title: Unstable Proximal Femur Fractures Treated With Proximal Femoral Locking Plates: A Retrospective, Multicenter Study of 111 Cases.
abstract: OBJECTIVE
  A few small case series have found that proximal femur fractures treated with a proximal femur locking plate (PFLP) have experienced more failures than expected. The purpose of this study was to review the clinical results of patients with acute, unstable proximal femur fractures treated with proximal femoral locking plates in a large, multicenter patient cohort.
  
  
  METHODS
  This is a retrospective clinical study.
  
  
  METHODS
  The study included patients from 12 regional trauma centers and tertiary referral hospitals.
  
  
  METHODS
  One hundred eleven consecutive patients with unstable proximal femur fractures stabilized with a PFLP and having required clinical and radiographic follow-up at a minimum of 12 months after injury.
  
  
  METHODS
  Surgical repair of an unstable proximal femur fracture with a PFLP.
  
  
  METHODS
  Treatment failures (failure of fixation, nonunion, and malunion) and need for revision surgery.
  
  
  RESULTS
  Forty-six patients (41.4%) experienced a major treatment failure, including failed fixation with or without nonunion (39), surgical malalignment or malunion (18), deep infection (8), or a combination of these. Thirty-eight (34%) patients underwent secondary surgeries, including 30 for failed fixation, nonunion, or both. Treatment failure was found to occur at a significantly higher rate in patients with major comorbidities, in femurs repaired in varus malalignment, and using specific plate designs.
  
  
  CONCLUSIONS
  Proximal femoral locking plates are associated with a high complication rate, frequently requiring revision or secondary surgeries in the treatment of unstable proximal femur fractures. Given the high complication rate with PFLPs, careful attention to reduction, use of a PFLP implant, and consideration should be given to alternative implants or fixation techniques when appropriate.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Harris Methodist Fort Worth Hospital, Fort Worth, TX; †Inova Fairfax Hospital, VA; ‡University of Cincinnati Orthopaedics, Cincinnati, OH; §Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, NE; ‖Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN; ¶OrthoIndy at St. Vincent Indianapolis, Indianapolis, IN; **Department of Orthopaedic Surgery, Saint Louis University, St. Louis, MO; and ††Stanford University Medical Center, Redwood City, CA.
authors.forename: Cory A
authors.initials: CA
authors.lastname: Collinge
authors.forename: Robert
authors.initials: R
authors.lastname: Hymes
authors.forename: Michael
authors.initials: M
authors.lastname: Archdeacon
authors.forename: Phillip
authors.initials: P
authors.lastname: Streubel
authors.forename: William
authors.initials: W
authors.lastname: Obremskey
authors.forename: Timothy
authors.initials: T
authors.lastname: Weber
authors.forename: J Tracy
authors.initials: JT
authors.lastname: Watson
authors.forename: David
authors.initials: D
authors.lastname: Lowenberg
mesh_terms: D001860:Bone Plates / Q000706:statistics & numerical data*; D001863:Bone Screws / Q000706:statistics & numerical data; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000706:statistics & numerical data; D017102:Fracture Healing; D006620:Hip Fractures / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology