A comparison of proximal femoral locking compression plates with dynamic hip screws in extracapsular femoral fractures

Introduction: The potential value of proximal femoral locking compression plate (PFLCP) for extracapsular femoral fractures has been discussed in several case reports; however, clinical control studies are lacking. Therefore, we performed a case control study to assess: (1) If PFLCP offers better functional results and fewer complications than dynamic hip screws (DHS)? (2) Which kind of extracapsular femoral fractures would benefit from PFLCP fixation? Hypothesis: The PFLCP fixation offers better functional results and fewer complications than the DHS for the treatment of extracapsular fractures. Patients and methods: A total of 83 patients with extracapsular femoral fractures were recruited. Forty-one patients underwent PFLCP fixation, and 42 patients underwent DHS fixation. Patient information, operative time, blood loss, functional level (as assessed by Sanders' traumatic hip rating scale), bone union, and implant complications were compared for the two treatment groups. Results: Patients with stable intertrochanteric fractures who underwent PFLCP fixation demonstrated shorter bone union time than the DHS fixation group (3.3 +/- 0.2 vs. 4.3 +/- 0.1 month; P<0.0001); however, both groups had 100% bone union and good to excellent scores on Sanders' traumatic hip rating scale (P=1.000). Patients with unstable intertrochanteric fractures who underwent PFLCP fixation experienced greater blood loss (619.0 +/- 23.9 vs. 474.1 +/- 19.8 ml; P<0.0001), which was mainly due to the need for open reduction (64.3% vs. 12.5%; P=0.003),compared to the DHS fixation group. No differences were identified with respect to bony union, functional level, or complications. Patients with subtrochanteric fractures who underwent PFLCP fixation demonstrated significantly shorter operative times (82.1 +/- 4.3 vs. 102.2 +/- 2.2 minutes; P < 0.0001), less blood loss (751.8 +/- 25.4 vs. 987.6 +/- 32.0 ml; P<0.0001), shorter bone union times (5.2 +/- 0.4 vs. 8.8 +/- 1.0 month; P=0.006), more good to excellent Sanders' traumatic hip rating scale scores (92.9% vs. 55.5%; P= 0.009), and fewer complications (14.2% vs. 66.6%; P=0.005) than the DHS fixation group. Conclusion: PFLCP fixation offers better functional outcomes and fewer complications for subtrochanteric femoral fractures but not for intertrochanteric femoral fractures. Levels of evidence: Case control study, level III. (C) 2014 Elsevier Masson SAS. All rights reserved.