[Treatment of trochanteric fractures by percutaneous compression plate].

PURPOSE OF THE STUDY

To present a new type of percutaneous compression plate (PCP) for a minimally invasive method of treating trochanteric hip fractures.

MATERIAL

Between September 2004 and December 2006, a total of 66 patients with hip fractures were treated by minimally invasive percutaneous osteosynthesis involving a PCP. The average age of the patients was 74.5 years (range, 27-95 years). The fractures were classified as pertrochanteric (AO31, A1.1-A2.3) in 73%, femoral neck fracture (AO31, B2) in 20%, and intertrochanteric fracture (AO31, A3.1) in 7% of the patients.

METHODS

Reduction was performed under conduction or general anaesthesia on a traction table, using an X-ray image intensifier system. Reduction and intra-operative temporary stabilisation of the fracture was facilitated by a posterior reduction device. Access was gained and a PCP was inserted through two incisions at the lateral side of the proximal femur.

RESULTS

The patients were followed up for at least 6 months. Radiographic union was found on average at 3 months post-operatively. No pseudoarthrosis or implant failure was recorded. At 6-month follow-up, 81% of the patients were able to walk without walking aid or with one walking cane only. Two crutches were used by 8% of the patients.To walk without help was impossible for 11% of the patients whose mobility had already been limited before the injury.

DISCUSSION

PCP osteosynthesis for trochanteric fractures is a novel minimally invasive approach providing a better treatment of the fracture. Compared to dynamic hip screw osteosynthesis used before, PCP allows for earlier weight bearing and noticeably reduces blood loss. Implant construction as well as post-operative controlled impaction of the fracture minimize the risk of osteosynthesis failure. The simple instrumentation construction enables us to reduce operative time.

CONCLUSIONS

The percutaneous compression plate is a contribution to minimally invasive osteosynthesis of trochanteric fractures. An increase in rotational stability of the implant due to its biaxial telescopic construction allows for earlier weight-bearing of the extremity, thus facilitating the patient's earlier return to everyday life activities. It also reduces operative trauma, blood loss and post-operative complications.