Sat., 10/15/11 Peds, Ger, Hip, Femur & IP, Paper #79, 11:32 am OTA-2011
Locking Plate Fixation Versus Cephalomedullay Nailing of Unstable Proximal Femur Fractures: A Comparative Cohort Study
Philipp N. Streubel, MD; Michael J. Moustoukas, MD; William T. Obremskey, MD;
Vanderbilt Medical Center, Nashville, Tennessee, USA
Purpose: Locking plate fixation is gaining acceptance as a tool for the treatment of unstable proximal femur fractures. The available literature on this method of fixation is, however, limited to isolated case reports. The purpose of this study is to compare clinical outcomes of proximal femur locked plating (PFLP) with those of cephalomedullary nailing (CMN) in a consecutive cohort of acute unstable proximal femur fractures. We hypothesized that both treatment methods would yield similar fracture healing rates.
Methods: After IRB study approval, 80 consecutive patients with 83 unstable proximal femur fractures (OTA 31A3) treated at a single Level 1 trauma center between 2003 and 2007 with either CMN were identified. Patient (age, gender, diabetes, smoking, morbid obesity, mechanism of injury) and surgical variables (delay and duration of surgery, estimated blood loss) were extracted from operative records, charts, and radiographs. Primary end point was nonunion. Secondary end points included mechanical failure, reoperation, and infection. Outcomes were compared between groups using univariate analysis (P <0.05). 23 patients (13 CMN, 10 PFLP) were lost to follow-up, and 5 died within 12 months of surgery (4 CMN, 1 PFLP). A total of 53 (66%) patients (30 PFLP and 23 CMN; 45% male; average age, 60 years; range, 21-94 years; 56% caused by high-energy trauma) were available for analysis with an average follow-up of 18 months.
Results: Gender distribution and diabetes were similar in both groups. CMN patients were on average 11 years older. PFLP-fixed fractures had been caused by high-energy trauma in 63% of cases (compared to 48% of CMN cases), and occurred in smokers in 44% of cases (compared to 22% for CMN). Nonunions occurred in 3 patients (13%) treated with CMN and 8 (25%) of those fixed with PFLP (P = 0.16). Deep infections occurred in 4% of CMN and 6% of PFLP. While no mechanical failures were observed in the CMN group, 11 (34%) occurred in the PFLP group (P <0.01). Malunions occurred in 9% of CMN and 22% of PFLP patients, respectively (P = 0.13). Three (13%) CMN and 9 (28%) PFLP patients required reoperation (P = 0.13). Mean estimated blood loss was higher (537 cc vs 264 cc, P <0.01) and duration of surgery longer (2 hours vs 3.3 hours, P <0.01) with PFLP.
Conclusions: Unstable proximal femur fractures appear to be at higher risk for construct failure, nonunion, and reoperation when treated with PFLP compared to CMN.
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• 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.