gms | German Medical Science

Questionnaire: Proximal fractures of the femur are demanding injuries because of the fracture pattern and high loads challenging the stable reconstruction. Since 2007 the LCP proximal femoral plate 4.5/5.0 (PF-LCP) represents a new generation of extramedullar, anatomically precontoured and angular-stable fixation devices to improve osteosynthesis of pertrochanteric and subtrochanteric fractures of the femur. We report about our early results and failures of this implant.

Methods: During a period of 30 months (01/2008 until 06/2010) 52 patients presenting with an per or subtrochanteric fracture of the femur were treated in our institution. 19 cases (12 male, 7 female) with a mean age of 59 years (range 19-96 ys) had osteosynthesis with PF-LCP. Postoperatively partial weight bearing was allowed. Follow up examination with clinical and radiological evaluation took place at 3, 6 and 12 months postoperatively.

Results and conclusions: Surgery was performed in all patients without intraoperative complications. Reasonable reduction and stable fixation was achieved in 18 cases. 1 case had to be revised immediately because of ad latus mal-alignment. In 5 cases secondary loss of reduction was objected during the 3 or 6 months follow up. Revision surgery with condylar plate re-osteosynthesis was performed in 4 cases and total hip prosthesis in 2 cases. In one case the proximal screw had to be changed because of loosening. 3 out of 8 patients underwent hardware removal complaining about persistent trochanteric pain. One patient died unrelated to surgery. Our early results show a high major complication rate (37%) with re-osteosynthesis or prosthesis implantation due to secondary loss of reduction. Consisting trochanteric pain was objected leading to hard ware removal in 21% (3/8). Failure analysis indicates, that a preserved medial hinge seems to be crucial key stone achieving stable consolidation. Further clinical and biomechanical testing is needed to evaluate the limitation of this device for the treatment of unstable trochanteric fractures.