Fri., 10/17/08 Geriatrics/Reconstruction, Paper #36, 4:06 pm OTA-2008
Percutaneous Compression Plating Compared to Sliding Hip Screw Fixation of Pertrochanteric Hip Fractures: A Prospective Randomized Study
Edward Yang, MD1 (n); Sheeraz Qureshi, MD2 (n);
Shawn Trokhan, MD2 (n); David Joseph, MD1 (n);
1Elmhurst Hospital Center, Elmhurst, New York, USA;
2Mt. Sinai School of Medicine, New York, New York, USA
Purpose: Over a 4-year period, the sliding hip screw (SHS) and the percutaneous compression plating system (PCCP) were used at our institution. Favorable experience with the PCCP led us to conduct a randomized prospective study to determine whether the perceived advantages of this system were supported in a formal study.
Methods: All patients with pertrochanteric hip fractures that met the study criteria and provided informed consent were randomized to an SHS or PCCP. Follow-up included clinical findings, radiographs until healing was confirmed, functional recovery score, pain assessment scores, and completion of the Short Form-36 (SF-36). Median follow-up was 12 months, with a range from 6 to 15 months.
Results: 66 patients, 47 females and 19 males with a mean age of 77 years, were entered into the study. The treatment groups were similar with respect to study variables (P >0.05). Operative times (48 vs 77 minutes) and blood loss (40 vs 101 mL) statistically favored the PCCP (P <0.001). There were no lateral wall fractures either intraoperatively or postoperatively in the PCCP group. The groups were similar immediately postoperatively but by discharge, fewer PCCP patients required walking aids (42% vs 58%). This trend continued throughout the study. The SF-36 showed favorable differences in the physical function scores at 2 weeks (30 vs 17) and this advantage continued through 12 months (72 vs 60). There was also an advantage in general health perception, social functioning, and role emotional favoring the PCCP. Pain at rest was slightly better at 3 and 6 months and pain with activity was lower from 3 to 12 months.
Conclusions: Our perceived advantages of the PCCP relative to the SHS were confirmed in this study. Previously published reports of shorter operative times and less blood loss with the PCCP were reaffirmed. A larger percentage of patients were able to ambulate independently. Pain with activity was consistently lower and multiple scales of the SF-36 confirmed improved quality of life. These findings suggest greater functional independence for subjects, reduced operating room times, and higher quality of life.
Significance: Comparable rates of healing, shorter operative times, and improved functional outcomes support wider use of this percutaneous system. These factors are strongly associated with economic and societal benefits in addition to improved patient outcomes.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• 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.