PCCP – First Choice of the Treatment of Trochanteric Fractures in our Orthopaedic Department

Česká verzia

Authors: M. Šimeček; K. Šimeček; V. Svoboda; T. Peterka
Authors place of work: Ortopedicko-traumatologické oddělení Nemocnice Písek a. s. přednosta: prim. MUDr. Karel Šimeček
Published in the journal: Rozhl. Chir., 2010, roč. 89, č. 2, s. 150-158.
Category: Monothematic special - Original

Summary

Introduction:
The authors present their experiences with the treatment of trochanteric fractures (31A1.1-31A3.3) using the Gotfried’s percutaneous compression plate (PCCP). The authors evaluate some parameters at other kinds of osteosynthesis in the same indication.

Material:
We made 230 osteosynthesis of trochanteric fractures in the period from August 2004 to December 2008. The PCCP was used 179x (72x type 31A1.1-3, 90x type 31A2.1-3, 17x type 31A3.1-3). The other kinds of osteosynthesis were used 51x (DHS 40x, PFN 9x and condylar plate 2x) in the same indication. The mean age, the hospitalization time, the interval admission – operation, wound complications and the lethality within 30 days, 90 days and 1 year were evaluated. Some patients were lost to follow up or died. The bone healing was evaluated at 119 PCCP and 43 other osteosynthesis, which remained in the study.

Method:
The stabilisation is done via two 2–3 cm long incisions. The plate, assembled on a introducer, is inserted through the proximal incision. The special hook for the plate fixation to the bone, two angular stable self-cutting neck screws and three diaphyseal screws are inserted from the distal incision.

Results:
The first value concerns the PCCP, the value in brackets concerns the other osteosynthesis. Number 179 (51).The mean age 78.9 (76.2) years, the interval admission – operation 0.95 (1.12) days, the hospitalization time 15.3 (16.5) days, the wound hematoma and revision 3 (1), the wound infection and revision 1 (1). Died within 30 days 8.4% (5.9%), within 90 days 13 % (13.7% ), within 1 year 33.9 % (29.2%). All 119 patients with PCCP (including 15 type AO 31A3) were healed within 8 months. No pseudoarthrosis, collaps or cut-out were noted at the PCCP group. Four failures, caused by an unsuitable indication or by a surgeon error, were noted in the group of the other osteosynthesis.

Discussion:
The advantage of the PCCP is minimally invasive technique and rotation stability. The authors proved that the PCCP reduces and fixes the fractured lateral wall at high subtrochanteric fractures (31 A3.1-3). The wall is healed and prevents collapse. The authors indicate AO type 31A3 fractures to the PCCP unlike the author of the method.

Conclusion:
The study confirmed that the PCCP is a minimally invasive osteosynthesis suitable for all types of trochanteric fractures. All 119 followed up patients including 15 with 31 A3.1-3 fractures were healed.

Key words:
intertrochanteric fracture – pertrochanteric fracture – PCCP – MIO – lateral trochanteric wall – minimally invasive osteosynthesis

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