Failure of proximal femoral locking compression plate: a case series.
OBJECTIVE
The treatment of fractures of the proximal femur has evolved significantly over recent years. The most recent advance is the proximal femoral locking compression plate (PF-LCP; Synthes, West Chester, PA). We present seven failures of the PF-LCP in an attempt to elicit reasons for the failures so that these pitfalls can be avoided in the future.


METHODS
Retrospective chart review.


METHODS
Level I trauma centers, tertiary referral hospitals.


METHODS
Ten patients at five institutions.


METHODS
Open reduction and internal fixation with a PF-LCP.


METHODS
Failure mode, time until failure, need for further surgery, bony union, or conversion to arthroplasty.


RESULTS
Of the seven cases, two were acute peritrochanteric fractures, one was a periprosthetic fracture at the site of a prior hip fusion, one was an early failure of a compression hip screw, and three were nonunions. The failure mode was implant fracture in four cases and loss of fixation in three cases resulting from varus collapse and implant cutout. Five of seven failures were within the first 3 weeks (average, 12.4 days). The average time to failure for all cases was 37.9 days (range, 5-175 days). The average patient age was 56.7 years (range, 36-72 years).


CONCLUSIONS
Biomechanical studies have shown the PF-LCP to be stronger or equivalent to other fixation methods for fractures of the femoral neck and subtrochanteric femur fractures. The seven failures in our cases may be partially the result of patient factors as well as technical factors; however, there appears to be a high rate of failure even when surgery is performed by experienced and fellowship-trained traumatologists.
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
Philip J
PJ
Glassner
Nirmal C
NC
Tejwani
D000328:Adult; D000368:Aged; D001860:Bone Plates / Q000009:adverse effects*; D019245:Compressive Strength; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography