Abstract
Background: Intertrochanteric hip fractures are one of the most common fractures.
Although stable fractures can be successfully treated with conventional implants as
DHS, the optimal implant for fixing unstable fractures remains a matter of debate.
The purpose of this study was to compare the outcomes of PFLCP versus
intramedullary nails (PFNs and gamma nails) in treatment of unstable
intertrochanteric hip fractures.
Patients and Methods: this is a prospective study on sixty adult patients with
unstable intertrochanteric hip fractures. All cases had been treated by Proximal
Femoral Locked Plate PFLCP (30 patients), Intramedullary (IM) nail (30 patients; 20
by PFN, and 10 by gamma nail). The mean follow up period was 14±1.5 months,
with serial clinical (using Harris hip score) and radiographic evaluations.
Results: There was no statistically significant difference between both groups as
regard patients´ demographic data, hospital stay, and time interval between admission
and the operation. The procedure of plating was more time consuming than
intramedullary nailing. There was more radiation exposure to the patients in the IM
group. The intramedullary fixation was less in the intra- and post-operative blood
loss. Sound union had been achieved in all cases except 2 cases in PFLCP group and
one case in IM group with no significant difference between both groups regarding
the mean time to fracture healing. Regarding the Harris hip scores, there was no
statistically significant difference between the two groups at 6 months and 12 months
evaluation. Superficial infection had occurred in 6 patients (3 patients from PFLCP
group and 3 patients from IM group). Although the rate of mechanically- related
complications (loosening, medialization of the femoral shaft, and varus collapse) in
PFLCP group and IM group was 30% and 10% respectively, there was no
statistically significant difference between the two groups (p=0.127).
Conclusion: The current study regarding treatment of unstable intertrochanteric
fracture does not clearly favor one implant over another. Although intramedullary
fixation shows apparent superiority over extramedullary fixation as it is minimal
invasive, has better biomechanical stability, and associated with fewer complications,
this did not translate to a significant difference in the final functional outcome.
Key words: Unstable intertrochanteric fractures, Intramedullary fixation,
Extramedullary fixation, Proximal femoral locking compression plate, Harris hip
function score.
Level of evidence: level I prospective comparative cases series study. |
