Operative Treatment of Peritrochanteric Osteoporotic Fractures with Proximal Femur Locking Compression Plate: A Consecutive Study

Abstract

Advances in modern medical science have increased life expectancy and the incidence of peritrochanteric fractures. Conventional implants such as sliding hip screws and angular blade plates can be used to effectively treat these fractures, but proximal femoral locking compression plates offer superior three-dimensional fixation and angular stability. From December 2012 to May 2015, 40 peritrochanteric fracture treated with LCP (Locking Compression Plate) were studied prospectively. With an average age of 69.77 years (range: 60 -80 years), there were fifteen females and six males. Patients with multiple fractures, open fractures, co morbidities, pathological fractures and more than 3 weeks old fractures were excluded. After six weeks, partial weight bearing was initiated and serial radiographs were taken at six, twelve and two months. 1.5 years later, union was achieved. The peritrochanteric fractures were categorized by AO classification. In our study, the majority of patients (n=21) had A1 fractures, with A1.1 (n=13 patients) being the most common, followed by A1.3 and A1.2 (n=5 and n=3, respectively). In our study, seventeen patients had A2 fractures, with A2.1, A2.2 and A2.3 occurring in eight, four and five patients, respectively. We only had two patients in A3 and one each in A3.1 and A3.2. The surgery ranged from 50 to 90 minutes, with a mean of 69 minutes (SD 11.29). In our study, complications included superficial wound infection in two individuals and deep infection in one patient. Three patients (n=3) developed Coxavara with shortening and one patient had a screw back out. At the final follow-up, patients were evaluated using the Modified Harris Hip Score. Our study found that LCP plates are more useful for unstable peritrochantric fractures in elderly osteoporotic patients, with a higher percentage of Coxavara in our study. This can be prevented by delaying weight bearing in unstable fractures. However, there was no control group to compare our results with other modalities of treatment.