Locked plating versus cephalomedullary nailing of unstable intertrochanteric femur fractures

Background: Proximal femur locking plates (PFLP) have received increased attention as an alternative for the treatment of proximal femur fractures. However, recent clinical data on these implants has raised concern about higher than expected failure rates. Question/purpose: The purpose of the present study was to compare outcomes of unstable pertrochanteric femur fractures (AO/OTA 31A3) treated at a level-1 trauma center using either PFLP or cephalomedullary nailing (CMN). Patients and methods: Sixty-two patients (31 PFLP and 31 CMN, 55 % female, average age 63 years, range 21–94) with 64 OTA 31A3 fractures (32 PFLP and 32 CMN) treated between 2003 and 2007 were retrospectively reviewed. No differences were found with regard to gender, BMI, diabetes and time to surgery. Results: One patient (5 %) in the CMN group underwent a reoperation (debridement with hardware removal), while eight PFLP patients (25 %) did (two debridements, two hardware removals, four nonunion repairs). One mechanical failure (5 %) occurred in the CMN group and 12 (38 %) in the PFLP group (p = 0.007). One nonunion (5 %) was observed in the CMN group, while 6 (19 %) occurred in the PFLP group. Conclusion: A higher rate of reoperation and mechanical failure can be expected for unstable intertrochanteric femur fracture when treated with PFLP than with CMN.