[Surgical outcome in pertrochanteric femur fracture: the impact of osteoporosis. Comparison between DHS and percutaneous compression plate]

M Knobe, R Münker, B Schmidt-Rohlfing, R M Sellei, H Schubert, H J Erli
Zeitschrift Für Orthopädie und Unfallchirurgie 2008, 146 (1): 44-51

AIM: The dynamic hip screw (DHS) often shows an impared outcome and a high incidence of therapeutic failure in patients with osteoporotic pertrochanteric femur fractures. This is caused predominantly by a fracture collapse and appears often in unstable fractures (31A2, 31A3). In a prospectively documented clinical study, we examined whether or not the percutaneous compression plate (PCCP, Gotfried) offers advantages following osteoporotic fractures.

METHOD: From August 2003 to December 2005, 103 patients underwent internal fixation with the DHS (n = 40, age 76.1, ASA 2.9) or with the PCCP (n = 63, age 76.9, ASA 2.8). Proximal femurs were classified with the Singh grading system, which uses six grades of trabecular patterns to describe the degree of osteoporosis. Reexamination of the patients (27 DHS, 43 PCCP) was performed on average 18 months later.

RESULTS: The PCCP was implanted into very osteoporotic femurs (Singh 2) in less time than the DHS (47 vs. 79 min). These patients treated with PCCP showed no difference in blood loss, but tended to have better outcomes (Merle d'Aubigné, Harris hip score) than those treated with DHS. Life quality, subjectively measured with the visual analogue score, was significantly better in the PCCP group with high-grade osteoporosis (Singh 2). The outcome after implantation of the PCCP was not correlated to the Singh index in stable or in unstable fractures. Mechanical complications occurred especially in unstable fractures (re-operation rate: DHS 4/18 [22 %], PCCP 3/29 [10 %], p = 0.266), without correlation to the Singh index. Excluding the avoidable complication of loosening of the screw-barrel portion, the re-operation rate for the PCCP was 3 % (cut-out: 1/29, p = 0.042) in unstable fractures.

CONCLUSION: Use of the minimally invasive PCCP technique in osteoporotic pertrochanteric femur fractures provides an alternative to the dynamic hip screw, especially with regard to surgical time and outcome. Advantages occurred also in the re-operation rate following fracture fixation complications. The cut-out rate was significantly lower than in the DHS group in unstable fractures.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"