur locking compression plate.

Background: Pertrochanteric femoral fractures are one of the most common fractures in old patients. However, fixing pertrochanteric fractures properly is clinically challenging. There are also no routine treatments for this fracture. Here, we report the clinical trial of pertrochanteric fracture treatment with a proximal femur locking compression plate (PFLCP). By recording and analysing the radiographic and clinical results from patients treated with PFLCP, we found that PFLCP could provide three-dimensional fixation mechanical advantages compared with conventional treatments, even in the case of unstable fractures in the osteoporotic bone.

Methods: The report included a total of 110 patients (72 females and 38 males) with pertrochanteric femoral fractures who were subjected to PFLCP treatment. The mean age of the patients was 75 (48-93) years. Pertrochanteric fracture includes both intertrochanteric and subtrochanteric femoral fractures: intertrochanteric fractures were classified according to Jensen (1980), whereas subtrochanteric fractures were classified according to Zickel (1980). Detailed clinical conditions of all patients, including blood loss, drainage and length of incision, were recorded individually. The duration of image intensification was also monitored. Patients were revisited at 6 weeks, 3 months, 6 months and 1 year after the operation. The progress of healing, as well as the occurrence of complications, was recorded.

Results: Amongst the 110 patients, 108 (98%) were available for follow-up check-up at 6 weeks, 104 (95%) at 3 months, 100 (91%) at 6 months and 94 (85%) at 1 year. The other patients were lost to follow-up because of death. The union rate was 95% (99/104), 98% (98/100) and 100% (94/94) at the 3-month, 6-month and 1-year period during the follow-up check-up, respectively. The patients healed satisfactorily and had no complications, such as cut-out in most cases. However, there was one case of breakage of the implant and one case of non-union at the 3-month period during the follow-up check-up. Amongst all patients, 77 cases were successfully reduced with traction on a fracture table under fluoroscopy; the others were opened to correct the displacement. The average operation time was 35.5 min, and the mean bleeding amount was 150 ml (including operative blood loss and wound drainage). The mean image intensifier time was 5 min and the mean length of incision was 9 cm.

Conclusion: The PFLCP can be a feasible alternative to the treatment of pertrochanteric fractures. Treatment with a PFLCP can provide good-to-excellent healing for pertrochanteric fractures, with a limited occurrence of complications.