title: Clinical outcome of conventional versus biological fixation of subtrochanteric fractures by proximal femoral locked plate.
abstract: BACKGROUND
  Surgical fixation is the standard management of the subtrochanteric fractures. Proximal femoral locked plating (PF-LCP) provides a strong construct for fixation with a high success rate. However, some studies reported implant failure due to loss of the postero-medial bone support and recommended an anatomical reduction. Other studies reported excellent to good results with indirect (biological) fixation without anatomical reduction. In this study, we reviewed the short-term clinical results of PF-LCP fixation for subtrochanteric fractures using both conventional and biological fixation.
  
  
  METHODS
  Forty six patients (34 males and 12 females) with comminuted subtrochanteric fractures were included aged between 18 and 74 (mean 44.3 years). They were treated in a single-blind random manner by either conventional (open, direct) or biological (indirect) reduction method and internal fixation with PF-LCP. Intra-operative variables including; duration of surgery, blood loss, fluoroscopy time and any complications were recorded. Post-operative differences including; duration of healing, implant failure, complications and the final clinical outcome by Harris Hip Score (HHS) were documented.
  
  
  RESULTS
  44 cases continued to the final follow-up (23 of the open fixation group and 21 of the biological fixation group). Patients of open group demonstrated greater blood loss (756±151 vs. 260±39ml; P<0.0001), longer operative times (129±16.9 vs. 91±8min; P<0.0001) and incisions (s) length (20.4±3 vs. 13.4±1cm; P<0.0001). More patients needed blood transfusion in open group (11 patients vs. six in closed group; P<0.0001). Patients of biological group demonstrated longer fluoroscopy time (80.9±7.3 vs. 47.2±5.8sec.; P<0.0001). For each group, one case of implant failure was recorded. Low patient compliance was a detrimental factor for the implant failure in both cases. No much difference was demonstrated for the healing rate (open group; 18.3±3.7 vs. biological group16.5±4 weeks; P<0.058) and for the functional outcome (open group; excellent/good: 54%/37%, biological group; excellent/good: 57%/33%; P=0.766).
  
  
  CONCLUSIONS
  PF-LCP provided a strong construct for fixation of the comminuted subtrochanteric fractures either by open or biological techniques. Low patient compliance is an influential factor for implant failure in both types.
authors.affiliation: Kasr Al-Ainy School of Medicine, Faculty of Medicine, Cairo University, Cairo 12345, Egypt. Electronic address: ehabede@hotmail.com.
authors.forename: Ihab I
authors.initials: II
authors.lastname: El-Desouky
authors.affiliation: Kasr Al-Ainy School of Medicine, Faculty of Medicine, Cairo University, Cairo 12345, Egypt. Electronic address: molhammf@Hotmail.Com.
authors.forename: Molham M
authors.initials: MM
authors.lastname: Mohamed
authors.affiliation: Kasr Al-Ainy School of Medicine, Faculty of Medicine, Cairo University, Cairo 12345, Egypt. Electronic address: ahmed.E.Kandil@Gmail.Com.
authors.forename: Ahmed E
authors.initials: AE
authors.lastname: Kandil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D005260:Female; D005471:Fluoroscopy; D005593:Fracture Fixation, Internal; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D020127:Recovery of Function; D016037:Single-Blind Method; D016896:Treatment Outcome; D055815:Young Adult
keywords: PF-LCP; Patient compliance; Proximal femoral plate; Subtrochanteric fractures