Strategies in Trauma and Limb Reconstruction

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VOLUME 8 , ISSUE 1 ( April, 2013 ) > List of Articles

Original Article

Clinical and functional outcomes of the PCCP study: a multi-center prospective study in Italy

Guido Antonini, R. Giancola, D. Berruti, E. Blanchietti, P. Pecchia, V. Francione, P. Greco, T. C. Russo, L. Pietrogrande

Keywords : Functional recovery, Percutaneous compression plate, Intertrochanteric femoral fracture, Reduced blood loss, Reduced transfusions, Femoral fixation

Citation Information : Antonini G, Giancola R, Berruti D, Blanchietti E, Pecchia P, Francione V, Greco P, Russo TC, Pietrogrande L. Clinical and functional outcomes of the PCCP study: a multi-center prospective study in Italy. 2013; 8 (1):13-20.

DOI: 10.1007/s11751-013-0159-6

License: CC BY-NC-SA 4.0

Published Online: 01-12-2016

Copyright Statement:  Copyright © 2013; The Author(s).


Abstract

The standard surgical management of hip fractures is associated with tissue trauma and bleeding which are added to the fracture injury. The percutaneous compression plate (PCCP) is a minimally invasive device that has been demonstrated in previous studies to reduce postoperative complications and blood loss. This prospective, multi-center, observational study assessed clinical and functional outcomes with PCCP as treatment for trochanteric fractures. Patients with a stable or unstable proximal femoral fracture of type AO 31.A1 or 31.A2 were enrolled in eight hospitals in Italy. The primary outcome of interest was the recovery of the pre-fracture functional status at 1-year follow-up; secondary outcomes of interest included blood transfusions, surgical time, complications, and mortality. A total of 273 patients were enrolled. The ASA score was 3 or 4 in 72.5 % of patients. The mean surgical time was 44.1 min; the mean post-surgery blood transfusions was 0.9 units. At 1 year, 48 patients (17.6 %) died, 28 (10.2 %) were lost to follow-up, 4 patients (1.5 %) were excluded, hence 193 patients (70.3 %) were available for final evaluation. At the 1-year follow-up visit, 51.9 % of patients recovered or improved their pre-fracture modified Harris Hip Score, 49.1 % of patients improved or maintained their walking abilities, and 66.6 % of patients residing at home pre-surgery maintained their domicile. The overall mortality rate was 17.6 %. Major complications included two fracture collapses, one excessive sliding of the cephalic screw leading to a partial fracture collapse and one back-out of the diaphyseal screw. This study demonstrates that treatment of trochanteric fractures with PCCP gives good outcomes and significant advantages such as low blood loss, short surgical time, low risk of complications, and good functional recovery in the majority of the patients.


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  1. Kannus P, Parkkari J, Niemi S, Pasanen M, Palvanen M, Järvinen M et al (2000) Prevention of hip fracture in elderly people with use of a hip protector. N Engl J Med 343:1506-1513
  2. Pillai A, Eranki V, Shenoy R, Hadidi M (2011) Age Related incidence and early outcomes of hip fractures: a prospective cohort study of 1177 patients. J Orthop Surg Res 6:1-5
  3. Cornwall R, Gilbert MS, Koval KJ, Strauss E, Siu AL (2004) Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics. Clin Orthop Relat Res 425:64-71
  4. Zuckerman JD (1996) Hip fracture. N Engl J Med 334(23):1519- 1525
  5. Beloosesky Y, Hendel D, Hershkovitz A, Skribnic G, Grinblat J (2001) Outcome of medically unstable elderly patients admitted to a geriatric ward after hip fracture. Aging (Milano) 13:78-84
  6. Michel JP, Hoffmeyer P, Klopfenstein C, Bruchez M, Grab B, d'Epinay CL (2000) Prognosis of functional recovery 1 year after hip fracture: typical patient profiles through cluster analysis. J Gerontol A Biol Sci Med Sci 55:M508-M515
  7. Barrios C, Walheim G, Broström LA, Olsson E, Stark A (1993) Walking ability after internal fixation of trochanteric hip fractures with Ender nails or sliding screw plate. A comparative study of gait. Clin Orthop Relat Res 294:187-192
  8. Beringer TR, Clarke J, Elliott JR, Marsh DR, Heyburn G, Steele IC (2006) Outcome following proximal femoral fracture in Northern Ireland. Ulster Med J 75:200-206
  9. Egol KA, Koval KJ, Zuckerman JD (1997) Funtional recovery following hip fracture in elderly. J Orthop Trauma 11:594-599
  10. Walheim G, Barrios C, Stark A, Broström LA, Olsson E (1990) Postoperative improvement of walking capacity in patients with trochanteric hip fracture: a prospective analysis 3 and 6 months after surgery. J Orthop Trauma 4:137-143
  11. Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M et al (2000) Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 55:M498-M507
  12. Anglen JO, Weinstein JN (2008) American Board of Orthopaedic Surgery Research Committee. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg Am 90:700-707
  13. Bensafi H, Laffosse JM, Giordano G, Dao C, Chiron P, Puget J (2006) The percutaneous compression plate (PCCP) in the treatment of trochanteric hip fractures in elderly patients. Acta Orthop Belg 72:314-319
  14. Lavini F, Renzi-Brivio L, Aulisa R, Cherubino F, Di Seglio PL, Galante N et al (2008) The treatment of stable and unstable proximal femoral fractures with a new trochanteric nail: results of a multicentre study with the Veronail. Strateg Trauma Limb Reconstr 3:15-22
  15. Gotfried Y (2000) Percutaneous compression plating of intertrochanteric hip fractures. J Orthop Trauma 14:490-495
  16. Gotfried Y (2002) Percutaneous compression plating for intertrochanteric hip fractures: treatment rationale. Orthopedics 25(6):647-652
  17. Janzing HM, Houben BJ, Brandt SE, Chhoeurn V, Lefever S, Broos P et al (2002) 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 52:293-298
  18. Muller ME, Allgower M, Willenegger H (1996) Manual of internal fixation. Berlin, Springer-Verlag, 1970. Orthopædic trauma association committee for coding and classification. Fracture and dislocation compendium. J Orthop Trauma 10:31-34
  19. Gotfried Y (2004) The lateral trochanteric wall: a key element in the reconstruction of unstable pertrochanteric hip fractures. Clin Orthop Relat Res 425:82-86
  20. Brandt SE, Lefever S, Janzing HM, Broos PL, Pilot P, Houben BJ (2002) Percutaneous compression plating (PCCP) versus the dynamic hip screw for pertrochanteric hip fractures: preliminary results. Injury 33:413-418
  21. Dripps RD (1963) New classification of physical status. Anesthesiology 24:111
  22. Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end result study using a new method of result evaluation. J Bone Joint Surg Am 51:737-755
  23. Knobe M, Münker R, Sellei RM, Schmidt-Rohlfing B, Erli HJ, Strobl CS et al (2009) Unstable pertrochanteric femur fractures. Failure rate, lag screw sliding and outcome with extra- and intramedullary devices (PCCP, DHS and PFN). Z Orthop Unfall 147:306-313
  24. Kim YH, Kim VE (1993) Uncemented porous-coated anatomic total hip replacement: results at six years in a consecutive series. J Bone Joint Surg Br 75:6-13
  25. Achten J, Parsons NR, Edlin RP, Griffin DR, Costa ML (2010) A randomized controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint. BMC Musculoskelet Disord 11:8
  26. Smith MV, Klein SE, Clohisy JC, Baca GR, Brophy RH, Wright RW (2012) Lower extremity-specific measures of disability and outcomes in orthopaedic surgery. J Bone Joint Surg Am 94(5): 468-477
  27. Laufer Y, Lahav M, Lenger R, Sprecher E (2005) Functional recovery following pertrochanteric hip fractures fixated with the dynamic hip screw vs. the percutaneous compression plate. Sci World J 5:221-229
  28. Adams CI, Robinson CM, Court-Brown CM, McQueen MM (2001) Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur. J Orthop Trauma 15:394-400
  29. Chirodian N, Arch B, Parker MJ (2005) Sliding hip screw fixation of trochanteric hip fractures: outcome of 1024 procedures. Injury 36:793-800
  30. Peyser A, Weil Y, Brocke L, Manor O, Mosheiff R, Liebergall M (2005) Percutaneous compression plating versus compression hip screw fixation for the treatment of intertrochanteric hip fractures. Injury 36:1343-1349
  31. Panesar SS, Mirza S, Bharadwaj G, Woolf V, Ravikumar R, Athanasiou T (2008) The percutaneous compression plate versus the dynamic hip screw: a meta-analysis. Acta Orthop Belg 74:38-48
  32. Saudan M, Lübbeke A, Sadowski C, Riand N, Stern R, Hoffmeyer P (2002) Pertrochanteric fractures: is there an advantage to an intramedullary nail? A randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma 16:386-393
  33. Peyser A, Weil YA, Brocke L, Sela Y, Mosheiff R, Mattan Y et al (2007) 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 89:1210-1217
  34. Kosygan KP, Mohan R, Newman RJ (2002) 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 84:19-22
  35. Bridle SH, Patel AD, Bircher M, Calvert PT (1991) Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br 73:330-334
  36. Desjardins AL, Roy A, Paiement G, Newman N, Pedlow F, Desloges D et al (1993) Unstable intertrochanteric fracture of the femur. A prospective randomized study comparing anatomical reduction and medial displacement osteotomy. J Bone Joint Surg Br 75:445-447
  37. Yang E, DeLaMora S (2008) Minimally invasive treatment of intertrochanteric hip fractures with the Gotfried percutaneous compression plate. Orthopedics 31:29-36
  38. van de Kerkhove MP, Antheunis PS, Luitse JS, Goslings JC (2008) Hip fractures in nonagenarians: perioperative mortality and survival. Injury 39:244-248
  39. Berkenbaum I, El Banna S (2004) Osteosynthesis of trochanteric fracture with percutaneous compression plate (P.C.C.P.). Rev Med Brux 25:40-46
  40. Willig R, Keinänen-Kiukaaniemi S, Jalovaara P (2001) Mortality and quality of life after trochanteric hip fracture. Public Health 115:323-327
  41. Elliott J, Beringer T, Kee F, Marsh D, Willis C, Stevenson M (2003) Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol 56:788-795
  42. Richmond J, Aharonoff GB, Zuckerman JD, Koval KJ (2003) Mortality risk after hip fracture. J Orthop Trauma 17:53-56
  43. Paksima N, Koval KJ, Aharanoff G, Walsh M, Kubiak EN, Zuckerman JD, Egol KA (2008) Predictors of mortality after hip fracture: a 10-year prospective study. Bull NYU Hosp Jt Dis 66:111-117
  44. Michel JP, Klopfenstein C, Hoffmeyer P, Stern R, Grab B (2002) Hip fracture surgery: is the pre-operative American Society of Anesthesiologists (ASA) score a predictor of functional outcome. Aging Clin Exp Res 14:389-394
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