High failure rate of proximal femoral locking plates in fixation of trochanteric fractures

Shuangjian He, Bin Yan, Jian Zhu, Xiaoyi Huang, Jianning Zhao, Shuangjian He, Bin Yan, Jian Zhu, Xiaoyi Huang, Jianning Zhao

Abstract

Background: The aim of this study was to report our previous results of treatments for trochanteric fractures with proximal femoral locking plates (PFLP) and to analyze the underlying mechanisms and possible risk factors associated with the high failure rate of this technique.

Methods: From January 2010 to October 2014, 273 consecutive patients with trochanteric femoral fractures were identified, and 95 patients (with 97 fractures) ultimately met the inclusion criteria. Clinical records regarding demographic features and intraoperative data including total incision length, operation time, blood loss, and failures detected in radiographs were documented and assessed. The collected data were analyzed with SPSS 19.0 software.

Results: The stable group (AO/OTA 31 A1 and A2.1) had less blood loss than the unstable group (AO/OTA 31 A2.2, A2.3, and A3). The ultimate failure rate was 36% in 97 fractures. The obvious complications in this study included nonunion in 7 (7.2%) fractures, implant breakage in 4 (4.1%) fractures, varus deformity in 34 (35%) fractures, and loosening of the proximal femoral screw in 21 (21.6%) fractures. Six patients received reoperations. The total failure rate in the stable group was 17% and was 50% in the unstable group. In patients greater than 60 years old in the unstable group, the failure rate was 60.5%.

Conclusions: High failure rates of PFLP were observed in patients with trochanteric fracture, especially in patients who were greater than 60 years old with unstable fracture types. PFLP was not an appropriate treatment for trochanteric fractures.

Keywords: Complications; Hip fracture; Locking plate; Mechanical failure; Trochanteric fractures.

Conflict of interest statement

Ethics approval and consent to participate

All clinical records and radiological data for this retrospective cohort study were approved by the ethical committee of Taxing People’s Hospital (No: 2016-0003). Informed consent was obtained from all the patients.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
A 75-year-old male with AO/OTA type 31A2.2 experienced plate breakage. a Radiograph after injury. b Postoperative radiograph showing good reduction and fixation with PFLP (1 week after surgery). c Plate breakage and varus collapse 16 weeks after surgery. d, e Postoperative radiograph and computed tomography (CT) showing nonunion (18 weeks after surgery). f Revision surgery of THA
Fig. 2
Fig. 2
A 78-year-old male with AO/OTA type 31A3.3 experienced plate breakage. a, b Postoperative anterio-posterior and lateral radiographs. c Plate breakage and varus collapse 10 weeks after surgery. d Postoperative radiograph of revision surgery of PFNA
Fig. 3
Fig. 3
A 79-year-old male with AO/OTA type 31A2.3 suffered mechanical failure and nonunion. a Postoperative radiograph showing loosening of proximal screws and varus collapse 36 weeks after surgery. b, c Postoperative radiograph showing that progressive loosening and penetration through femoral head of proximal femoral screws as well as shortening of femoral neck (44 and 56 weeks after surgery, respectively). d, e CT scan showing nonunion and penetration through femoral head (56 weeks after surgery). f Revision surgery of THA
Fig. 4
Fig. 4
A 81-year-old female with AO/OTA type 31A2.1 experienced loosening of proximal screws. a Radiograph after injury. b Postoperative radiograph showing good reduction and fixation (1 week after surgery). c Ten weeks postoperative radiograph showing loosening of proximal femoral screws, loss of reduction and varus collapse. d Progressive loss of reduction, screws loosening and varus collapse (24 weeks after surgery)
Fig. 5
Fig. 5
A 71-year-old male with AO/OTA type 31A3.3 experienced plate breakage. a Radiograph after injury. b Postoperative radiograph showing good reduction and fixation with PFLP (1 week after surgery). c Plate breakage and varus collapse 36 weeks after surgery. d Seventy-two weeks postoperative radiograph showing malunion and varus deformity

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