Efficacy of percutaneous compression plate for femoral neck fractures in elderly patients / 中华创伤骨科杂志

ABSTRACT

Objective:To investigate the advantages and disadvantages of percutaneous compression plate (PCCP) for femoral neck fractures in the elderly patients.Methods:A retrospective study was conducted of the 31 elderly patients with femoral neck fracture who had been treated with PCCP from January 2012 to December 2018 at Orthopaedic Department, The First People's Hospital of Yancheng, Orthopaedic Department, The Ninth People's Hospital of Wuxi and Department of Orthopaedics, The People's Hospital of Wuxi. They were 16 men and 15 women, aged from 65 to 80 years (average, 70.5 years). By the Garden classification, 7 cases were type Ⅱ, 15 cases type Ⅲ and 9 cases type Ⅳ; by the Singh index, 4 cases were level Ⅲ, 11 cases level Ⅳ, 10 cases level Ⅴ and 6 cases level Ⅵ. The time from injury to operation ranged from 3 to 14 days (average, 5.8 days). The operation time, intraoperative blood loss, fracture reduction, fracture union time, complications and functional recovery of the hip were observed.Results:The operation time averaged 73.4 min and intraoperative blood loss 116.4 mL. At one week after operation, the Garden alignment index was level Ⅰ in 25 cases and level Ⅱ in 6. Superficial incision infection was noted in one case intraoperatively. Follow-ups for the 31 patients ranged from 12 to 47 months (mean, 18.9 months). All the fractures united after 4.9 months on average (from 4 to 8 months). Delayed union occurred in 2 cases, neck shortening in 12 cases, and avascular necrosis of femoral head in 3 displaced subcranial fractures 2 of which were high shear ones. The necrosis of femoral head was treated by arthroplasty in 2 and by conservative treatment in one. The Harris hip scores at the last follow-up for the 31 patients averaged 90.9 (from 75 to 100), giving 15 excellent, 12 good and 4 fair cases and an excellent to good rate of 87.1% (27/31).Conclusions:In treatment of femoral neck fractures in the elderly patients, PCCP has advantages of allowing early weight-bearing after operation, a high rate of fracture union, limited complications and quick and fine functional recovery of the hip. However, it should be used with caution in patients with severe osteoporosis, displaced subcranial or high shear fracture.