Perioperative lateral trochanteric wall fractures: Sliding hip screw versus percutaneous compression plate for intertrochanteric hip fractures

Objectives: This study was performed to determine the incidence of perioperative lateral wall fractures with a standard sliding hip screw (SHS) versus a percutaneous compression plate (PCCP) using identical meticulous closed reduction techniques in both groups. Design: Retrospective analysis of a prospective trauma registry. Setting: Urban Level I trauma center. Patients: Over a 7-year period, 337 patients with intertrochanteric hip fractures were treated with either a SHS or a PCCP at our institution. The PCCP group (Group 1) consisted of 200 patients, of which 141 (71%) had adequate images to be included in the study. The SHS group (Group 2) consisted of 137 patients, of which 100 (73%) had adequate images to be included in the study. Intervention: Closed reduction and plate application with either a standard sliding hip screw or a percutaneous compression plate for an Orthopaedic Trauma Association 31A1 or 31A2 intertrochanteric hip fracture. Main Outcome Measure: Radiographic evidence of lateral trochanteric wall fracture as measured by intraoperative and perioperative radiographs. Results: There was an overall lateral wall fracture incidence of 20% in the SHS group versus 1.4% in the PCCP group (P < 0.01). For the unstable 31A2 fracture types, there was a lateral wall fracture incidence of 29.8% in the SHS group versus 1.9% in the PCCP group (P < 0.01). Conclusions: Overall, the PCCP group had a significantly decreased incidence of lateral trochanteric wall fracture compared with the SHS group. This difference became greater when just unstable intertrochanteric fractures were analyzed. An anatomic reduction, combined with a device (PCCP) that uses small-diameter defects in the lateral trochanteric wall, essentially eliminates perioperative lateral trochanteric wall fractures.