The study was a single center retrospective cross sectional study conducted at Abubakar Tafawa-balewa Teaching Hospital (ATBUTH), a tertiary referral centre located in North-eastern Nigeria. A 2 year retrospective data of all skeletally matured patients that presented with any of the stable IT, unstable IT or sub trochanteric fractures, who had consented for surgical treatment with PFLCP between 1st October 2019 and 30th September 2021 and have completed a follow-up for 1 year were included. Patients with pathologic fractures, medically not fit for surgery or declined surgery were excluded from the study.
Following approval from the ethics committee, clinical and radiologic data was collected including demographics, mechanism of injury, laterality, duration before presentation, diagnosis, fracture site, body mass index (BMI) and Singh index.
SURGICAL APPROACHES All operative interventions were performed by the orthopaedic surgeons in the department. Exposure of the proximal femur was performed using the direct lateral approach with subarachnoid block (SAB) or epidural anaesthesia. Meticulous tissue dissection and handling was done.
Proximal femur locked plate fixation for intertrochanteric and subtrochanteric fractures utilized a proximal femur plate with 3 proximal holes at 135 degress,120 degrees and 95 degrees for 6.0mm locking cancellous screw fixation into the femoral head and neck. The distal holes for femoral shaft fixation were fixed using 4.5mm non-locking or 5.0mm locking screws utilizing the lateral subvastus approach to the proximal femur.
Surgical wound was irrigated with normal saline in all cases where surgery time exceeds 90 minutes and active redivac drain inserted. All Patients received 1.5gram of ceftriaxone/sulbatam at the point of SAB/epidural anaesthesia and intravenous antibiotics was continued for atleast 72 hours after surgery and oral 3rd generation quinolones (levofloxacin) subsequently for 10 days based on local antibiotic protocol.
Postoperative care High risk Patients received subcutaneous clexane 40-80 iu daily for atleast 72hours and subsequently oral dabigatran (pradaxa), 110mg daily for 1 month. Functional exercises of the lower extremities were commenced 48hours after surgery including isometric muscle contraction and relaxation, abduction, hip and knee extension not exceeding 90°. Activity intensity and frequency were determined based on individual tolerance.
Patients were mobilized with either bilateral axillary crutches or Zimmer’s frame 48 hours after surgery on non-weight bearing until radiological union was achieved. After discharge Patients underwent follow-up at 6 weeks, 3 months, 6 months and 1 year (fig 1 and 2). Immediate post-operative xray s were done to assess for fracture reduction, while follow-up radiographs were done to assess union, non-union,mal-union(varus collapse),Mechanical failure(screw loosening, implant breakage and other parameters).
Reliability of PFLCP was assessed using the rate of radiologic union and Poor Outcomes were defined as mechanical failure/non-union or varus collapse.
All data were analyzed using SPSS 23 software. Categorical data was presented as descriptive statistic and chi square test to test for statistical significance of the variables (age, sex,duration of presentation, BMI, singh index) against outcome measures. Continuous data were described as mean and standard deviation with t-test for statistical significance. The predictors of PFLCP failure in proximal femur fractures using logistic regression analysis, at 95% confidence interval and at a P-value of 0.05.