Published: 2021-09-28

Comparison between the outcome of proximal femoral locking compression plate and dynamic hip screw in intertrochanteric femoral fractures

Adnan Arif, Hamza Waqar Bhatti, Noman Ahmed Chaudhary, Abdullah Sadiq


Background: Inter-trochanteric femoral fractures are associated with a high complication rate and mortality. This study aims to compare the proximal femoral locking compression plate (PFLCP) with dynamic hip screws (DHS) for inter-trochanteric femoral fractures in terms of mean bone union time.

Methods: It was a prospective randomized study conducted at the department of orthopedics, Benazir Bhutto Hospital, Rawalpindi, Pakistan from June 2015 to December 2015. Sixty patients with a diagnosis of inter-trochanteric fractures, requiring orthopedic surgery, were included in the study. After randomization thirty patients underwent PFLCP fixation and the other thirty patients underwent DHS fixation. Patient information, demographic data, and functional level were assessed. Mean bone union time and implant complications were compared for the two treatment groups.

Results: Patients who underwent PFLCP fixation demonstrated shorter bone union time (2.8±0.2 months) than those who underwent DHS fixation (3.2±0.1 months) (p<0.000). PFLCP group had 90% bone union whereas DHS group had 76.66% bone union at 12 weeks (p=0.16).

Conclusions: PFLCP is better than DHS for intertrochanteric femoral fractures in terms of shorter mean bone union time and fewer complications.


Femoral fractures, Bone screws, Locking compression plate

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Ahn J, Bernstein J. Fractures in brief: intertrochanteric hip fractures. Clin Orthop Relat Res. 2010;468(5):1450-52.

Ozkan K, Unay K, Demicay C. Distal unlocked proximal femoral intramedullary nailing for intertrochanteric femur fractures. Int Orthop. 2009;33(5):1397-400.

Little NJ, Verma V, Fernando C. A prospective trial comparing the Holland nail with the dynamic hip screw in the treatment of intertrochanteric fractures of the hip. J Bone Joint Surg Br. 2008;90(8):1073-8.

McKinley JC, Robinson CM. Treatment of displaced intracapsular hip fractures with total hip arthroplasty: comparison of primary arthroplasty with early salvage arthroplasty after failed internal fixation. J Bone Joint Surg Am. 2002;84(11):2010-5.

Campbell WC, Canale ST, Beaty JH. Campbell’s operative orthopaedics. 11th ed. Philadelphia, PA: Mosby/Elsevier. 2008.

Paganini-Hill A, Chao A, Ross RK, Henderson BE. Exercise and other factors in the prevention of hip fracture: the Leisure World study. Epidemiology. 1991;2(1):16-25.

Rockwood CA, Green DP, Bucholz RW. Rockwood and Green’s fractures in adults. 7th ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams and Wilkins. 2010.

Grisso JA, Kelsey JL, Strom BL, Chiu GY, Maislin G, O’Brien LA et al. Risk factors for falls as a cause of hip fracture in women. The Northeast Hip Fracture Study Group. N Engl J Med. 1991;324:1326-31.

Wenbo Z, Lei L, Hui Z, Yue F, Fuxing P, Tianfu Y. Effect of dynamic hip screw on the treatment of femoral neck fracture in the elderly. Chinese J Traumatol. 2014;17(2):69-72.

Dhamangaonkar AC, Joshi D, Goregaonkar A.B, Tawari AA. Proximal femoral locking plate versus dynamic hip screw for unstable intertrochanteric femoral fractures. J Orthop Surg. 2013;21(3):317-22.

Fogagnolo F, Kfuri M Jr, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg. 2004;124:31-7.

Johnson BJ, Stevenson J, Chamma R. Short-term follow-up of pertrochanteric fractures treated using the proximal femoral locking plate. J Orthop Trauma. 2014;28:283-7.

Knobe M, Drescher W, Heussen N. Is helical blade nailing superior to locked minimally invasive plating in unstable pertrochanteric fractures. Clin Orthop Relat Res. 2012;470:2302-12.

Asif N, Ahmad S, Qureshi OA, Jilani LZ, Hamesh T, Jameel T. Unstable Intertrochanteric Fracture Fixation - Is Proximal Femoral Locked Compression Plate Better Than Dynamic Hip Screw. J Clin Diagn Res. 2016;10(1):RC09-13.

Zha GC, Chen ZI, Qi XB, Sun JY. Treatment of pertrochanteric fractures with a proximal femur locking compression plate. Injury. 2011;42:1294-9.

Streubel PN, Moustoukas MJ, Obremskey WT. Mechanical failure after locking plate fixation of unstable intertrochanteric femur fractures. J Orthop Trauma. 2013;27:22-8.

Glassner PJ, Tejwani NC. Failure of proximal femoral locking compression plate: a case series. J Orthop Trauma. 2011;25:76-83.

Miller DL, Goswami T. A review of locking compression plate biomechanics and their advantages as internal fixators in fracture healing. Clin Biomech. 2007;22:1049-62.

Hu SJ, Zhang SM, Yu GR. Treatment of femoral subtrochanteric fractures with proximal lateral femur locking plates. Acta Ortop Bras. 2012;20:329-333.

Gotfried Y. The lateral trochanteric wall: a key element in the reconstruction of unstable pertrochanteric hip fractures. Clin Orthop Relat Res. 2004;425:82-6.

Boyd HB, Griffin LL. Classification and treatment of trochanteric fractures. Arch Surg. 1949;58(6):853-66.

Agrawal P, Gaba S, Das S, Singh R, Kumar A, Yadav G. Dynamic hip screw versus proximal femur locking compression plate in intertrochanteric femur fractures (AO 31A1 and 31A2): A prospective randomized study. J Nat Sci Biol Med. 2017;8(1):87-93.

Cummings SR, Browner W, Black DM. Bone density at various sites for prediction of hip fractures. Lancet. 1993;341(8837):72-5.

Cummings SR, Nevitt MC, Browner WS. Risk factors for hip fracture in white women. N Eng J med. 1995;332(12):767-74.

Faulkner KA, Cauley JA, Studenski SA. Study of Osteoporotic Fractures Research Group. Lifestyle predicts falls independent of physical risk factors. Osteoporosis int. 2009;20(12):2025-34.

Alswat KA. Gender Disparities in Osteoporosis. J Clin Med Res. 2017;9(5):382-7.

Chinmoy D, Dinesh KM, Sunil S. Trochanteric fractures treated with PFLCP versus DHS. Int J Health Res Med Legal Practice. 2017;3(1):73-6.

Suman S, Meena A, Manjhi L. Dynamic Hip Screw and Proximal Femoral Locking Compression Plate as a Surgical Treatment of Trochanteric Fracture of Femur a Comparative Study. J Dental Med Sci. 2017;16(01):24-6.

Zhong B, Zhang Y, Zhang C, Luo CF. A comparison of proximal femoral locking compression plates with dynamic hip screws in extracapsular femoral fractures. Orthopaed Traumatol Surg Res. 2014;100(6):663-8.

Haidukewych GJ. Intertrochanteric Fractures: Ten Tips to Improve Results. J Bone Joint Surg Am. 2009;91:712-9.