Abstract
Aim
To review the results of patients who underwent fixation of complex proximal femur fractures using the Proximal Femur Locking Plates (PFP) and analyse causes of failure of PFP.
Methods
Retrospective review of radiographs and case notes of PFP fixations in two hospitals between February 2008 and June 2011. Primary outcome was union at six months. Secondary outcome included post-operative complications, and need for further surgical intervention.
Results
There were a total of 32 patients who underwent 34 operations. Two patient had fracture of both the proximal femur requiring bilateral PFP fixation. Mean age of the patients was 68.4 years (range 17–96 years). There were twelve males and twenty female patients. 26 (81%) of the operations were done as primary surgery for fixation of the complex proximal femur fractures. According to the AO/OTA fracture classification, there were four cases of 31-A2.2, seven cases of 31-A2.3, two cases of 31-A3.1 one case each of 31-A3.2 and 32-B1.1 and ten cases of 31 A3.3 fractures. At least six months of follow up was achieved for 30 cases. Union was achieved in 20 fixations (62%) primarily; two more cases needed bone grafting at three months which went on to union improving the total union rate to 70% at 6 months. There was failure of fixation in eight cases requiring further surgery. Varus fixation, loss of posteromedial buttress and loss of protected weight bearing were associated with fixation failure.
Conclusion
Contrary to the reported literature, (1) our results are better. Analysis of the failure cases emphasises the importance of postero medial buttress restoration, avoidance of varus fixation, and protection of weight bearing till fracture unites to achieve good outcome.
