Gotfried percutaneous compression plating (PCCP) versus dynamic hip screw (DHS) in hip fractures: blood loss and 1-year mortality

Background: Hip fractures are common, expensive and lead to considerable morbidity and mortality. An ageing population in the United Kingdom means that rates of this injury are increasing, making them a pressing public health issue. The National Institute of Health and Care Excellence (NICE) recommends that extramedullary implants are used over intramedullary nails to fix intertrochanteric fractures, which make up half of all hip fractures. However, there is currently no guidance on the preferred type of extramedullary device whether this be the commonly used dynamic hip screw (DHS) or another newer device. It has been suggested that a percutaneous compression plate (PCCP) can reduce complications and improve functional outcome compared with the traditional DHS. Review Question: In patients with intertrochanteric hip fractures, is the PCCP more effective than the DHS in terms of relevant intraoperative and postoperative outcomes such as blood loss, implant failure, and mortality? Literature Search: We first searched for relevant information in the NICE Clinical Guideline on Hip Fracture Management (CG124), then National Health Service (NHS) evidence for Clinical Knowledge Summaries, then the Cochrane library for systematic reviews. Finally, we conducted an electronic search of the PubMed database. Review Findings: We selected five systematic reviews and eight primary studies for review. The main findings were that the PCCP was associated with significantly less blood loss, fewer blood transfusions, and shorter operating times compared with the DHS. However, no significant differences were found in postoperative pain, orthopaedic performance, and mortality rates between the two methods. There was no comparison of cost-effectiveness between the two methods. Conclusions: The PCCP is superior to the DHS in terms of intraoperative blood loss and, potentially, non-orthopaedic postoperative complications such as deep vein thrombosis and nosocomial infection. However, there was no significant difference in mortality rates between the two methods. Current studies on this topic have several methodological issues and some are of relatively poor quality. Further higher quality research and cost-effectiveness are necessary to further evaluate the efficacy of these methods.

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Percutaneous compression plating (PCCP) versus the dynamic hip screw for pertrochanteric hip fractures: preliminary results

Injury ◽

10.1016/s0020-1383(02)00080-3 ◽

2002 ◽

Vol 33 (5) ◽

pp. 413-418 ◽

Cited By ~ 51

Author(s):

S.E Brandt ◽

S Lefever ◽

H.M.J Janzing ◽

P.L.O Broos ◽

P Pilot ◽

...

Keyword(s):

Hip Fractures ◽

Dynamic Hip Screw ◽

Preliminary Results ◽

Hip Screw ◽

Compression Plating

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Design and biomechanical study of slide-poking external fixator for hip fracture

Journal of International Medical Research ◽

10.1177/0300060520950934 ◽

2020 ◽

Vol 48 (12) ◽

pp. 030006052095093

Author(s):

Hua-Biao Chen ◽

Hong-Bo Wu ◽

Min Chen ◽

Yu-Liang Huang

Keyword(s):

Hip Fracture ◽

Femoral Head ◽

Hip Fractures ◽

External Fixator ◽

Dynamic Hip Screw ◽

Control Groups ◽

Vertical Loading ◽

Hip Screw ◽

The Mean ◽

And Control

Background Femoral head collapse and coxa vara lead to internal fixator failure in elderly patients with hip fracture. External fixator application is an optimal choice; however, the existing methods have many disadvantages. Methods Type 31-A1.3 hip fracture models were developed in nine pairs of 1-year-old fresh bovine corpse femur specimens. Each left femur specimen was fixed by a dynamic hip screw (control group), and each right femur specimen was fixed by the slide-poking external fixator (experimental group). Vertical loading and torsion tests were then performed in both groups. Results In the vertical loading experiment, a 1000-N load was implemented. The mean vertical downward displacement of the femoral head in the experimental and control groups was 1.49322 ± 0.116280 and 2.13656 ± 0.166374 mm, respectively. In the torsion experiment, when the torsion was increased to 10.0 Nm, the mean torsion angle in the experimental and control groups was 7.9733° ± 1.65704° and 15.4889° ± 0.73228°, respectively. The slide-poking external fixator was significantly more resistant to compression and rotation than the dynamic hip screw. Conclusion The slide-poking external fixator for hip fractures that was designed and developed in this study can provide sufficient stability to resist compression and rotation in hip fractures.

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Biomechanical analysis of the treatment of intertrochanteric hip fracture with different lengths of dynamic hip screw side plates

Technology and Health Care ◽

10.3233/thc-202248 ◽

2020 ◽

Vol 28 (6) ◽

pp. 593-602

Author(s):

Cheng-Chi Wang ◽

Cheng-Hung Lee ◽

Ning-Chien Chin ◽

Kun-Hui Chen ◽

Chien-Chou Pan ◽

...

Keyword(s):

Hip Fractures ◽

Dynamic Hip Screw ◽

Biomechanical Analysis ◽

Element Analysis ◽

Side Plate ◽

Lag Screw ◽

Pull Out ◽

Cortical Screw ◽

Hip Screw ◽

Biomechanical Effect

BACKGROUND: Dynamic hip screw (DHS) is a common implant used to treat stable-type intertrochanteric hip fractures. There are many factors that can affect the success rate of the surgery, including the length of side plates. It is therefore important to investigate the biomechanical effect of different DHS side plates on bones. OBJECTIVE: In order to reduce the likelihood of an implant failure, the aim of this study was to use finite element analysis (FEA) to investigate and understand the effect of side plates with different lengths in DHS. METHODS: In this FEA study, a 3D model with cortical bone, cancellous bone, side plate, lag screw, and cortical screws to simulate the implantation of DHS with different lengths of side plate (2-hole, 4-hole, and 6-hole) for intertrochanteric hip fractures was constructed. The loading condition was used to simulate the force (400 N) on the femoral head and the stress distribution on the lag screw, side plate, cortical screws, and femur was measured. RESULTS: The highest stress points occured around the region of contact between the screw and the cortical bones. The stress on the femur at the most distal cortical screw was the greatest. The shorter the length of the side plate, the greater the stress on the cortical screws, resulting in an increased stress on the femur surrounding the cortical screws. CONCLUSIONS: The use of DHS with 2-hole side plate may increase the risk of side plate pull-out. The results of this study provide a biomechanical analysis for selection of DHS implant lengths that can be useful for orthopaedic surgeons.

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EFFECTS OF DIFFERENT LATERAL FEMORAL WALL THICKNESSES IN INTERTROCHANTERIC HIP FRACTURE TREATED WITH DYNAMIC HIP SCREW

Journal of Mechanics in Medicine and Biology ◽

10.1142/s0219519419400220 ◽

2019 ◽

Vol 19 (02) ◽

pp. 1940022

Author(s):

CHENG-CHI WANG ◽

CHENG-HUNG LEE ◽

KUN-HUI CHEN ◽

CHIEN-CHOU PAN ◽

KUO-CHIH SU

Keyword(s):

Hip Fractures ◽

Stress Shielding ◽

Simulation Models ◽

Lateral Wall ◽

Dynamic Hip Screw ◽

Shielding Effect ◽

Element Analysis ◽

Lag Screw ◽

Hip Screw ◽

Biomechanical Effect

Dynamic hip screw (DHS) is commonly used for stable-type intertrochanteric hip fractures. The importance of lateral femoral wall has been mentioned while treating intertrochanteric hip fractures with DHS. The aim of this study was mainly to investigate the biomechanical effect of different thickness of lateral femoral wall using finite element analysis (FEA). This study constructed FEA simulation models for five different lateral femoral wall thicknesses, and demonstrated the stress distribution on the femoral bone, the cortical screws, the cancellous bone around the lag screw, and the lag screw. The main results showed that when the DHS is implanted, less stress will be distributed at the implantation site on the femur due to the stress-shielding effect. The stress on the cortical screws will be greater at the junction of the cortical screws and the cortical bone. Intertrochanteric hip fractures with a thinner lateral wall thickness may cause higher stress on the femur after DHS is implanted.

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Comparison of the Outcome between Conventional Open Technique and Minimally Invasive Technique Using Dynamic Hip Screw for Fixation of Inter-Trochanteric Fracture of Femur

Journal of BP Koirala Institute of Health Sciences ◽

10.3126/jbpkihs.v1i2.22073 ◽

2018 ◽

Vol 1 (2) ◽

pp. 7-20

Author(s):

Rajiv Maharjan ◽

S.R. Paneru ◽

R. Rijal ◽

P. Chaudhary ◽

G.P. Khanal

Keyword(s):

Blood Loss ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Invasive Technique ◽

Open Technique ◽

Minimal Incision ◽

Hip Screw ◽

Incision Technique ◽

Operative Recovery

Background: Inter-trochanteric fracture of femur causes significant morbidity and mortality in elderly. Dynamic Hip Screw (DHS) fixation is the most effective and safe method of treatment. Conventional open technique (CDHS) is the popular and familiar one; however, minimal incision technique (MIDHS) has many advantages like: smaller incision, lesser dissection/blood loss, less requirement of transfusion, less painful, faster recovery etc. Objectives: To Compare CDHS and MIDHS technique of DHS fixation for inter-trochanteric fracture femur in terms of functional outcome, safety and associated complications (if any). Methods: Eligible patients presenting within study period were randomized into CDHS group (n= 33) and MIDHS group (n= 32). Success of randomization was tested by analyzing demographics, injury characteristics and pre-op. clinical data (p> 0.05). They were followed up at 2, 6, 12, 24 and 52 weeks post-op. for clinico-radiological and functional assessment. Results: The duration of surgery, lag screw positioning, post-operative hospital stay and surgical site infection were not significantly different between the groups. However, need for blood transfusion, length of incision and post-operative VAS score for pain were significantly lesser for MIDHS group than CDHS group (p< 0.05). Patients in MIDHS group started walking with aids significantly earlier in post-operative recovery period. The Harris Hip Score at final follow-up and grading of the results and surgical complications were not significantly different between the groups. Conclusion: The minimal incision technique had various immediate / short term advantages over conventional technique; like: minimal scar, minimal soft tissue dissection / less blood loss requiring less transfusion, lesser pain in post-operative period and ability to ambulate early.

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Randomised controlled trial of the dynamic hip screw (DHS) versus the proximal femoral nail (PFN) for unstable hip fractures

http://isrctn.org/> ◽

10.1186/isrctn43959180 ◽

2012 ◽

Author(s):

J White

Keyword(s):

Randomised Controlled Trial ◽

Hip Fractures ◽

Controlled Trial ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Femoral Nail ◽

Hip Screw ◽

Randomised Controlled

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Blood loss in trochanteric fractures: multivariate analysis comparing dynamic hip screw and Gamma nail

Injury ◽

10.1016/s0020-1383(17)30657-5 ◽

2017 ◽

Vol 48 ◽

pp. S44-S47 ◽

Cited By ~ 5

Author(s):

Mario Ronga ◽

Daniele Bonzini ◽

Marco Valoroso ◽

Giuseppe La Barbera ◽

Jacopo Tamini ◽

...

Keyword(s):

Multivariate Analysis ◽

Blood Loss ◽

Gamma Nail ◽

Dynamic Hip Screw ◽

Trochanteric Fractures ◽

Hip Screw

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Comparative evaluation of dynamic hip screw and proximal femoral nail for fracture of intertrochanteric femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164033 ◽

2016 ◽

Vol 2 (4) ◽

pp. 286

Author(s):

Sachin Yadav ◽

D. C. Srivastava ◽

Manish Shukla

Keyword(s):

Blood Loss ◽

Wound Infection ◽

Screw Fixation ◽

Dynamic Hip Screw ◽

Interlocking Nail ◽

Intravenous Antibiotics ◽

Superficial Wound ◽

Hip Screw ◽

A Prospective Study

Background: The aim of the present study was to compare the result in terms of rate of union, time of ambulation and functional recovery of fracture intertrochanteric femur treated by dynamic hip screw (DHS) and proximal femoral interlocking nail (PFN) and to compare complications in terms of implant failure, infection, blood loss and C arm exposure in both groups.Methods: This was a prospective study of 92 cases, 38 cases were treated by PFN and 54 cases were treated by DHS. Patients were followed up at 6, 12, 18 and 24 weeks. The results were compared for functional outcome using Palmer and Parker score and also for various complications.Results: Comparison of mobility score at six month follow up period revealed the PFN group to be significantly more mobile (5.8 Vs. 4.19 respectively, p <0.001) than the DHS group. In our study 6 patients managed with DHS (6.52%) developed superficial wound infection which responded to intravenous antibiotics. No patient with PFN had wound infection. Only 2 patients in the PFN group and 12 patients in the DHS group had persistent pain at the incision site.Conclusions: Dynamic hip screw fixation of these fracture requires less preoperative time, is associated with less exposure to radiation but the blood loss is much higher. On the contrary PFN allows faster mobilization and greater mobility scores at six months.

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