Study of proximal femoral locking compression plate in extra capsular fracture neck of femur

Authors

  • Ravi G.O. Department of Orthopaedics, JJM Medical College, Davangere
  • Shaik Hussain Saheb Department of Anatomy, JJM Medical College, Davangere

DOI:

https://doi.org/10.18203/2320-6012.ijrms20151430

Keywords:

Intertrochanteric fractures, Subtrochanteric fracture, Proximal femoral locking compression plate (PFLP), Harris hip score

Abstract

Background: The hip joint transmits weight several times that of the body weight particularly during running, functioning as both a highly mobile and very stable joint.  In weight bearing the pressure forces are transmitted to the head and neck of the femur at an angle of 1650 to 1700, regardless of the position of pelvis. The planes of force coincide with strongly developed trabeculae. The reacting force normally runs perpendicular to the cartilaginous epiphyseal plate.  The mechanism of bone failure in a structure will fail if it suffers an overload situation. An overload situation will occur if the system is unable to absorb the energy that is applied to it. In the hip joint area this overload situation can occur as a result of number of independent but often interrelated factors. The present work is conducted to study the; profiles of patients with extra capsular fracture neck of femur, efficiency and outcome of fractures treated with Proximal Femoral Locking Compression Plate (PFLCP), intra - operative & post-operative complication following management of extra capsular fracture neck of femur with Proximal Femoral Locking Compression Plate.

Methods: This is a prospective study of 21 cases of extra capsular fracture neck of femur admitted to Victoria and Bowring and Lady Curzon Hospitals, Bangalore, treated with PFLCP.

Results: In our study of 21 cases, cases 13 cases were intertrochanteric fracture and remaining 8 were subtrochanteric fracture with the mean age was 51.47 years. Minimum age was 19 years and maximum age was 85 years. 14 patients (67%) were males and 7 patients (33%) were females, 13 IX patients (62%) had right-sided fracture and 8 patients (38%) had left-sided fracture. with right side being more common side affected. The average duration of stay in the hospital was 25.31 days. The average follow up was 18 months [11 to 23 months]. Out of 21 patients in our study 16 patients (76%) are able to sit cross-legged and can squat on ground without any problem. The functional results were graded according to Harris Hip Scoring, In our study, 10 patients (48%)had excellent results, 8 patients (38%)had good results, 2 patients (10%)had poor result, and 1 failed case (5%) as she is an elderly female of 85 years with limited activity both preoperatively due to physiological age and general weakness.

Conclusions: In conclusion the potentiality of the Proximal Femoral Locking Compression Plate (PF-LCP) in varied indications, shows its versatility. Although not free of complications our study has demonstrated excellent results. The procedure offers, faster mobilization, rapid return to activities of daily living, improves the quality of life and gave a long term solution in patients with extracapsular fracture neck of femur. Larger studies with longer follow up will further validate the procedure.

 

References

Wong PC. Femoral neck fractures among the major racial groups in Singapore. Incidence pattern compared with Non Asian communities. Singapore Med J. 1964;J5:150-7.

Adams CI1, Robinson CM, Court-Brown CM, McQueen MM. Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur. J Orthop Trauma 2001;15:394-400.

Olsson O, Ceder L, Hauggaard A. Femoral shortening in intertrochanteric fractures, a comparison between the Medoff sliding plate and the compression hip screw. J Bone Joint Surg. 2001;83(B):572-78.

Bartonícek J, Dousa P, et al. Duration of surgery in osteosynthesis of fractures of the trochanter. Acta Chir Orthop Traumatol Cech. 2001;68(5):294-9.

Parker MJ, Handoll HH. Extramedullary fixation implants for extracapsular hip fractures’. Orthopaedic Department, Peterborough District Hospital, Cambridgeshire, UK. Cochrane Database Syst Rev. 2002;(2):CD000339.

Wagner M. Study on General principles for the clinical use of the LCP. Injury. Klinik für Traumaand Sportmedizin Austria. 2003;34(2):31-42.

Schutz M, Südkamp NP. Revolution in plate osteosynthesis: new internal fixator systems. Clinic for Trauma and Reconstructive Surgery J Orthop Sci. 2003;8(2):252-8.

Wagner M, Frenk A, Frigg R. New concepts for bone fracture treatment and the Locking Compression Plate. Clinic for Trauma and Sportmedicine, Vienna. Surg Technol Int. 2004;12:271-7.

Egol KA, Kubiak EN, et al Biomechanics of locked plates and screws. Fulkerson EKummer FJKoval KJ. New York University-Hospital for Joint Diseases, New York. NY, USA. J Orthop Trauma. 2004;18(8):488-93.

Cornell, Charles N. Fixation considerations in osteoporotic bone fractures, bone disease. Current Opinion in Orthopaedics. 2005;16(5):376-81.

Stern R. Are there advances in the treatment of extraerly? Orthopaedic Surgery Service, University Hospital of Geneva, Switzerland. Injury. 2007 Sep;38 Suppl 3:S77-87.

Miller DL, Goswami TA. Review of locking compression plate biomechanics and their advantages as internal fixators in fracture healing. Department of Biomedical Engineering, Wright State University. 2007;22(10):1049-62.

Epub 2007 Sep 27. 46. Miller DL, Goswami T, Prayson MJ. Overview of the locking compression plate and its clinical applications in fraineering, Wright State University, USA. J Surg Orthop Adv. 2008;17(4):271-81.

Schmidt, Andrew H. Locked Plating for Subtro Thing. Techniques in Orthopaedics. 2008;23(2):106-12.

Floyd, John C P, O'Toole RV, Stall A, Forward DP, et al. Biomechanical comparison of proximal locking plates and blade plates for the treatment of comminuted subtrochanteric femoral fractures. J Orthop Trauma. 2009;23(9):628-33.

Crist BD, Khalafi A, Hazelwood SJ, Lee MA, et al. A biomechanical comparison of locked plate fixation with percutaneous insertion capability versus the angled blade plate in a subtrochanteric fracture gap model. J Orthop Trauma. 2009;23(9):622-7.

McGrory BJ, Lucas R. The use of Locking plates for greater trochanteric fixation. Orthopaedic Associates of Portland, Portland, USA. Orthopedics. 2009;32(12):917.

Kim, JW, Oh CW, Byun YS, Oh JK, Kim HJ, Min WK, et al. A Biomechanical Analysis of Locking Plate Fixation with Minimally Invasive Plate osteosynthesis in a subtrochonteric Fracture Model. Jour of Trauma. 2011;70(1):E19-E23.

Sun JF, Li ZB, Shen YY, Han B, Deng L, Gu MQ. Minimally invasive treatment of intertrochanteric fractures with locking compression plate in the elderly. China Journal of Orthopaedics and Traumatology. 2010;23(5):337-9.

Wieser K, Babst R. Fixation failure of the LCP proximal femoral plate 4.5/5.0 in patients with missing posteromedial support in unstable per inter and sub trochanteric fractures of the proximal femur. Arch Orthop Trauma Surg. 2010;130:1281-7.

Minghua XIE Wenwei YAO Hangan et al. Efficiency Analysis of proximal femoral Locking Plate for the Treatment of Intertrochanteric Fractures. China Foreign Medical Treatment. 2010-12.

XU S-H, WANG W-L, LUO Y-W, LAI Z-J, WAN W-Go, ZENG W-H. A comparative study of locking compression Plate and Dynamic Hip Screw in Treatment of Femoral Intertrochanteric Fractures. Guide of China Medicine. 2011-15.

Yang S, Yon W. A comparative study of DHS, PFLP, and PFN for Plate and Dynamic Hip Screw in Treatment of Elderly Patients with Intertrochanteric Fracture Guide of China Medicine 2011-15 Latest Update 57.

Zha G-C, Chen Z-L, Qi X-B. Treatment of pertrochonteric fractures with a proximal femur locking compression plate International journal of the care of the injured (injury) January 2011; 42(11):1294-9.

Glassner PJ, Tejwani NC. Failure of proximal femoral locking compression plate. A case series. Journal of Orthopadeic Trauma. 2011;25(2):76-83.

Yong W, Yang Y-Y, Yu Z-H, Li C-Q, Wu Y-S, Zheng X-X. Comparative study of intertrochanteric fractures treated with proximal femur locking compress plate in aged. China journal of orthopaedics and traumatology. 2011;24(5):370-3.

Banks E, Reeves GK, Beral V, Balkwill A, Liu B, Roddam A. Hip Fracture Incidence in Relation to Age, Menopausal Status, and Age at Menopause: Prospective Analysis. PLoS Med. 2009;6(11): e1000181.

Glassner PJ, Tejwani NC. Failure of proximal femoral locking compression plate: A case series. Journal of orthopedic trauma. 2011;25(2):76-83

Enocson A, Mattisson L, Ottosson C, Lapidus LJ. Hip arthroplasty after failed fixation of trochanteric and subtrochanteric fractures. Acta Orthop. 2012; 83(5): 493–498.

Wang Y, Yang YY, Yu ZH, Li CQ, Wu YS, Zheng XX. [Comparative study of intertrochanteric fractures treated with proximal femur locking compress plate in aged]. Zhongguo Gu Shang. 2011;24(5):370–3.

Ecker Malcolm L.et.al. Treatment of trochanteric hip fractures using compression screw. J Bone Joint Surg. 1975;57:23-7.

Boyd HB, Anderson LD. Management of unstable trochanteric fractures. Surg Gynecol Obstet. 1961;112:633.

Kyle RF, Cooper J. Total Hip Arthroplasty After Failed Fixation of Hip Fractures. Orthopedics. 2006;29(9):783.

G.H. Yeyse Moore etal. Treatment of intertrochanteric fractures of the femur: a comparison of the Richards screw-plate with the Jewett nail-plate. J Bone Joint Surg (Br). The Bone & Joint Journal. 1983;65(3):262-7.

Finsen V, Borset M, Buvik GE, Hauke I. Preoperative traction in patients with hip fractures. Injury 1992;23(4):242–4.

Resch S, Thorngren K-G. Preoperative traction comparison between skin and skeletal traction in 78 patients. Acta Orthopaedica Scandinavica. 1998;69(3):277–9.

Downloads

Published

2017-01-17

How to Cite

G.O., R., & Saheb, S. H. (2017). Study of proximal femoral locking compression plate in extra capsular fracture neck of femur. International Journal of Research in Medical Sciences, 3(12), 3726–3733. https://doi.org/10.18203/2320-6012.ijrms20151430

Issue

Section

Original Research Articles