Minimally invasive percutaneous compression plating versus dynamic hip screw for intertrochanteric fractures: a randomized control trial

Abstract

Objective: Intertrochanteric femur fracture is a common injury in elderly patients. The dynamic hip screw (DHS) has served as the standard choice for fixation; however it has several drawbacks. Studies of the percutaneous compression plate (PCCP) are still inconclusive in regards to its efficacy and safety. By comparing the two methods, we assessed their clinical therapeutic outcome.

Methods: A total of 121 elderly patients with intertrochanteric femur fractures (type AO/OTA 31.A1-A2, Evans type 1) were divided randomly into two groups undergoing either a minimally invasive PCCP procedure or a conventional DHS fixation.

Results: The mean operation duration was significantly shorter in the PCCP group (55.2 min versus 88.5 min, P<0.01). The blood loss was 156.5 ml±18.3 ml in the PCCP group and 513.2 ml±66.2 ml in the DHS group (P<0.01). Among the patients treated with PCCP, 3.1% needed blood transfusions, compared with 44.6% of those that had DHS surgery (P<0.01). The PCCP group displayed less postoperative complications (P<0.05). The mean American Society of Anesthesiologists score and Harris hip score in the PCCP group were better than those in the DHS group. There were no significant differences in the mean hospital stay, mortality rates, or fracture healing.

Conclusion: Due to several advantages, PCCP has the potential to become the ideal choice for treating intertrochanteric fractures (type AO/OTA 31.A1-A2, Evans type 1), particularly in the elderly.