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Gotfried percutaneous compression plating (PCCP) versus dynamic hip screw (DHS) in hip fractures: blood loss and
Diego Gaddi1, Giorgio Piarulli, Andrea Angeloni
1Clinica Ortopedica AO San Gerardo, Università degli Studi di Milano-Bicocca, Via Pergolesi 33, 20900, Monza, Italy, diegogaddi@gmail.com.
Insights
Percutaneous compression plating (PCCP) and dynamic hip screw (DHS) showed similar outcomes for intertrochanteric fractures. Patient factors, not surgical method, significantly impact 1-year mortality in elderly patients.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Trauma Surgery
Background:
- Intertrochanteric fractures are common in the elderly, with a significant 1-year mortality rate of approximately 25%.
- Increased mortality risk post-hip fracture is potentially linked to blood loss and pre-existing comorbidities.
Purpose of the Study:
- To compare percutaneous compression plating (PCCP) with dynamic hip screw (DHS) for treating intertrochanteric fractures.
- To determine if PCCP reduces blood loss and 1-year mortality compared to DHS.
- To identify surgical and patient-related factors influencing mortality.
Main Methods:
- A retrospective comparative study of 280 patients (2004-2008) with type 31A1 or 31A2 hip fractures.
- Exclusion criteria included age <60 years, multiple injuries, and pathological fractures.
- 194 patients received DHS, and 86 patients received PCCP.
Main Results:
- No significant differences in blood loss, transfusion rates, or 1-year mortality between PCCP and DHS groups.
- Gender, age, American Society of Anaesthesiologists (ASA) score, and preoperative hemoglobin levels were significant factors affecting mortality.
Conclusions:
- Both PCCP and DHS are comparable in managing blood loss and transfusion requirements for intertrochanteric fractures.
- Mortality is primarily associated with patient-specific factors reflecting overall health status.
- Improved preventative orthogeriatric care is crucial for reducing mortality in this patient population.
Background:
Intertrochanteric fractures are among the most common fracture in elderly and are correlated with an average 1-year mortality of 25 %. Increased mortality after hip fracture could be related to blood loss and comorbidities.
Aims:
We compared two groups of patients treated with percutaneous compression plating (PCCP) and dynamic hip screw (DHS) with the hypothesis that treatment with PCCP can reduce blood loss and 1-year mortality. We furthermore investigated the role of several surgical-related and patient-related factors on mortality of all the enrolled patients.
Methods:
We performed a comparative retrospective study of 280 patients with type 31A1 or 31A2 hip fractures treated in our department from January 2004 to May 2008. Exclusion criteria were age <60 years, multiple injuries and pathological fractures. A total of 194 patients were treated with DHS, and 86 patients were treated with PCCP.
Results:
No statistical differences were found in term of blood loss, blood transfusion and 1-year mortality between the two groups, whereas we found a significant incidence of gender, age, American Society of Anaesthesiologists score and preoperative haemoglobin on mortality.
Discussion:
Both plates seem to be comparable in terms of blood loss and blood transfusion rate, and mortality was rather correlated with some patient-related factors reflecting the global health status.
Conclusion:
Emerging mortality in this kind of patient should encourage us to improve preventative orthogeriatric health care.
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