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Abstract

Background:

Hip fractures are common, expensive and lead to considerable morbidity and mortality. An ageing population in the United Kingdom means that rates of this injury are increasing, making them a pressing public health issue. The National Institute of Health and Care Excellence (NICE) recommends that extramedullary implants are used over intramedullary nails to fix intertrochanteric fractures, which make up half of all hip fractures. However, there is currently no guidance on the preferred type of extramedullary device whether this be the commonly used dynamic hip screw (DHS) or another newer device. It has been suggested that a percutaneous compression plate (PCCP) can reduce complications and improve functional outcome compared with the traditional DHS.

Review Question:

In patients with intertrochanteric hip fractures, is the PCCP more effective than the DHS in terms of relevant intraoperative and postoperative outcomes such as blood loss, implant failure, and mortality?

Literature Search:

We first searched for relevant information in the NICE Clinical Guideline on Hip Fracture Management (CG124), then National Health Service (NHS) evidence for Clinical Knowledge Summaries, then the Cochrane library for systematic reviews. Finally, we conducted an electronic search of the PubMed database.

Review Findings:

We selected five systematic reviews and eight primary studies for review. The main findings were that the PCCP was associated with significantly less blood loss, fewer blood transfusions, and shorter operating times compared with the DHS. However, no significant differences were found in postoperative pain, orthopaedic performance, and mortality rates between the two methods. There was no comparison of cost-effectiveness between the two methods.

Conclusions:

The PCCP is superior to the DHS in terms of intraoperative blood loss and, potentially, non-orthopaedic postoperative complications such as deep vein thrombosis and nosocomial infection. However, there was no significant difference in mortality rates between the two methods. Current studies on this topic have several methodological issues and some are of relatively poor quality. Further higher quality research and cost-effectiveness are necessary to further evaluate the efficacy of these methods.

Keywords

Hip fracture internal fixation outcomes

Introduction

Hip fractures are a very common cause of hospital admission in the United Kingdom. Around 75 000 patients suffer a hip fracture each year, at considerable cost to the National Health Service (NHS) – more than £2 billion.¹ Hip fractures are becoming more common due to an ageing population, with an approximate year on year increase of 1%.² Over 90% of patients are more than 65 years of age and often have multiple comorbidities.³ Unsurprisingly, hip fractures are a leading cause of mortality and morbidity among elderly patients.⁴ Therefore, hip fractures represent a crucial public health issue with their optimal management being vital for both patient and health service, particularly in the current climate of budget cuts and increasing pressure on the service.

In this evidence review, we will focus on the management of extracapsular fractures (distal to hip joint). In particular, we will look at trochanteric fractures, which make up around half of hip fractures, and their surgical outcomes. The best management has been debated for over 30 years; the aim is to achieve a stable fixation while simultaneously allowing early recovery. The failure of these implants is related either due to the type of fixation used or the stability of the fracture.⁵ Over the years, several methods have been proposed to provide optimum fixation.⁶ It has been shown recently that prompt surgical management (within 24 hours) using internal fixation under regional anaesthesia reduces mortality rates.⁷

The National Institute for Health and Care Excellence (NICE) guidelines for hip fracture management detail the surgical procedure for these trochanteric fractures:

Use extramedullary implants such as a sliding hip screw in preference to an intramedullary nail in patients with trochanteric fractures.⁸

It has been shown elsewhere, such as in a 2014 Cochrane Review, that a sliding hip screw (dynamic hip screw in this review) is superior to an intramedullary nail and further comparison with intramedullary nail methods is not a priority.⁹ However, NICE does not explicitly state the optimum extramedullary implant, highlighting the uncertainty and debate surrounding this. In this evidence review, we will be comparing the use of 2 different extramedullary implants: dynamic hip screw (DHS) and percutaneous compression plating (PCCP).

Over several years, the DHS has demonstrated effective stabilisation of trochanteric fractures with excellent functional outcomes.¹⁰ The DHS comprises a plate and screws applied to the lateral side of the femur and allows the fracture to collapse in a controlled fashion, providing stability while allowing prompt postoperative weight bearing.^11,12 The DHS is used extensively in NHS practice, and results from the National Hip Database for 2016 show that around 80% of trochanteric fractures receive the DHS implant.¹³

In the late 1990s, Gotfried proposed a new surgical technique for the management of intertrochanteric fractures using the PCCP. It was suggested this new implant has fewer complications and better outcomes when compared with the DHS.¹⁴ Percutaneous compression plate is a minimally invasive technique (inserted via 2 small ports) and provides increased rotational stability (uses 2 screws instead of 1).¹⁵ Figure 1 shows a radiological comparison of the 2 implants.

Figure 1.

Radiological comparison of dynamic hip screw¹⁶ and percutaneous compression plate.¹⁷

In this literature review, we will evaluate current literature to examine important intraoperative and postoperative complications to determine whether PCCP is a preferable method of fixation compared with DHS.

Methods

Search strategy and inclusion/exclusion criteria

We first searched for high-quality secondary sources such as clinical guidelines from NICE. Percutaneous compression plate was not mentioned in the most recent guideline on hip fracture management in CG124 published in June 2011 and last updated in March 2014.

Therefore, we then searched for Clinical Knowledge Summaries on this subject using NHS evidence. The following search terms were used sequentially:

1. Percutaneous compression plate
2. Dynamic hip screw
3. Hip fracture

However, this did not return any relevant documents.

Following this, we consulted the Cochrane library for systematic reviews on this subject with the following search term:

Dynamic hip screw AND percutaneous compression plate

This returned one relevant systematic review which was included in this study.¹¹

Finally, we searched for primary sources with an electronic search of the PubMed database using the search term on February 21, 2017:

((((((Gotfried percutaneous compression plate AND dynamic hip screw)) OR (Gotfried percutaneous compression plate AND sliding hip screw)) OR (percutaneous compression plating AND sliding hip screw)) OR (percutaneous compression plating AND dynamic hip screw)) OR (percutaneous compression plate AND hip fracture)) OR Gotfried percutaneous compression plate

We reviewed the identified studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines¹⁸ with a pre-defined set of inclusion/exclusion criteria. Studies were first reviewed by title, with all eligible studies proceeding to abstract review. Then, studies deemed ineligible on abstract review were excluded, with the remaining studies proceeding to full-text review. The reference list of reviewed articles was consulted to potentially identify further studies not identified at electronic search.

Inclusion/exclusion criteria

All included studies compared intraoperative and postoperative outcomes for PCCP and DHS methods of fixation for intertrochanteric fractures of the hip. Studies were excluded if they were not conducted on humans, cadaveric, or not in English language. Furthermore, studies were excluded if they did not compare the PCCP method with DHS, included fractures other than intertrochanteric, or did not report relevant outcomes. Finally, one study was excluded as it was not available in full-text form. Figure 2 displays the literature search process.

Figure 2.

Literature search. DHS indicates dynamic hip screw; PCCP, percutaneous compression plating.

Data extraction

From each included study, relevant intraoperative and postoperative outcomes for both PCCP and DHS groups were obtained. An outcome was only included in this review if more than one primary study and more than one meta-analysis reported it.

Data analysis

No original data analysis has been undertaken as part of this review. Instead, findings of the included studies have been described.

Quality assessment

The studies we reviewed were assessed using CASP (Critical Appraisal Skills Programme) checklist tools by at least 2 of the authors.¹⁹

Results

Characteristics of included studies

Five systematic reviews were included in this review.^11,20–23 Four of these were from China^20–23 and one was from the United Kingdom.¹¹ The number of studies included in these reviews ranged from 5 to 14.^20,21,23 Both randomised and non-randomised studies were included in these reviews (Table 1).

Table 1.

Characteristics of included systematic reviews.

Author	Year of publication	Country of origin	Number of studies included	Number of RCTs included	Number of qRCTs included	Number of NRS included
Long et al²⁰	2016	China	5	5	0	0
Zhang et al²¹	2014	China	5	5	0	0
Parker and Das¹¹	2013	United Kingdom	4	4	0	0
Ma et al²²	2012	China	9	5	1	3
Cheng et al²³	2012	China	14	5	1	8

Abbreviations: NRS, non-randomised study; qRCT, quasi-randomised controlled trial; RCT, randomised controlled trial.

Eight primary studies from different countries were included in this review^17,24–30 (Table 2). Seven of the primary studies were randomised controlled trials (RCTs)^{17,24,26–30} and one was a retrospective non-randomised trial²⁵ (Table 4). The number of participants ranged from 68 to 280.^25,26

Table 2.

Characteristics of included primary studies.

Author	Year of publication	Country of origin	Study type	No. of participants
Cheng et al²⁴	2014	China	P-RCT	151
Gaddi et al²⁵	2014	Italy	NRS	280
Yang et al²⁶	2011	America	P-RCT SB	68
Peyser et al¹⁷	2007	Israel	P-RCT	103
Peyser et al²⁷	2005	Israel	NRS	263
Brandt et al²⁸	2002	Netherlands and Belgium	P-RCT	71
Kosygan et al²⁹	2002	England	P-RCT	108
Janzing et al³⁰	2002	Belgium	P-RCT	115

Abbreviations: NRS, non-randomised study; P-RCT, prospective randomised controlled trial; qRCT, quasi-randomised controlled trial; SB, single blinded.

Systematic review and meta-analyses review results

The findings from the 5 meta-analyses from the systematic reviews are summarised in Tables 3 and 4. Every study except that by Parker and Das¹¹ found that the PCCP method was associated with significantly less intraoperative blood loss. All of the meta-analyses found that a significantly higher number of blood units were given to DHS patients compared with PCCP patients.^11,20–23 The study by Cheng et al²³ was the only one to find that PCCP was associated with a significantly reduced fall in haemoglobin compared with the DHS technique. The studies by Cheng et al²³ and Ma et al²² found that the PCCP technique had significantly shorter operation times and fewer patients that received a blood transfusion compared with the DHS group. The studies by Long et al²⁰ and Cheng et al²³ found that the PCCP group had significantly fewer postoperative complications (Tables 3 and 4).

Table 3.

Intraoperative outcomes for PCCP and DHS as reported by meta-analyses included in this review.

Study	Length of surgery, min		Intraoperative blood loss, mL		Fall in Hb		Mean units of blood transfused		No. of patients transfused
Study	PCCP	DHS	PCCP	DHS	PCCP	DHS	PCCP	DHS	PCCP	DHS
Long et al²⁰	NSD		Favour PCCP		—		Favour PCCP		—
Zhang et al²¹	NSD		Favour PCCP		—		Favour PCCP		—
Parker and Das¹¹	NSD		NSD		NSD		Favour PCCP		NSD
Ma et al²²	Favour PCCP		Favour PCCP		—		—		Favour PCCP
Cheng et al²³	Favour PCCP		Favour PCCP		Favour PCCP		—		Favour PCCP

Abbreviations: DHS, dynamic hip screw; Hb, haemoglobin; NSD, no significant difference; PCCP, percutaneous compression plating.

Bold formatting indicates significant difference at P = .05 as reported; — indicates not reported.

Table 4.

Postoperative outcomes for PCCP and DHS as reported by meta-analyses included in this review.

Study	Reoperation		Cut-out		Other fracture healing complications		Wound infection		Non-orthopaedic postoperative complications (eg, pneumonia, DVT)		Length of hospital stay, d		Mean VAS pain score		Mortality
Study	PCCP	DHS	PCCP	DHS	PCCP	DHS	PCCP	DHS	PCCP	DHS	PCCP	DHS	PCCP	DHS	PCCP	DHS
Long et al²⁰	—		—		—		—		Favour PCCP		NSD		—		NSD
Zhang et al²¹	NSD		NSD		NSD		—		NSD		NSD		—		NSD
Parker and Das¹¹	NSD		NSD		NSD		NSD		NSD		NSD		—		NSD
Ma et al²²	—		—		—		—		NSD		NSD		—		—
Cheng et al²³	—		—		—		—		Favour PCCP		—		—		—

Abbreviations: DHS, dynamic hip screw; Hb, haemoglobin; NSD, no significant difference; PCCP, percutaneous compression plating.

Bold formatting indicates significant difference at P = .05 as reported; cut-out, need for operative removal of implant component; — indicates not reported.

No significant difference was found between the PCCP group and DHS group in terms of postoperative length of stay,^11,20–22 orthopaedic complications,^11,21 or mortality rates^11,20–23 (Tables 3 and 4). Notably, none of these meta-analyses included postoperative pain in their analyses (Table 4).

Primary study review results

The 8 primary studies that were identified were selected for review. Their findings are summarised in Tables 5 and 6. Of the 8 studies, 5 found that the operating time for PCCP was significantly shorter than that for DHS.^{24,26–28,30} Only 1 study reported that DHS operating times were significantly shorter than PCCP times,²⁹ whereas the remaining 2 studies found no significant difference between the 2 methods.^17,25 In addition, 3 studies found that DHS was associated with a significantly higher intraoperative blood loss compared with PCCP.^17,24,26 The remaining study by Kosygan et al²⁹ reported no significant difference between the 2 methods. The study by Brandt et al²⁸ found that significantly more DHS patients received a blood transfusion compared with PCCP patients. The other 2 studies found no significant difference between the 2 techniques.^17,24 Janzing et al³⁰ were the only group to report a significantly lower mean visual analog scale postoperative pain score in the PCCP group compared with the DHS group.

Table 5.

Intraoperative outcomes for PCCP and DHS as reported by primary studies included in this review.

Study	Length of surgery, min		Intraoperative blood loss, mL		Fall in Hb		Mean units of blood transfused		No. of patients transfused
Study	PCCP	DHS	PCCP	DHS	PCCP	DHS	PCCP	DHS	PCCP	DHS
Cheng et al²⁴	55.2	88.5	156.5	513.2	—	—	—	—	2 (3.1%)	25 (44.6%)
Gaddi et al²⁵	54.15	56.97	—	—	2.04	2.02	0.17	0.24	—	—
Yang et al²⁶	48	78	41	101	—	—	0.72	1.06	—	—
Peyser et al¹⁷	53.2	51.1	73.4	223.5	2.4	2.6	1.2	1.3	34 (68.0%)	42 (79.2%)
Peyser et al²⁷	67.5	82.7	—	—	—	—	—	—	—	—
Brandt et al²⁸	45.3	63.8	—	—	—	—	—	—	6 (18.2%)	24 (63.2%)
Kosygan et al²⁹	58	49	68	83.6	2.4	2.7	1.2	1.7	—	—
Janzing et al³⁰	49	65	—	—	1.87	2.46	0.56	0.97	—	—

Abbreviations: DHS, dynamic hip screw; Hb, haemoglobin; PCCP, percutaneous compression plating.

Bold formatting indicates significant difference at P = .05 as reported; — indicates not reported.

Table 6.

Postoperative outcomes for PCCP and DHS as reported by primary studies included in this review.

Study	Reoperation		Cut-out		Other fracture healing complications		Wound infection		Non-orthopaedic postoperative complications (eg, pneumonia, DVT)		Length of hospital stay, d		Mean VAS pain score		1-y mortality
Study	PCCP	DHS	PCCP	DHS	PCCP	DHS	PCCP	DHS	PCCP	DHS	PCCP	DHS	PCCP	DHS	PCCP	DHS
Cheng et al²⁴	—	—	—	—	0 (0%)	2 (3.6%)	—	—	—	—	7.85	8.2	2.65	4.93	—	—
Gaddi et al²⁵	—	—	—	—	—	—	—	—	—	—	—	—	—	—	13 (15.1%)	38 (19.6%)
Yang et al²⁶	—	—	0 (0%)	0 (0%)	0 (0%)	0 (0%)	—	—	—	—	—	—	3	3	5 (15.2%)	9 (27.3%)
Peyser et al¹⁷	3 (6%)	1 (1.9%)	1 (2%)	2 (3.8%)	2 (4%)	2 (3.8%)	0 (0%)	1 (1.9%)	9 (18.0%)	11 (20.8%)	11.1	10.9	—	—	5 (10%)	13 (24.5%)
Peyser et al²⁷	—	—	—	—	—	—	—	—	—	—	11.6	9.9	—	—	—	—
Brandt et al²⁸	1 (3.0%)	3 (7.9%)	—	—	2 (6.1%)	4 (10.5%)	—	—	6 (18.2%)	10 (26.3%)	—	—	—	—	—	—
Kosygan et al²⁹	1 (1.8%)	2 (3.6%)	2 (3.6%)	2 (3.6%)	2 (3.6%)	3 (3.6%)	0 (0%)	1 (1.8%)	—	—	23.8	21.7	—	—	7 (13.5%)^a	9 (16.1%)^a
Janzing et al³⁰	4 (7.5%)	2 (3.2%)	3 (5.6%)	1 (1.6%)	4 (7.5%)	2 (3.2%)	—	—	—	—	—	—	3.2	4.2	11 (20.1%)	12 (19.4%)

Abbreviations: DHS, dynamic hip screw; Hb, haemoglobin; PCCP, percutaneous compression plating.

Bold formatting indicates significant difference at P = .05 as reported; cut-out, need for operative removal of implant component; — indicates not reported.

Measured 6 months postoperatively.

No significant difference was found between the PCCP group and DHS group in terms of length of stay,^17,24,27,29 mortality,^{17,25,26,29,30} non-orthopaedic postoperative complications,^17,28 reoperation rate,^17,28–30 implant failure,^17,26,29,30 fracture healing,^{17,24,26,28–30} postoperative fall in haemoglobin,^17,25,29,30 or units transfused.^{17,25,26,29,30}

Quality Assessment of Included Studies

The quality of each study included in this review was critically appraised. In terms of patient inclusion and exclusion criteria, only Ma et al²² excluded studies with pathological or metastatic fractures, unstable fractures, and contralateral fractures.

The search strategies used by the reviews were thorough. Adequate databases, including EMBASE, MEDLINE, the CCRCT, and the World Health Organization (WHO) International Clinical Trials Registry, were searched with definitive search terms in all reviews. However, Zhang et al,²¹ Parker and Das,¹¹ and Long et al²⁰ did not search for any non-English literature and only Cheng et al,²³ Parker and Das,¹¹ and Ma et al²² looked through reference lists for relevant studies. Ma et al²² was the only study to search for unpublished literature, giving it the greatest scope in terms of search strategy. Sample sizes throughout the trials were small which may underpower the results of the reviews.

Bias assessment was performed by 2 authors independently in all reviews. A number of acceptable methods were used, including the Cochrane tool and Coleman methodology score. Zhang et al²¹ and Long et al²⁰ had strict exclusion criteria, excluding quasi-randomised controlled trials (qRCTs). However, Cheng et al²³ and Ma et al²² allowed non-randomised trials and found a high risk of selection bias. Ma et al²² found a universally unclear risk of performance, attrition, and detection bias but a low risk of reporting bias. Zhang et al²¹ identified 2 trials with a high risk of attrition bias, and both Zhang et al²¹ and Long et al²⁰ found an unclear risk of performance and detection bias in all but one trial. Only one trial, by Yang et al,²⁶ blinded outcome assessment which may reduce risk of detection bias. The only review to account for surgeon experience in assessing bias was the work by Parker and Das¹¹; they found that only 2 RCTs, those by Kosygan et al²⁹ and Peyser et al,¹⁷ included this. The presence of publication bias was found in all reviews apart from Parker and Das.¹¹ This may over-represent studies that indicate a difference between PCCP and DHS.

Two RCTs, Janzing et al³⁰ and Brandt et al,²⁸ used the same data set. These were included in the reviews by Zhang et al,²¹ Ma et al,²² and Long et al²⁰ and may be over-represented in meta-analyses. However, these studies scored well in the bias assessment and so their data are likely valid.

Discussion

This review compares the performance of the DHS and PCCP for fixation of intertrochanteric fractures in terms of intraoperative and postoperative outcomes. The outcomes of 5 systematic reviews and 8 primary studies were compared. The main finding is that PCCP reduces intraoperative blood loss compared with DHS while providing good fixation for intertrochanteric fractures, which has also been shown elsewhere.³¹

The systematic reviews focused on slightly different outcomes which made comparison more difficult. For example, blood loss was measured, either through postoperative haemoglobin drops or intraoperative losses in millilitre. Nevertheless, all reported length of surgery, blood loss, and postoperative complications. Of the 5 reviews, 4 reported mortality,^11,20,21,23 transfusion rate,^11,22,23 volume,^11,20,21 and hospital stay.^11,20–22 Only 2 of the reviews reported implant-specific complications (eg, reoperation^11,21), fall in Hb,^11,23 and fracture healing complications.^11,21

The data regarding operation time, blood loss, transfusion rate, and hospital stay length were highly heterogeneous, with almost all consistently scoring in the high 90% range on the I2 test (χ2 was also used) in all systematic reviews.

There are issues concerning some of the outcomes. For example, operation time is affected more by fracture type than procedure,³² something which was taken into account only by Ma et al,²² which included only AO/OTA 31.A1-A2 type fractures (stable fractures). In addition, other reviews included trials which used different fracture classifications, either the American Orthopaedic or the Evans fracture type, which could potentially lead to patients having different severity of fracture. Surgeon experience and familiarity with the procedures is also a crucial factor influencing operating time. Some RCTs did provide a learning curve for surgeons to become familiar with the procedure, such as Cheng et al²⁴; only the review by Parker and Das¹¹ specifically considered this.

Length of hospital stay is relevant yet difficult to compare between reviews as it is heavily impacted by country and hospital-specific factors, patient comorbidity, and rehabilitation, none of which were controlled for. Other outcomes are also dependent on various confounding factors such as transfusion rate as different hospitals/countries use different guidelines for transfusion.

There were some problems identified with the PCCP method in the studies, which may hinder wide-scale use. For example, the PCCP is a more challenging operation than the DHS³⁰ which may make it unfeasible to train surgeons in the time-pressured environment of the NHS. In addition, the cost of this implant has not been compared with the DHS.³³ The lack of information regarding the cost of PCCP may be indicative of high cost. Cost-effectiveness is extremely important and decisive factor in many treatments.

The most recent studies improved in quality, including only randomised trials. This is important to consider when interpreting the results, as this may have reduced the number of significant differences seen in later trials between the 2 methods. Generally, the methodology in these systematic reviews, in particular, those by Zhang et al²¹ and Long et al,²⁰ is valid. The review by Ma et al²² had good methodology but included qRCTs which introduced risk of selection bias into the results. The study by Cheng et al²³ was generally well conducted, with an extensive search strategy and large number of trials, although the inclusion of non-randomised trials and qRCTs makes its data less reliable than other reviews. The review by Parker and Das¹¹ had generally good study design and considered factors such as the impact of surgeon experience, which the other studies did not, as well as looking at more comprehensive outcomes. The outcomes chosen by the other reviews could have been more complete with pain levels, a very important surgical outcome³⁴ and mobility largely absent. The heterogeneity associated with some of the outcomes measured was unavoidable but significant. Overall, we thought that all of the reviews met an acceptable level of evidence while also highlighting the need for further research.

This study comprehensively reports the findings of all relevant studies comparing the performance of PCCP and DHS for intertrochanteric fractures and assesses the quality of the evidence thoroughly. A limitation of this work is the lack of an original meta-analysis.

The number of patients used in the systematic reviews was relatively small and from different countries which makes it difficult to apply these results directly to a UK population. However, we believe that these results warrant further research into the possible benefits of PCCP for the UK population. It may be helpful to set up a registry for trochanteric fracture implants and their outcomes, similar to the National Joint Registry. This could be useful as it may track differences in the UK setting between treatment modalities and their outcomes and highlight any important differences in outcomes.

Conclusions

In conclusion, PCCP appears to demonstrate an advantage over DHS in intertrochanteric hip fractures by reducing blood loss. Current RCTs and the subsequent systematic reviews are of varying quality. Further research is warranted in this area as the PCCP may reduce postoperative complications making it an attractive option in particularly frail patients. Further cost-based analysis would be useful first before this could be applied to the UK situation.

Footnotes

Funding:

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests:

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Author Contributions

JHS performed the literature search and JHS and AC wrote the manuscript. All authors reviewed the papers and the manuscript.

References

Swift

Ftouh

Langford

Chesser

Johanssen

Interdisciplinary management of hip fracture. Clin Med. 2016;16:541–544.

Baker

Salar

Ollivere

et al . Evolution of the hip fracture population: time to consider the future? A retrospective observational analysis. BMJ Open. 2014;4:e004405.

Carpintero

Caeiro

Carpintero

Morales

Silva

Mesa

Complications of hip fractures: a review. World J Orthop. 2014;5:402–411.

Sheikh

Hossain

Aqil

Akinbamijo

Mushtaq

Kapoor

A comprehensive analysis of the causes and predictors of 30-day mortality following hip fracture surgery. Clin Orthop Surg. 2017;9:10–18.

Flores

Harrington

Heller

The stability of intertrochanteric fractures treated with a sliding screw-plate. J Bone Joint Surg Br. 1990;72:37–40.

Arirachakaran

Amphansap

Thanindratarn

Piyapittayanun

Srisawat

Kongtharvonskul

Comparative outcome of PFNA, Gamma nails, PCCP, Medoff plate, LISS and dynamic hip screws for fixation in elderly trochanteric fractures: a systematic review and network meta-analysis of randomized controlled trials. Eur J Orthop Surg Traumatol. 2017;27:937–952. doi:10.1007/s00590-017-1964-2.

Kesmezacar

Ayhan

Unlu

Seker

Karaca

Predictors of mortality in elderly patients with an intertrochanteric or a femoral neck fracture. J Trauma. 2010;68:153–158.

NICE. Hip fracture: management. https://www.nice.org.uk/guidance/cg124. Updated 2014. Accessed April 20, 2017.

Queally

Harris

Handoll

HHG

Parker

MJ.

Intramedullary nails for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2014;9:CD004961.

10.

Shetty

Dynamic hip screw with trochanteric stablization plate fixation of unstable inter-trochanteric fractures: a prospective study of functional and radiological outcomes. J Clin Diagn Res. 2016;10:RC06–RC08.

11.

Parker

Das

Extramedullary fixation implants and external fixators for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2013;2:CD000339.

12.

Caudle

Hopson

Clarke

RP.

Unstable intertrochanteric fractures of the hip. Orthop Rev. 1987;16:538–549.

13.

Boulton

Bunning

Burgon

et al . National Hip Fracture Database annual report 2016. http://www.nhfd.co.uk/report2016. Updated 2016. Accessed May 1, 2017.

14.

Gotfried

Percutaneous compression plating of intertrochanteric hip fractures. J Orthop Trauma. 2000;14:490–495.

15.

Gotfried

Percutaneous compression plating for intertrochanteric hip fractures: treatment rationale. Orthopedics. 2002;25:647–652.

16.

George

Hashmi

Barlas

Grant

CP.

Dynamic hip screw migration – an unusual case. Injury Extra. 2006;37:28–30.

17.

Peyser

Weil

Brocke

et al . A prospective, randomised study comparing the percutaneous compression plate and the compression hip screw for the treatment of intertrochanteric fractures of the hip. J Bone Joint Surg Br. 2007;89:1210–1217.

18.

Moher

Liberati

Tetzlaff

Altman

; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Open Med. 2009;3:123–130.

19.

Critical Appraisal Skills Programme. Critical Appraisal Skills Programme (CASP): making sense of evidence. http://www.casp-uk.net/casp-tools-checklists. Updated 2017. Accessed April, 2017.

20.

Long

Lin

et al . Percutaneous compression plate versus dynamic hip screw for treatment of intertrochanteric hip fractures: a overview of systematic reviews and update meta-analysis of randomized controlled trials. Int J Surg. 2016;33:1–7.

21.

Zhang Shen

Huang

Xie

Percutaneous compression plate versus dynamic hip screw for treatment of intertrochanteric hip fractures: a meta-analyse of five randomized controlled trials. Sci World J. 2014;2014:512512.

22.

Xing

et al . The percutaneous compression plate versus the dynamic hip screw for treatment of intertrochanteric hip fractures: a systematic review and meta-analysis of comparative studies. Orthop Traumatol Surg Res. 2012;98:773–783.

23.

Cheng

Zhang

Liu

Zhang

A meta-analysis of percutaneous compression plate versus sliding hip screw for the management of intertrochanteric fractures of the hip. J Trauma Acute Care Surg. 2012;72:1435–1443.

24.

Cheng

Huang

Gong

Wang

Liang

Minimally invasive percutaneous compression plating versus dynamic hip screw for intertrochanteric fractures: a randomized control trial. Chin J Traumatol. 2014;17:249–255.

25.

Gaddi

Piarulli

Angeloni

Gandolla

Munegato

Bigoni

Gotfried percutaneous compression plating (PCCP) versus dynamic hip screw (DHS) in hip fractures: blood loss and 1-year mortality. Aging Clin Exp Res. 2014;26:497–503.

26.

Yang

Qureshi

Trokhan

Joseph

Gotfried percutaneous compression plating compared with sliding hip screw fixation of intertrochanteric hip fractures: a prospective randomized study. J Bone Joint Surg Am. 2011;93:942–947.

27.

Peyser

Weil

Brocke

Manor

Mosheiff

Liebergall

Percutaneous compression plating versus compression hip screw fixation for the treatment of intertrochanteric hip fractures. Injury. 2005;36:1343–1349.

28.

Brandt

Lefever

Janzing

HMJ

Broos

PLO

Pilot

Houben

BJJ

. Percutaneous compression plating (PCCP) versus the dynamic hip screw for pertrochanteric hip fractures: preliminary results. Injury. 2002;33:413–418.

29.

Kosygan

Mohan

Newman

RJ.

The Gotfried percutaneous compression plate compared with the conventional classic hip screw for the fixation of intertrochanteric fractures of the hip. J Bone Joint Surg Br. 2002;84:19–22.

30.

Janzing

Houben

Brandt

et al . The Gotfried percutaneous compression plate versus the dynamic hip screw in the treatment of pertrochanteric hip fractures: minimal invasive treatment reduces operative time and postoperative pain. J Trauma. 2002;52:293–298.

31.

Crespo

Gómez

Palacios

et al . Long-term results after treatment of pertrochanteric femoral fractures with percutaneous compression plate (PCCP). Eur J Orthop Surg Traumatol. 2016;26:613–617.

32.

Man

Wong

SH.

Excess mortality for operated geriatric hip fracture in Hong Kong. Hong Kong Med J. 2016;22:6–10.

33.

Crespo

Galvez

Tenías

Cano

Crespo

Palacios

A comparative study between gamma nail and percutaneous compression plating for the treatment of intertrochanteric hip fractures. Eur J Trauma Emerg Surg. 2012;38:443–449.

34.

Handoll

HHG

Sherrington

Mak

JCS

. Interventions aimed at improving and restoring mobility after hip fracture surgery in adults. Cochrane Database Syst Rev. 2011;3:CD001704.

Is There Evidence that the Percutaneous Compression Plate Method of Internal Fixation for Intertrochanteric Hip Fractures Leads to Better Intraoperative and Postoperative Outcomes than the Dynamic Hip Screw?

Abstract

Background:

Review Question:

Literature Search:

Review Findings:

Conclusions:

Keywords

Introduction

Methods

Search strategy and inclusion/exclusion criteria

Inclusion/exclusion criteria

Data extraction

Data analysis

Quality assessment

Results

Characteristics of included studies

Systematic review and meta-analyses review results

Primary study review results

Quality Assessment of Included Studies

Discussion

Conclusions

Footnotes

Funding:

Declaration of Conflicting Interests:

Author Contributions

References