Perioperative Lateral Trochanteric Wall Fractures: Sliding Hip Screw versus Percutaneous Compression Plate for Intertrochanteric Hip Fractures

Abstract

Overall, the PCCP group had a significantly decreased incidence of lateral trochanteric wall fracture compared with the SHS group. This difference became greater when just unstable intertrochanteric fractures were analyzed. An anatomic reduction, combined with a device (PCCP) that uses small-diameter defects in the lateral trochanteric wall, essentially eliminates perioperative lateral trochanteric wall fractures.

Unstable Intertrochanteric Femur Fractures: Is There a Consensus on Definition and Treatment in Germany?

“…Locked minimally invasive plating also potentially could reduce the complication rate [13,14,21,23,24,26,39]. It seems advantageous in reducing intraoperative lateral wall fractures (A3 equivalent) [14,21,26] and in treating patients with poor bone quality or osteoporosis [23]. Surprisingly, there was no comment regarding this innovative technique by the respondents in our survey.…”

“…Recent randomized studies [43,45], however, showed no differences in complications and functional outcomes between the standard and blade designs, with reoperation rates between 0% and 3%. Locked minimally invasive plating also potentially could reduce the complication rate [13,14,21,23,24,26,39]. It seems advantageous in reducing intraoperative lateral wall fractures (A3 equivalent) [14,21,26] and in treating patients with poor bone quality or osteoporosis [23].…”

“…The survey also included questions regarding hospital sizes, hospital levels in Germany [8], geographic locations, department characteristics, and number of intertrochanteric femur fractures treated per year (self-reported measures) ( Table 1). Items 1 to 3 contained questions about demographic data, Item 4 timing of surgery [1,7,29,32,42], Items 5 and 6 classification systems (including AO/OTA [30] and Evans [11]) and instability criteria [11,17,30,44], Items 7 to 10 implant selection, Items 11 to 15 surgeon, patient positioning, and estimation of surgical and radiographic screening time, Items 16 to 18 weightbearing, hospitalization time, and discharge procedure, Item 19 expected complications, Items 20 and 21 importance of cement augmentation and minimally invasive extramedullary systems [13,21,23,24,26,39], Items 22 to 24 radiographic evaluation, reoperation rate, and importance of outcome scores, Item 25 main problems in unstable intertrochanteric fracture treatment, and Item 26 willingness to participate in a multicenter study.…”

“…Over the last 30 years, new techniques and implants reportedly have minimized complications while promoting early rehabilitation [2, 3, 13, 18, 21-24, 28, 35, 38-40, 43, 45]. The intramedullary hip screw (IMHS) has become a common internal fixation strategy, heralded for its biomechanical superiority [16,25] and minimally invasive application [2,3,18,21,28,38,40,45] compared to more traditional extramedullary techniques, such as the sliding hip screw (SHS) [2,3,5,18,23,35,37] or the newer locked minimally invasive plates [13,21,23,24,26,39].…”

Fixation of Subtrochantric Fractures Using Distal Femoral Locking Compression Plate of Contralateral Side

“…The plate is placed at the lateral [22,23,24] . This characteristic is similar to that of the percutaneous compression plates (PCCP) designed by Gotfried, which can not only prevent rotation of proximal femoral head fragment, but also control the locked compression of the fragments [25] . The use of a DHS or DCS (dynamic condylar screw) provides no stress shielding, and the proximal fragment excessively slides along the axial lag screw.…”