Double-plate compound osteosynthesis for pathological fractures of the proximal femur: high survivorship and low complication rate.
INTRODUCTION
Management of pathological fractures of the proximal femur is often challenging. Compound double-plate osteosynthesis has been specifically developed for surgical treatment of these pathological fractures. To our knowledge, this study represents the largest series to date of double-plate compound osteosynthesis with the longest follow-up.


MATERIALS AND METHODS
Using our institutional digital database, we identified 61 procedures in 53 patients at the proximal femur. Patients were divided into two groups. A 'primary' group with all cases in which a double-plate compound osteosynthesis was performed as initial procedure (n = 46) and a 'revision' group with all cases in which a double-plate compound osteosynthesis was performed as revision procedure after failed previous attempts of internal fixation (n = 15). (1) The survivorship of the hip was calculated using the Kaplan-Meier survivorship analysis. (2) Complications were graded using Sink's classification. (3) The functional outcome was quantified with the Merle d'Aubigné and Postel score. (4) Risk factors were identified based on a multivariate Cox-regression analysis.


RESULTS
The cumulative Kaplan-Meier survivorship of the primary group was 96% at 6 months, 90% at 1 year, 5 years and thereafter and 83% at 6 months, 74% at 1 year, 53% at 2 years for the 'revision' group (p = 0.0008). According to the classification of Sink et al., the rate of grade III and IV complications was significantly lower in the primary group (p < 0.0001). The mean Merle d'Aubigné score was 14 ± 7 at 0-3 months, 13 ± 3 at 3-6 months, 15 ± 3 at 6-12 months and 15 ± 4 thereafter (p = 0.54). The only multivariate negative predictor was previous surgery with a hazard ratio of 9.2 (p < 0.006).


CONCLUSION
Double-plate compound osteosynthesis is a valuable treatment option for pathological fractures in proximal femur with good functional results.
['Merckaert|Sophie R|SR|', 'Fontanellaz-Castiglione|Christian D|CD|', 'Fornari|Eric D|ED|', 'Tannast|Moritz|M|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D005260:Female D005264:Femoral Fractures D005593:Fracture Fixation, Internal D005598:Fractures, Spontaneous D006801:Humans D008297:Male D008875:Middle Aged D011183:Postoperative Complications D012189:Retrospective Studies
Compound osteosynthesis Pathological fractures Proximal femur Bone metastasis