Background: Proximal fractures of the femur remain one of the most challenging orthopedic problems. Every effort should be made to allow elderly patients to resume their pre-injury functional activity, thus reducing the postoperative complications caused by immobilization.

Aim: The aim of this work was to evaluate the results of using the proximal femoral locked plate in the management of unstable intertrochantric fractures.

Patients and Methods: This study included 20 patients who were admitted to El-Hadra University Hospital, Faculty of Medicine, Alexandria University, suffering from unstable trochanteric fractures between September 2014 and February 2016. Every patient was followed up for at least 6 months. The follow up period ranged between 6 to 21 months with a mean of 7.5 months.

The ethical committee in the Faculty of Medicine in Alexandria University accepted the performance of the study. An informed consent was taken from all patients subjected to this academic work.

A full workup including history, clinical examination, radiological examination and routine laboratory investigations was done for every patient.

Results: This study included 20 patients who were admitted to El-Hadra University Hospital, Faculty of Medicine, Alexandria University, suffering from unstable trochanteric fractures between September 2014 and February 2016. Every patient was followed up for at least 6 months. The follow up period ranged between 6 to 21 months with a mean of (7.5 ± 3.57) month. Two cases out of the 20 studied patients were enrolled from the final assessment because one had metal failure and was revised with a DHS 2 weeks after the index procedure and the second was infected and ended up with a Girdlestone procedure after 3 months. Therefore, the final results included only 18 patients. The duration of surgery in this study ranged between 55.0 – 180.0 minutes with a mean of 104.5 ± 35.4 minutes.

Conclusion: PFLCP is a fair implant choice in the treatment of unstable trochanteric fracture pattern

1. Bottle A, Aylin P. Mortality associated with delay in operation after hip fracture: observational study. BMJ 2006; 332(7547):947-51.
2. Fox HJ, Pooler J, Prothero D, Bannister GC. Factors affecting the outcome after proximal femoral fractures. Injury 1994; 25(5):297-300.
3. Cummings SR, Rubin SM, Black D. The future of hip fractures in the United States. Numbers, costs, and potential effects of postmenopausal estrogen. Clin OrthopRelat Res 1990; (252):163-6.
4. Koval KJ, Aharonoff GB, Rokito AS, Lyon T, Zuckerman JD. Patients with femoral neck and intertrochanteric fractures. Are they the same? Clin OrthopRelat Res 1996; (330):166-72.
5. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 1995; 77(7):1058-64.
6. Zain Elabdien BS, Olerud S, Karlstrom G. The influence of age on the morphology of trochanteric fracture. Arch Orthop Trauma Surg 1984; 103(3):156-61.
7. Hanafy M. Comparative study of the treatment of reverse obliquity and transverse trochanteric fractures by intramedullary hip screw versus dynamic condylar screw. Master Thesis. Faculty of Medince: Alexandria University; 2010.
8. El-Sheshtawy SH. Evaluation of the results of treatment of unstable trochanteric fractures using intramedullary hip screw. Master Thesis. Faculty of Medince: Alexandria University; 2011.
9. Medoff RJ, Maes K. A new device for the fixation of unstable pertrochanteric fractures of the hip. J Bone Joint Surg Am 1991; 73(8):1192-9.
10. Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg Br 1949; 31b(2):190-203.
11. Pugh WL. A self-adjusting nail-plate for fractures about the hip joint. J Bone Joint Surg Am 1955; 37-a(5):1085-93.
12. Kaufer H. Mechanics of the treatment of hip injuries. Clin Orthop Relat Res 1980; (146):53-61.
13. El-Hefnawi M. Treatment of stable trochanteric fractures using dynamic hip screw versus external fixation, A compartive study. Master Thesis. Faculty of Medince: Alexandria University; 2011.
14. Ahmed AR, Gaber H, Hassan A. External fixation of trochanteric fractures in high risk patients. EgypOrthop J 2009; 44(4):342-55

15. Massie WK. Functional flxation of femoral neck fractures; telescoping nail technic. Clin OrthopRelat Res 1958; 12:230-55.
16. Wolfgang GL, Bryant MH, O'Neill JP. Treatment of intertrochanteric fracture of the femur using sliding screw plate fixation. Clin Orthop Relat Res 1982; (163):148-58.
17. Simpson AH, Varty K, Dodd CA. Sliding hip screws: modes of failure. Injury 1989; 20(4):227-31.
18. Dhamangaonkar AC, Joshi D, Goregaonkar AB, Tawari AA. Proximal femoral locking plate versus dynamic hip screw for unstable intertrochanteric femoral fractures. J Orthop Surg (Hong Kong) 2013; 21(3):317-22.
19. Wagner M, Frenk A, Frigg R. New concepts for bone fracture treatment and the Locking Compression Plate. Surg Technol Int 2004; 12:271-7.
20. Cronier P, Pietu G, Dujardin C, Bigorre N, Ducellier F, Gerard R. The concept of locking plates. OrthopTraumatol Surg Res 2010;96:17-36.
21. Chalise PK, Mishra AK, Shah SB, Adhikari V, Singh RP. Outcome of pertrochantric fracture of the femur treated with proximal femoral locking compression plate. Nepal Med Coll J 2012; 14(4):324-7.
22. Hasenboehler EA, Agudelo JF, Morgan SJ, Smith WR, Hak DJ, Stahel PF. Treatment of complex proximal femoral fractures with the proximal femur locking compression plate. Orthopedics 2007; 30(8):618-23.
23. Balderston RA, Rothman RH, Booth RE, Hozock WJ. The Hip. 1st ed. Lea and Febiger: Philadelphia; 1992.
24. Williams P, Warwick R. Anatomy of the hip joint. In: Stanton BR, Jenson NE. (eds). Gray’s Anatomy. Philadelphia: W.B. Saunders Co; 1980. 477-82.
25. Roberts CS, Nawab A, Wang M, Voor MJ, Seligson D. Second generation intramedullary nailing of subtrochanteric femur fractures: a biomechanical study of fracture site motion. J Orthop Trauma 2002; 16(4):231-8.
26. Crock HV. An atlas of the arterial supply of the head and neck of the femur in man. Clin OrthopRelat Res 1980; (152):17-27.
27. Wroblewski BM, Siney PD, Fleming PA, Bobak P. The calcar femorale in cemented stem fixation in total hip arthroplasty. J Bone Joint Surg Br 2000; 82(6):842-5.
28. Griffin JB. The calcar femorale redefined. Clin OrthopRelat Res 1982; (164):211-4.
29. Singh M, Nagrath AR, Maini PS. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg Am 1970; 52(3):457-67.
30. Kranendonk DH, Jurist JM, Lee HG. Femoral trabecular patterns and bone mineral content. J Bone Joint Surg Am 1972; 54(7):1472-8.

Amr Eltorky

Department of Orthopedics Surgery and Traumatology, Faculty of Medicine, University of Alexandria