Treatment of proximal femoral fractureswithproximal femur locking compression plate

Abstract

Proximal femoral Fractures account for a large proportion of hospitalization among trauma cases. An overwhelming majority of these patients (>90%) are aged above 50 years. The cost of hip fracture is tremendous. The morbidity and mortality secondary to proximal femoral fracture are equally astonishing. Roughly 20% of patients who have hip fracture, or 1 in 5, will die in the year following the fracture, and most of these patients will die in the first months of recovery.

Disability increases substantially following proximal femoral fractures and is such that about half of the surviving patients will not regain their pre-fracture ambulatory capacity and may lose their functional independence. Increasing age, cognitive dysfunction, and male sex were significantly associated with increased mortality and poor ambulation.

The relatively new development of the hybrid locking plate contoured to the proximal femur may offer a new tool in managing these fractures. Given the relative youth of these implants, the long-term outcome for fractures treated with proximal femur locking plates has not been defined. Further investigation with randomized controlled trials comparing proximal femoral locking plates and intramedullary devices is suggested for evaluating biomechanical and functional outcomes. Currently recognized limitations of locking plates are delayed time to full weight bearing and also, if fracture reduction is less than anatomic, then the potential for nonunion and implant failure may be high because the fixed-angle device will maintain the fracture gap and is not designed to promote secondary bone healing. The present study was conducted on 30 patients with a mean age of 62.5 years for a follow up period of 2 years. There were 17 males and 13 females, with 22 patients with intertrochanteric fractures and 8 patients with subtrochanteric fracture.

Mean time to union in intertrochanteric fractures was 3.9 ± 1.1 months and for subtrochanteric fractures was 6.4 ± 4.3 months. The incidence of mortality was 6 out of 30 patients (20%), incidence of varus collapse with unstable fractures was 44% and with stable fractures incidence was 0%.

Out of the remaining 24 patients who completed the 2 years follow up period, according to Hospital for Special Surgery – hip rating system: 3 patients (12.5%) had poor outcome, 10 patients (41.7%) had fair outcome, 7 patients (29.1%) had good outcome and 4 patients (16.7%) had excellent outcome.