title: Locked plating versus cephalomedullary nailing of unstable intertrochanteric femur fractures.
abstract: BACKGROUND
  Proximal femur locking plates (PFLP) have received increased attention as an alternative for the treatment of proximal femur fractures. However, recent clinical data on these implants has raised concern about higher than expected failure rates.
  
  
  OBJECTIVE
  The purpose of the present study was to compare outcomes of unstable pertrochanteric femur fractures (AO/OTA 31A3) treated at a level-1 trauma center using either PFLP or cephalomedullary nailing (CMN).
  
  
  METHODS
  Sixty-two patients (31 PFLP and 31 CMN, 55 % female, average age 63 years, range 21-94) with 64 OTA 31A3 fractures (32 PFLP and 32 CMN) treated between 2003 and 2007 were retrospectively reviewed. No differences were found with regard to gender, BMI, diabetes and time to surgery.
  
  
  RESULTS
  One patient (5 %) in the CMN group underwent a reoperation (debridement with hardware removal), while eight PFLP patients (25 %) did (two debridements, two hardware removals, four nonunion repairs). One mechanical failure (5 %) occurred in the CMN group and 12 (38 %) in the PFLP group (p = 0.007). One nonunion (5 %) was observed in the CMN group, while 6 (19 %) occurred in the PFLP group.
  
  
  CONCLUSIONS
  A higher rate of reoperation and mechanical failure can be expected for unstable intertrochanteric femur fracture when treated with PFLP than with CMN.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, 4400 Emile Street, 981080 Nebraska Medical Center, Omaha, NE, 68198, USA. philipp.streubel@unmc.edu.
authors.forename: Philipp N
authors.identifier: http://orcid.org/0000-0002-4585-1779
authors.initials: PN
authors.lastname: Streubel
authors.affiliation: Orthopedic Trauma Service, Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt Medical Center, 1215 21st Avenue South, Suite 4200 MCE-South Tower, Nashville, TN, 37232, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Moustoukas
authors.affiliation: Orthopedic Trauma Service, Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt Medical Center, 1215 21st Avenue South, Suite 4200 MCE-South Tower, Nashville, TN, 37232, USA.
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
keywords: Complications; Hip fracture; Internal fixation; Intertrochanteric femur fracture; Intramedullary nailing; Locked plating