Functional Outcome of Dynamic Hip Screw Versus Proximal Femur Locking Compression Plate in Unstable Intertrochanteric Fracture of Femur

Abstract

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 lessen the risk of failure by screw cut‑out and varus collapse, the common mode of DHS failure.
Materials and methods: 15 men and 5 women aged 32 to 78 (mean, 55) years were randomised to the proximal femoral locking plate group, whereas 14 men and 6 women aged 38 to 75 (mean, 59) years were randomised to the conventional 135º DHS group. The time to union, medialisation of the shaft, neck-shaft angle, limb shortening, varus collapse, and functional outcome (using the Hospital for Special Surgery Hip Rating System) were assessed.
Randomisation was based on the odd and even serial numbers at presentation. The modes of
injury in the respective groups were: road traffic accident (n=12 & 6) and fall (n=8 & 14).
Children and patients with compound fractures and associated head, chest or abdominal injuries were excluded.
Result: 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 88.9% bone union whereas DHS group had 77.8% bone union at 12 weeks (p=0.20). Out of the total study population, 58 (64.4%) were females while 32 (35.6%) were males. 45 (50%) of the cases were due to low energy trauma (slips and falls) corresponding to the etiology of intertrochanteric femoral fractures. Right lower limb was more commonly affected than the left.