Reverse Contralateral Distal Femoral Locking Compression Plate for Subtrochanteric Femoral Fractures: A Comparative Retrospective Study with Cephalomedullary Nail and Technical Note

Background: Cephalomedullary nails (CMN) have been proven to be the implant of choice in Subtrochanteric Femoral Fractures. The reverse contralateral distal femoral locking compression plate (DF-LCP) is an alternative fixation in cases that are unsuitable for nailing. The comparative studies made of these two fixation techniques are inadequate. Objective: To retrospectively analyze and compare the outcomes of these two fixation techniques and demonstrate the apparent surgical technique for applying the reverse contralateral DF-LCP. Materials and Methods: The present study included patients over 18 years of age diagnosed of subtrochanteric fractures and treated with either DF-LCP or CMN. Retrospective comparative analyses of union time, operative times, estimated blood loss, and complications were conducted from their medical records and serial radiographs. The surgical technique for reverse contralateral DF-LCP fixation is also described in the present study. Results: The present study enrolled 106 eligible patients, in which 33 patients were treated with reverse contralateral DF-LCP, and 73 patients with CMN. There were no significant differences in age, gender, type of fracture, or history of smoking between the two groups. However, there were significant differences in the requirements of the open reduction technique with 26 fractures (78.8%) in the DF-LCP group and 17 fractures (23.3%) in the CMN group (p<0.001). The comparative outcomes of the DF-LCP and CMN groups demonstrated the statistically significant difference in the number of malreductions or malunions, comprising four events (12.1%) and 22 events (30.1%), respectively (p=0.036). There were no statistically significant differences in terms of union time, operative time, and the amounts of estimated blood loss. Conclusion: The reverse contralateral DF-LCP fixation technique demonstrated comparable outcomes in terms of union time, operative time, and blood loss, and was deemed a safe procedure for subtrochanteric femoral fracture. Lower occurrences of malreduction or malunion complication were shown in DF-LCP group. Keywords: Subtrochanteric fracture; Reverse contralateral distal femoral locking compression plate; Cephalomedullary nail