Percutaneous compression plating for intertrochanteric fractures. Surgical technique, tips for surgery, and results.

OBJECTIVE

Fixation of intertrochanteric fractures by a minimally invasive technique using the Percutaneous Compression Plate (PCCP) allowing anatomic reduction and immediate postoperative weight bearing.

INDICATIONS

Intertrochanteric fractures.

CONTRAINDICATIONS

Intertrochanteric fractures that cannot be reduced by closed manipulation, subtrochanteric and reverse oblique fractures (AO/OTA 31-A3).

SURGICAL TECHNIQUE

Placement of patient on a fracture table with a posterior reduction device (PORD) supporting the fracture. Reduction of the fracture by closed manipulation. Percutaneous insertion of the plate through a lateral proximal incision. Adaptation of the plate to the lateral aspect of the proximal femoral shaft with a bone clamp inserted through a second, more distal incision. Insertion of telescoping compression neck screw through the plate into the neck and securing of plate to the femoral shaft with three additional screws. Finally, completion of fracture fixation with second neck screw.

RESULTS

Of 130 patients with intertrochanteric fractures treated using the described technique at the Orthopedic Surgery Department Hadassah University Hospital, Jerusalem, Israel, between May 2000 and December 2001, 108 were available for this study. Patients' age averaged 81 years (+/- 8 years). Mean surgical time was 67 min and mean hospital stay 11.5 days. 40% of patients did not require a transfusion during hospitalization, while 8.3% needed more than three units of packed cells. Complications occurred in four patients: two implant failures that were successfully revised with a Compression Hip Screw, one nonunion treated with hip arthroplasty; the fourth patient had a shortening of 3 cm needing a heel lift. Three patients developed an infection, one requiring surgical debridement.