Radiological and functional outcome of unstable intertrochanteric fractures treated with proximal femoral locking plate

Chanchal Kumar Singh, Juhi Deshpande


Background: Intertrochanteric fracture is a common orthopaedic injury sustained in elderly population because of osteoporosis and trivial fall. Life threatening systemic complications occur mainly due to immobility.

Methods: We included 62 patients (40 males and 22 females) of unstable intertrochanteric fracture (AO 31 A2 and A3) attending Department of Orthopaedics. They were all subjected to surgical treatment with proximal femoral locking plate. Patients were followed up at 3rd, 6th and 12th month for outcomes variables i.e.; functional (Harris hip score, Palmer and Parker mobility score) and radiological outcomes (neck shaft angle, loss of reduction, union and implant related complications). Statistical analysis was done using Friedman’s test after calculating the data in terms of mean and median using SPSS 20 software.

Results: Mean age of our patients was 64 years, 40 were males and 22 females. 50 patients sustained fracture due to trivial fall and 12 due to RTA. 35 out of 62 patients had medical co-morbidites. 26 patients needed open reduction of fracture and 36 were close reduced. 22 of patients had severe comminution (AO A 3 III type). Average blood loss was 254 ml. Mean degree of loss of reduction was 5 degrees in 6th month and 4 degrees in 12th month. Union was achieved in 48 out of 50 patients at 12th month.  Most of the patients achieved fair to good functional outcome scores at 12th month of follow up. We noticed difficulties in fracture reduction as well as complications related to implant.

Conclusions: PFLP is an effective implant in comminuted intertrochanteric fractures with broken lateral wall. Complications can be minimised by following principles of locking plate meticulously.


Unstable intertrochanteric fracture, Proximal femoral locking plate, Functional outcome

Full Text:



Broderick JM, Bruce-Brand R, Stanley E, Mulhall KJ. Osteoporotic hip fractures: the burden of fixation failure. ScientificWorldJournal. 2013;515197.

Marks R. Hip fracture epidemiological trends, outcomes, and risk factors, 1970-2009. Int J Gen Med. 2010 Apr 8;3:1-17.

Boyce WJ, Vessey MP. Rising incidence of fracture of the proximal femur. Lancet. 1985;1(8421):150-1.

Hu SJ, Zhang SM, Yu GR. Treatment of femoral subtrochanteric fractures with proximal lateral femur locking plates. Acta Ortop Bras. 2012;20(6):329-33.

Johnson B, Stevenson J, Chamma R, Patel A, Rhee SJ, Lever C, Starks I, Roberts PJ. Short-term follow-up of pertrochanteric fractures treated using the proximal femoral locking plate. J Orthop Trauma. 2014;28(5):283-7.

Zhang L, Shen J, Yu S, Huang Q, Xie Z. Percutaneous compression plate versus dynamic hip screw for treatment of intertrochanteric Hip fractures: a meta-analyse of five randomized controlled trials. Scientific World J. 2014;512512.

Uzun M, Erturer E, Ozturk I, Akman S, Seçkin F, Ozcelik IB. Long-term radiographic complications following treatment of unstable intertrochanteric femoral fractures with the proximal femoral nail and effects on functional results. Acta Orthop Traumatol Turc. 2009;43(6):457-63.

Ozkan K, Turkmen I, Sahin A, Yildiz Y, Erturk S, Soylemez MS. A biomechanical comparison of proximal femoral nails and locking proximal anatomic femoral plates in femoral fracture fixation: A study on synthetic bones. Indian J Orthop. 2015;49(3):347-51.

Yu J, Zhang C, Li L, Kwong JSW, Xue L, Zeng X, et al. Internal fixation treatments for intertrochanteric fracture: a systematic review and meta-analysis of randomized evidence. Sci Rep. 2015;5.

Muhr G, Tscherne H, Thomas R. Comminuted trochanteric femoral fractures in geriatric patients: the results of 231 cases treated with internal fixation and acrylic cement. Clin Orthop Relat Res. 1979;(138):41-4.

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.

Knobe M, Gradl G, Ladenburger A, Tarkin IS, Pape HC. Unstable intertrochanteric femur fractures: is there a consensus on definition and treatment in Germany?. Clin Orthop Relat Res. 2013;471(9):2831-40.

Kumar N, Kataria H, Yadav C, Gadagoli BS, Raj R. Evaluation of proximal femoral locking plate in unstable extracapsular proximal femoral fractures: Surgical technique & mid term follow up results. J Clin Orthop Trauma. 2014;5(3):137-45.

Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop. 1998;(348):87-94.

Evans PJ, McGrory BJ. Fractures of the proximal femur. Hosp Physician 2002;38(4):30-8.

Evans JG, Prudham D, Wandless I. A prospective study of fractured proximal femur: incidence and outcome. Public Health 1979;93(4):235-41.

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

Mittal R, Banerjee S. Proximal femoral fractures: Principles of management and review of literature. J Clin Orthop Trauma. 2012;3(1):15-23.

Miyamoto RG, Kaplan KM, Levine BR, Egol KA, Zuckerman JD. Surgical Management of Hip Fractures: An Evidence-based Review of the Literature. I: Femoral Neck Fractures. J Am Acad Orthop Surg. 2008;16(10):596-607.

Nordin S, Zulkifli O, Faisham WI. Mechanical failure of Dynamic Hip Screw (DHS) fixation in intertrochanteric fracture of the femur. Med J Malaysia 2001;56:12-7.

Kivi M, Mirbolook A, Khajeh JS, Rouhi RM. Fixation of Intertrochanteric Fractures: Dynamic Hip Screw versus Locking Compression Plate. Trauma Mon. 2013;18(2):67-70.

Emami M, Manafi A, Hashemi B, Nemati A, Safari S. Comparison of intertrochanteric fracture fixation with dynamic hip screw and bipolar hemiarthroplasty techniques. Arch Bone Jt Surg. 2013;1(1):14-7.

Streubel PN, Moustoukas MJ, Obremskey WT. Mechanical failure after locking plate fixation of unstable intertrochanteric femur fractures. J Orthop Trauma. 2013;27(1):22-8.

Gadegone WM, Salphale YS. Proximal femoral nail- an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year. Int Orthop. 2007;31(3):403-8.

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 JCDR 2016;10(1):9-13.

Balasubramanian N, Babu G, Prakasam S. Treatment of Non Unions of Subtrochanteric Fractures Using an Anatomical Proximal Femur Locked Compression Plate - A Prospective Study of 13 Patients. J Orthop Case Rep. 2016;6(1):65-8.

Parker MJ, Blundell C. Choice of implant for internal fixation of femoral neck fractures. Meta-analysis of 25 randomised trials including 4,925 patients. Acta Orthop Scand. 1998;69(2):138-43.

Yu J, Zhang C, Li L, Kwong JSW, Xue L, Zeng X, et al. Internal fixation treatments for intertrochanteric fracture: a systematic review and meta-analysis of randomized evidence. Sci Rep. 2015;5.

Fogagnolo F, Kfuri M, Paccola CJ. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg. 2004;124(1):31-7.

LLW. Hip Fracture Mortality: Relation to Age, Treatment, Preopera: Clinical Orthopaedics and Related Research. Available at:,.8.aspx. Accessed on 22 June 2021.

Castelli A, Daidone S, Jacobs R, Kasteridis P, Street AD. The Determinants of Costs and Length of Stay for Hip Fracture Patients. PLoS One. 2015;10(7):133545.

Mangram A, Moeser P, Corneille MG, Prokuski LJ, Zhou N, Sohn J, et al. Geriatric trauma hip fractures: is there a difference in outcomes based on fracture patterns? World J Emerg Surg WJES. 2014;9.

Desai SJ, Wood KS, Marsh J, Bryant D, Abdo H, Lawendy AR, et al. Factors affecting transfusion requirement after hip fracture: Can we reduce the need for blood? Can J Surg 2014;57(5):342-8.

Zhang L, Yin P, Lv H, Long A, Gao Y, Zhang L, Tang P. Anemia on Admission Is an Independent Predictor of Long-Term Mortality in Hip Fracture Population: A Prospective Study With 2-Year Follow-Up. Medicine. 2016;95(5):2469.

Wieser K, Babst R. Fixation failure of the LCP proximal femoral plate 4.5/5.0 in patients with missing posteromedial support in unstable per-, inter, and subtrochanteric fractures of the proximal femur. Arch Orthop Trauma Surg. 2010;130(10):1281-7.

Lin KJ, Wei HW, Lin KP, Tsai CL, Lee PY. Proximal Femoral Morphology and the Relevance to Design of Anatomically Precontoured Plates: A Study of the Chinese Population. Sci World J. 2014;201694.

Kim WY, Han CH, Park JI, Kim JY. Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop. 2001;25(6):360-2.

Gunadham U, Jampa J, Suntornsup S, Leewiriyaphun B. The outcome in early cases of treatment of subtrochanteric fractures with proximal femur locking compression plate. Malays Orthop J. 2014;8(2):22-8.

Jonnes C, Najimudeen S. Type II Intertrochanteric Fractures: Proximal Femoral Nailing (PFN) Versus Dynamic Hip Screw (DHS). Arch Bone Jt Surg. 2016;4(1):23-8.

Hsueh KK, Fang CK, Chen CM, Su YP, Wu HF, Chiu FY. Risk factors in cutout of sliding hip screw in intertrochanteric fractures: an evaluation of 937 patients. Int Orthop. 2010;34(8):1273-6.

Schneider K, Oh JK, Zderic I, Stoffel K, Richards RG, Wolf S, et al. What is the underlying mechanism for the failure mode observed in the proximal femoral locking compression plate? A biomechanical study. Injury. 2015;46(8):1483-90.