Limited access surgery is thought to reduce post-operative morbidity and provide faster recovery of function. The percutaneous compression plate (PCCP) is a recently introduced device for the fixation of intertrochanteric fractures with minimal exposure. It has several potential mechanical advantages over the conventional compression hip screw (CHS). Our aim in this prospective, randomised, controlled study was to compare the outcome of patients operated on using these two devices.

We randomised 104 patients with intertrochanteric fractures (AO/OTA 31.A1–A2) to surgical treatment with either the PCCP or CHS and followed them for one year postoperatively.

The mean operating blood loss was 161.0 ml (8 to 450) in the PCCP group and 374.0 ml (11 to 980) in the CHS group (Student’s t-test, p < 0.0001). The pain score and ability to bear weight were significantly better in the PCCP group at six weeks post-operatively. Analysis of the radiographs in a proportion of the patients revealed a reduced amount of medial displacement in the PCCP group (two patients, 4%) compared with the CHS group (10 patients, 18.9%); Fisher’s exact test, p < 0.02.

The PCCP device was associated with reduced intra-operative blood loss, less postoperative pain and a reduced incidence of collapse of the fracture.

Introduction: Minimally invasive surgery (MIS) is associated with reduced postoperative morbidity and faster recovery of function. The PerCutaneous Compression Plate (PCCP) device was recently developed by Got-fried as a MIS technique for the fixation of osteoporotic hip fractures. PCCP provides rotational stability by means of two hip screws, and lateral cortical support by a proximal extension of the plate and by the relatively small diameter (9.3 mm) of the hip screws. The purpose of this prospective study is to compare the outcome of PCCP to the “gold standard” Compression Hip Screw (CHS) device.

Methods: 104 Patients with intertrochanteric fractures were randomized to be treated by PCCP (50 patients) or CHS (53 patients). One patient was switched from PCCP to CHS during surgery. Inclusion criteria were age above 60, close fracture reduction, no pathological fracture, and no surgical procedure in the same leg in the last year.

Results: The groups were comparable in patient age, gender, ASA, length of surgery and hospital stay. Operative blood loss was 177.8 ml in the PCCP group and 371.3 ml in the CHS group (p< 0.0001). At the 6^th week clinic visit, patients in the PCCP group were able to bear more weight on the injured leg than patients in the CHS group (p< 0.03). Mortality during the first year follow-up period was 10% in the PCCP group and 24.5% in the CHS group (p~0.05). Analysis of X-ray radiographs revealed collapse in 4% of the patients in PCCP group and 19% in CHS group (p< 0.01).

Conclusions: Our results suggest that PCCP provides some of the advantages of MIS: reduced blood loss, as well as improves the stability of fracture fixation, demonstrated by improved early weight bearing and less fracture collapse. We found a trend for decreased first year mortality rate.