A comparative study between proximal femoral locking compression plates and proximal femoral nails in management of unstable intertrochanteric hip fractures.

Introduction: intertrochanteric femur fractures are one of the most devastating injuries. Most of the 
fractures in the elderly results from either falling to ground or traffic accident. Fixing intertrochanteric 
fractures properly is clinically challenging. Various implants both intramedullary and extramedullary 
are available for their fixation. Purpose: is to compare the results of proximal femoral nails (PFN) 
and proximal femoral locking compression plates (PFLCP) in management of unstable 
intertrochanteric fractures and to evaluate the clinical results and complications. Materials and 
methods: 30 patients above 50 years with unstable intertrochanteric fractures 15 patients treated with 
proximal femoral nail and 15 patients treated with Proximal femoral locking compression plates.
Results: Intraoperative blood loss (P <.001), incision length (P <.001) and operative time (P <.001) 
were significantly less in the PFN group than in the PFLCP group. No significant difference was 
found between the groups in terms of radiologic exposure time (P = .048) and hospital length of stay 
(P = .044). Time to full union was significantly (P = .021) lower in the PFN group (mean 16.5 ± 1.6 
weeks ; range, 14 to 20 weeks) than in the PFLCP group (mean 18.3 ± 2.3 weeks; range, 16 to 22 
weeks). Of the 15 PFLCP patients, 14 achieve union uneventfully; all 15 PFN patients achieved 
union. Two PFN patients and three PFLCP patients developed a superficial infection (P = 1); all 5 
infections were controlled with oral antibiotics. There was 1 nonunion in the PFLCP group but none 
in the PFN group. The nonunion patient, who also had a broken implant without any history of fresh 
trauma, was treated with implant removal then bipolar hemiarthroplasty. The group's incidence of 
fracture-unrelated postoperative complications (eg, bed sore, deep vein thrombosis) was comparable 
and not significantly different (P = 1). There was no significant difference between the groups in 
terms of functional outcome (HHS) at final follow-up (P =0.108). Conclusion: both PFN and PFLCP 
were effective treatments for unstable trochanteric femur fractures. Both have good functional 
outcomes and acceptable complication rates. PFN is superior to PFLCP and showed statistically 
significant differences in shorter incisions and intraoperative bleeding , hospital length of stay , 
shorter time to full weight-bearing and time to union.