A new article, published by Dr. Joshua Langford and Dr. Edward Yang, on Orthofix PCCP (PerCutaneous Compression Plate), along with an Editorial, will be published in the April issue of Journal of Orthopedic Trauma.
This clinical study demonstrates the excellent results with the PCCP compared to SHS (Sliding Hip Screw), regarding the prevention of lateral wall fractures and thus improving functional recovery. This reaches statistical significance for several sub-groups, especially for the more comminuted (highly complex) fractures.
The editorial triggered by the study is written by Dr. Russell and Dr. Sanders (designing surgeons of the Intertan Nail, S&N) and its very appropriate title is: Pertrochanteric fractures: time for a change. The editors advocate a shift in treatment goal of these fractures: surgeons should aim to improve functional recovery; malunions should no longer be tolerable. This new PCCP article fully supports their position and the PCCP is definitely on their radar.
To view the article abstract, you can go to the following site: http://www.ncbi.nlm.nih.gov/pubmed/21399466
J Orthop Trauma. 2011 Apr;25(4):191-5.
Perioperative Lateral Trochanteric Wall Fractures: Sliding Hip Screw versus Percutaneous Compression Plate for Intertrochanteric Hip Fractures.
Langford J, Pillai G, Ugliailoro AD, Yang E.
From *Orlando Regional Medical Center, Orlando, FL; †The Mount Sinai Department of Orthopaedics, New York, NY; and ‡UMDNJ-New Jersey Medical School, Department of Orthopaedic Surgery, Division of Musculoskeletal Oncology, Newark, NJ.
OBJECTIVES: : This study was performed to determine the incidence of perioperative lateral wall fractures with a standard sliding hip screw (SHS) versus a percutaneous compression plate (PCCP - Orthofix) using identical meticulous closed reduction techniques in both groups.
DESIGN: Retrospective analysis of a prospective trauma registry.
SETTING: Urban Level I trauma centre.
PATIENTS: Over a 7-year period, 337 patients with intertrochanteric hip fractures were treated with either a SHS or a PCCP at our institution. The PCCP group (Group 1) consisted of 200 patients, of which 141 (71%) had adequate images to be included in the study. The SHS group (Group 2) consisted of 137 patients, of which 100 (73%) had adequate images to be included in the study.
INTERVENTION: Closed reduction and plate application with either a standard sliding hip screw or a percutaneous compression plate for an Orthopaedic Trauma Association 31A1 or 31A2 intertrochanteric hip fracture.
MAIN OUTCOME MEASURE: Radiographic evidence of lateral trochanteric wall fracture as measured by intraoperative and perioperative radiographs.
RESULTS: There was an overall lateral wall fracture incidence of 20% in the SHS group versus 1.4% in the PCCP group (P < 0.01). For the unstable 31A2 fracture types, there was a lateral wall fracture incidence of 29.8% in the SHS group versus 1.9% in the PCCP group (P < 0.01).
CONCLUSIONS: Overall, the PCCP group had a significantly decreased incidence of lateral trochanteric wall fracture compared with the SHS group. This difference became greater when just unstable intertrochanteric fractures were analyzed. An anatomic reduction, combined with a device (PCCP) that uses small-diameter defects in the lateral trochanteric wall, essentially eliminates perioperative lateral trochanteric wall fractures.