Comparison of stable and unstable pertrochanteric femur fractures managed with 2- and 4-hole side plates

• Published in: Canadian Journal of Surgery 2014-10, Vol.57 (5), p.327-330
• Main Authors: Baird, Robert Peter, BSc (Hons), BMBS, O’Brien, Peter, MD, Cruickshank, David, MD, BSc
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Bone Plates; Bone Screws; Female; Femoral Fractures - surgery; Follow-Up Studies; Fracture fixation; Fracture Fixation, Internal - methods; Fracture Healing; Fractures; Hip joint; Humans; Male; Medical treatment; Methods; Orthopedics; Pain management; Prospective Studies; Studies; Surgery; Time Factors; Treatment Outcome
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.026113

Background Sliding hip screw (SHS) fixation traditionally involves the use of 4-hole side plates; however, 4-hole plates have disadvantages, including longer surgery and greater postoperative pain, and there is little evidence that they provide increased stability. We compared 2- and 4-hole side plates in stable and unstable pertrochanteric fractures. Methods We prospectively enrolled consecutive patients with pertrochanteric femoral fractures treated between Jan. 1, 2004, and Apr. 30, 2009, with a 135° SHS using either a 2- or 4-hole side plate, based on surgeon preference. Results A total of 327 patients were managed with an SHS device (252 women, 75 men). There were 208 stable fracture patterns (AO/OTA 31 A1, A2.1) and 119 unstable (AO/OTA 31 A2.2, A2.3, A3). We managed 172 patients with 2-hole plates and 155 with 4-hole plates. The average duration of surgery (30.44 v. 51.45 min), blood loss (26.0 v. 31.3 g/L) and transfusion requirements (43% v. 31. 60% transfusion) were significantly lower with the 2-hole than the 4-hole plate. There was no significant difference in length of stay (19 v. 16 d). With stable fractures there was no significant difference in failure rate (6.3% v. 4.9%). In unstable fractures there was a significantly higher rate of failure using 2-hole side plates (24.4% v. 10.8%). Conclusion In stable fractures, use of an SHS with a 2-hole side plate results in shorter surgery and less blood loss/transfusion than a 4-hole side plate, with equivalent survival. In unstable fractures, there is a greater than 2-fold rate of failure when a 2-hole side plate is used.