OTA 2012 Posters

Scientific Poster #1 Hip/Femur OTA-2012

Results of Complex Proximal Femur Fractures Treated With Locking Proximal Femur Plates

Cory A. Collinge, MD1; Timothy Weber, MD2; J. Tracy Watson,MD3; Michael Archdeacon, MD4; David Lowenberg, MD5; David Zamarano,MD6; Florian Huber, MD7; Michael Prayson, MD8; Timothy Achor, MD9;
1Harris Methodist Fort Worth Hospital, Fort Worth, Texas, USA;
2OrthoIndy, Indianapolis, Indiana, USA;
3Saint Louis University School of Medicine, Saint Louis, Missouri, USA;
4University of Cincinnati Academic Medical Center, Cincinnati, Ohio, USA;
5Stanford University Medical Center, Palo Alto, California, USA;
6University of California, Irvine Medical Center, Anaheim, California, USA;
7Peninsula Orthopedic Associates, Salisbury, Maryland, USA;
8Miami Valley Hospital, Dayton, Ohio, USA;
9University of Texas, Houston Medical Center, Houston, Texas, USA

Background/Purpose: Complex fractures of the proximal femur involving the peritrochanteric and subtrochanteric areas are a treatment challenge. Intramedullary rods and angled blade plates have been used for these fractures, but specific problems exist with each of these options. As a result, locking proximal femur plates (LPFPs) are now available as a plating option for these fractures to address some of these shortcomings. Clinical evaluation of these plates is not adequately reported. Our purpose was to determine the clinical results of a large series of patients with complex proximal femur fractures treated with an LPFP.

Methods: 103 patients with an unstable peri- or subtrochanteric femur fracture were treated with an LPFP between January 2007 and December 2010 at 9 regional trauma centers (7 Level I and 2 Level II). Retrospective analysis of medical record and radiographs was performed of patients with follow-up >12 months. Primary outcomes assessed were union, alignment, fixation failure, need for secondary surgeries, and infection.

Results: 65 patients met criteria for inclusion and followed up at an average of 33 months (range, 12-56 months). Treatment failure occurred in 17 patients (26%), including 15 failures of fixation associated with nonunion, malalignment, or malunion requiring revision. Loss of proximal fixation with broken, loosened, or bent implants and resultant varus malalignment was the characteristic mode of failure. There were two deep infections, both requiring plate removal and ultimately total hip arthroplasty. Factors that significantly affected failure included age, tobacco usage, plate manufacturer, and surgical varus malalignment.

Conclusion: LPFPs are associated with a relatively high treatment failure rate in the treatment of complex proximal femur fractures. Predictors of failure were identified including increased age, tobacco use, PFLPs from a specific manufacturer, and iatrogenic varus malalignment. The treating surgeon must be aware of a high potential for complication when applying these plates to complex proximal femur fractures.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.