Citation Information :
Wadhwani J, Siwach R, Bansal H, Singh R, Kamboj P, More H. A Prospective Randomized Study for Comparison of Modified Proximal Femoral Plate with Dynamic Hip Screw System. 2024; 6 (2):136-141.
Aim: To conduct a prospective randomized study comparing the functional and radiological outcomes of dynamic hip screw (DHS) and modified proximal femoral locking compression plate (PFLCP) in Asian population with intertrochanteric fractures.
Materials and methods: The modified PFLCP design has been created by the authors. The modification to the standard PFLCP design involves increasing the screw density for the trochanteric area, along with the provision of locking as well as compression screw slots. It is an angular stable construct with the ability to achieve compression across the fracture site. We included 112 patients (1:1 parallel design, n = 56) with intertrochanteric fractures. Randomization was done using the lottery method. The mean age was 65.66 years (range, 28–90) and 64.07 years (range, 31–90) in the DHS group and PFLCP group, respectively. The mean duration of surgery, intraoperative blood loss, and functional outcome at 6 months using the Harris hip score (HHS) were compared.
Results: In the DHS group and PFLCP group, the mean time to union was 18.3 and 17.2 weeks, respectively. Significant shortening at final follow-up occurred in 15.68 and 12% of patients (p = 0.59). Postoperative discharge from the surgical site occurred in 5.88 and 4% of patients. Implant failure occurred in 3.92 and 8% of patients (p = 0.43). Varus collapse occurred in 33.33 and 14% of patients (p = 0.022), respectively. The mean HHS was 82.6 and 86.3 in the DHS and PFLCP groups, respectively (p = 0.19).
Conclusion: The modified PFLCP is capable of providing equally effective radiological and functional outcomes. The modified PFLCP can be used as an alternative to the DHS in intertrochanteric fractures in severely osteoporotic patients.
Kannus P, Parkkari J, Sievänen H, et al. Epidemiology of hip fractures. Bone 1996;18(1 Suppl):57–63. DOI: 10.1016/8756-3282(95)00381-9
Gullberg B, Duppe H, Nilsson B. Incidence of hip fractures in Malmö, Sweden (1950-1991). Bone 1993;14(Suppl 1):23–29. DOI: 10.1016/8756-3282(93)90345-b
Pande KC. Prevalence of low bone mass in healthy Indian population. J Indian Med Assoc 2002;100(10):598–600. PMID: 12452513.
Singh G, Gautam S, Ahmed N, et al. Evaluation of various methods of trochanteric fracture fixation and their comparison- a prospective study. J Evol Med Dent Sci 2019;8(17):1388–1394. DOI: 10.14260/jemds/2019/309
Laohapoonrungsee A, Arpornchayanon O, Phornputkul C. Two-hole side-plate DHS in the treatment of intertrochanteric fracture: results and complications. Injury 2005;36(11):1355–1360. DOI: 10.1016/j.injury.2005.04.014
Kim WY, Han CH, Park JI, et al. Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop 2001;25(6):360–362. DOI: 10.1007/s002640100287
Nordin S, Zulkifli O, Faisham WI. Mechanical failure of dynamic hip screw (DHS) fixation in intertrochanteric fracture of the femur. Med J Malaysia 2002;56:12–17. PMID: 14569760.
Singh J, Rai B, Singh M, et al. Outcome of peritrochanteric fractures with proximal femur locking compression plate. J Med Sci Clin Res 2018;6(1):32348–32355. DOI: 10.18535/jmscr/v6i1.148
Frigg R. Development of the locking compression plate. Injury 2003;34(Suppl 2):6–10. DOI: 10.1016/j.injury.2003.09.020
Fulkerson E, Egol KA, Kubiak EN, et al. Fixation of diaphyseal fractures with a segmental defect: a biomechanical comparison of locked and conventional plating techniques. J Trauma 2006;60(4):830–835. DOI: 10.1097/01.ta.0000195462.53525.0c
Agrawal P, Gaba S, Das S, et al. Dynamic hip screw versus proximal femur locking compression plate in intertrochanteric femur fractures (AO 31A1 and 31A2): a prospective randomized study. J Nat Sci Biol Med 2017;8(1):87–93. DOI: 10.4103/0976-9668.198352
Seetharamaiah VB, Basavarajanna S, Pingat A, et al. A comparative study of clinic-radiological outcome: dhs vs pflcp in intertrochanteric fractures of femur. J Evid Based Health 2015;2(50):8565–8570. DOI: 10.18410/jebmh/2015/1180
Kovalak E, Ermutlu C, Atay T, et al. Management of unstable pertrochanteric fractures with proximal femoral locking compression plates and affect of neck-shaft angle on functional outcomes. J Clin Orthop Trauma 2017;8(3):209–214. DOI: 10.1016/j.jcot.2017.07.006
Shah MD, Kapoor CS, Soni RJ, et al. Evaluation of outcome of proximal femur locking compression plate (PFLCP) in unstable proximal femur fractures. J Clin Orthop Trauma 2016;8(4):308–312. DOI: 10.1016/j.jcot.2016.11.005
He S, Yan B, Zhu J, et al. High failure rate of proximal femoral locking plates in fixation of trochanteric fractures. J Orthop Surg Res 2018;13(1):248. DOI: 10.1186/s13018-018-0951-6
Kivi MM, Mirbolook A, Jahromi SK, et al. Fixation of intertrochanteric fractures: dynamic hip screw versus locking compression plate. Trauma Mon 2013;18(2):67–70. DOI: 10.5812/traumamon.10436
Muller ME, Nazarian S, Koch P, et al. AO classification of fractures. The Comprehensive Classification of Fractures of Long Bones. Berlin: Springer; 1990. p. 120.
Zlowodzki M, Brink O, Switzer J, et al. The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study. J Bone Joint Surg Br 2008;90(11):1487–1494. DOI: 10.1302/0301-620X.90B11.20582
Zang W, Liu PF, Han XF. A comparative study of proximal femoral locking compress plate, proximal femoral nail antirotation and dynamic hip screw in intertrochanteric fractures. Eur Rev Med Pharmacol Sci 2018;22(1 Suppl):119–123. DOI: 10.26355/eurrev_201807_15373
Asif N, Ahmad S, Qureshi OA, et al. Unstable intertrochanteric fracture fixation–Is proximal femoral locked compression plate better than dynamic hip screw. J Clin Diagn Res 2016;10(1):9–13. DOI: 10.7860/JCDR/2016/11179.7084
Chinmoy D, Dinesh KM, Sunil S. Trochanteric fractures treated with PFLCP versus DHS. Int J Med Sci 2016;3:73–76. DOI: 01.2017-83381695
Dhamangaonkar AC, Joshi D, Goregaonkar AB, et al. Proximal femoral locking plate versus dynamic hip screw for unstable intertrochanteric femoral fractures. J Orthop Surg 2013;21(3):317–322. DOI: 10.1177/230949901302100311