Clinical and functional outcomes of the PCCP study: a multi-center prospective study in Italy

Abstract

The standard surgical management of hip fractures is associated with tissue trauma and bleeding which are added to the fracture injury. The percutaneous compression plate (PCCP) is a minimally invasive device that has been demonstrated in previous studies to reduce postoperative complications and blood loss. This prospective, multi-center, observational study assessed clinical and functional outcomes with PCCP as treatment for trochanteric fractures. Patients with a stable or unstable proximal femoral fracture of type AO 31.A1 or 31.A2 were enrolled in eight hospitals in Italy. The primary outcome of interest was the recovery of the pre-fracture functional status at 1-year follow-up; secondary outcomes of interest included blood transfusions, surgical time, complications, and mortality. A total of 273 patients were enrolled. The ASA score was 3 or 4 in 72.5 % of patients. The mean surgical time was 44.1 min; the mean post-surgery blood transfusions was 0.9 units. At 1 year, 48 patients (17.6 %) died, 28 (10.2 %) were lost to follow-up, 4 patients (1.5 %) were excluded, hence 193 patients (70.3 %) were available for final evaluation. At the 1-year follow-up visit, 51.9 % of patients recovered or improved their pre-fracture modified Harris Hip Score, 49.1 % of patients improved or maintained their walking abilities, and 66.6 % of patients residing at home pre-surgery maintained their domicile. The overall mortality rate was 17.6 %. Major complications included two fracture collapses, one excessive sliding of the cephalic screw leading to a partial fracture collapse and one back-out of the diaphyseal screw. This study demonstrates that treatment of trochanteric fractures with PCCP gives good outcomes and significant advantages such as low blood loss, short surgical time, low risk of complications, and good functional recovery in the majority of the patients.

Which implant is superior for treating simple pertrochanteric fractures of the proximal femur in the elderly patients?

“…Although numerous investigators have recommended treating the AO/OTA 31A1.2 and 31A1.3 fractures with an intramedullary nail, DHS, or PCCP, [15,16] to the best of our knowledge, no clinical studies have compared these three implants for these stable fractures. We therefore evaluated the pre-, peri-, and postoperative properties of patients who underwent PFNA or DHS or PCCP.…”

Minimally Invasive Reduction and Fixation in Orthopedic Trauma

“…BO has gained considerable popularity since its advent for fracture management and subsequent successful application in basic research and clinical application. The techniques of less invasive stabilization system for long bone fractures, the internal compression fixation technique via a minimally invasive incision for displaced intra-articular calcaneal fractures,[56] and other percutaneous reduction and fixation techniques,[78] all embody the advantages and successful application in the treatment of traumatic fractures following BO concept.…”