Dynamic locking plate vs. simple cannulated screws for nondisplaced intracapsular hip fracture: A comparative study
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Yaniv Warschawski1, Zachary T Sharfman1, Omri Berger2
1Division of Orthopedic Surgery, Tel Aviv Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
For non-displaced intracapsular hip fractures (ICHFs), the dynamic locking plate (Targon FN) and cancellous cannulated screws (CCS) showed similar complication rates and clinical outcomes. Given the cost difference, CCS is suggested for treating non-displaced ICHFs.
Area of Science:
- Orthopedic surgery
- Trauma care
- Biomedical engineering
Background:
- Intracapsular hip fractures (ICHFs) present significant morbidity and economic burden.
- Standard care for displaced ICHFs in the elderly is arthroplasty.
- Treatment for non-displaced ICHFs, particularly in younger patients, remains debated, with internal fixation options including dynamic locking plates and cancellous cannulated screws (CCS).
Purpose of the Study:
- To compare the efficacy and safety of Targon FN dynamic locking plates versus CCS for treating non-displaced ICHFs.
- To evaluate complication rates, functional outcomes, and quality of life between the two fixation methods.
Main Methods:
- Retrospective review of 115 patients with non-displaced ICHFs treated between 2009-2012.
- Comparison of Targon FN (34 patients) and CCS (81 patients) implants.
- Prospective data collection on radiographical analysis, pain (VAS), quality of life (SF-12), and function (MHHS).
Main Results:
- No significant differences in fracture characteristics or demographics (excluding age) between groups.
- Similar post-operative revision rates and perioperative complication rates for Targon FN and CCS (p>0.05).
- No statistical differences in quality of life (SF-12), function (MHHS), or pain scores (VAS).
Conclusions:
- Targon FN and CCS demonstrate comparable complication rates and clinical outcomes for non-displaced ICHFs.
- Considering the significant cost difference, CCS is recommended for the treatment of non-displaced ICHFs.
- This suggests cost-effectiveness should be a key factor in selecting fixation methods for these fractures.
Introduction:
Intracapsular hip fractures (ICHF) are a common cause of morbidity and mortality and pose a great economic burden on the health care systems. Appropriate surgical treatment requires balancing optimal outcomes with the cost of treatment to the health care system. While in elderly patients with displaced ICHF arthroplasty became the standard of care, the internal fixation method for conserving the femoral head in younger patients or in nondisplaced ICHF is still in debate. We compared a dynamic locking plate with the standard cancellous cannulated screws (CCS) for treatment of nondisplaced ICHF.
Methods:
All patients treated with internal fixation for nondisplaced ICHF between July 2009 and December 2012 at our level one trauma center were included in this study. Patients treated with Targon FN (Aesculap) implants and CCS (Synthes) were compared. Charts were reviewed for demographics, intraoperative data and peri/post operative complications retrospectively. Radiographical analysis, pain (VAS), quality of life (SF12) and function (MHHS) data were prospectively gathered.
Results:
One hundred and fifteen non-displaced ICHFs were treated with internal fixation, 81 with CCS and 34 with Targon FN implant; the mean follow-up was 19 and 28 months, respectively. Group fracture characteristics (Garden/Powel classification), and demographics, excluding age, were not significantly different. Post-operative revision rates of the Targon FN and CCS groups, perioperative complications were not statistically different (p>0.05). Quality of life (SF-12), function (Modified Harris Hip Score) and Visual Analogue Scale (VAS) pain scores were not statistical different.
Conclusions:
Complication rates and clinical outcomes for the treatment of nondisplaced ICHF with Targon FN and SCC showed no significant differences. Based on this evidence in consideration of the substantial cost differential between the Targon FN and SCC we suggest SCC for treatment of nondisplaced ICHF.
Level Of Evidence:
III.
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