title: A comparison of proximal femoral locking compression plates with dynamic hip screws in extracapsular femoral fractures.
abstract: BACKGROUND
  The potential value of proximal femoral locking compression plate (PFLCP) for extracapsular femoral fractures has been discussed in several case reports; however, clinical control studies are lacking. Therefore, we performed a case control study to assess: (1) If PFLCP offers better functional results and fewer complications than dynamic hip screws (DHS)? (2) Which kind of extracapsular femoral fractures would benefit from PFLCP fixation?
  
  
  OBJECTIVE
  The PFLCP fixation offers better functional results and fewer complications than the DHS for the treatment of extracapsular fractures.
  
  
  METHODS
  A total of 83 patients with extracapsular femoral fractures were recruited. Forty-one patients underwent PFLCP fixation, and 42 patients underwent DHS fixation. Patient information, operative time, blood loss, functional level (as assessed by Sanders' traumatic hip rating scale), bone union, and implant complications were compared for the two treatment groups.
  
  
  RESULTS
  Patients with stable intertrochanteric fractures who underwent PFLCP fixation demonstrated shorter bone union time than the DHS fixation group (3.3 ± 0.2 vs. 4.3 ± 0.1 month; P<0.0001); however, both groups had 100% bone union and good to excellent scores on Sanders' traumatic hip rating scale (P=1.000). Patients with unstable intertrochanteric fractures who underwent PFLCP fixation experienced greater blood loss (619.0 ± 23.9 vs. 474.1 ± 19.8 ml; P<0.0001), which was mainly due to the need for open reduction (64.3% vs. 12.5%; P=0.003), compared to the DHS fixation group. No differences were identified with respect to bony union, functional level, or complications. Patients with subtrochanteric fractures who underwent PFLCP fixation demonstrated significantly shorter operative times (82.1 ± 4.3 vs. 102.2 ± 2.2 minutes; P<0.0001), less blood loss (751.8 ± 25.4 vs. 987.6 ± 32.0 ml; P<0.0001), shorter bone union times (5.2 ± 0.4 vs. 8.8 ± 1.0 month; P=0.006), more good to excellent Sanders' traumatic hip rating scale scores (92.9% vs. 55.5%; P=0.009), and fewer complications (14.2% vs. 66.6%; P=0.005) than the DHS fixation group.
  
  
  CONCLUSIONS
  PFLCP fixation offers better functional outcomes and fewer complications for subtrochanteric femoral fractures but not for intertrochanteric femoral fractures.
  
  
  METHODS
  Case control study, level III.
authors.affiliation: Orthopaedic department, 6th People's hospital affiliated to Shanghai Jiaotong university, 600, Yishan Road, Shanghai, PR China.
authors.forename: B
authors.initials: B
authors.lastname: Zhong
authors.affiliation: Orthopaedic department, Tongren hospital affiliated to Shanghai Jiaotong university, Shanghai, PR China.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Orthopaedic department, 6th People's hospital affiliated to Shanghai Jiaotong university, 600, Yishan Road, Shanghai, PR China. Electronic address: hydraliskrush@126.com.
authors.forename: C
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Orthopaedic department, 6th People's hospital affiliated to Shanghai Jiaotong university, 600, Yishan Road, Shanghai, PR China.
authors.forename: C-F
authors.initials: CF
authors.lastname: Luo
mesh_terms: D016063:Blood Loss, Surgical; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D016348:Osseointegration; D011183:Postoperative Complications
keywords: Dynamic hip screw; Extracapsular femoral fracture; Proximal femoral locking compression plate