Abstract / Summary
Objective: To retrospectively compare the clinical and functional outcomes of wedge plate and dynamic hip screw (DHS) fixation in adult patients with trochanteric femoral fractures.Methods: This retrospective comparative analysis included 64 hips in 63 patients aged 18-60 years who underwent primary fixation of a trochanteric femoral fracture with either a wedge plate (n=38) or a dynamic hip screw (DHS; n=26) between 2005 and 2010. Eligible hips had clinical and radiographic records sufficient for final functional assessment at least 6 months after surgery. Of 149 potentially eligible patients, 66 could not be contacted. Patients who died before final assessment, hips converted to partial arthroplasty after fixation failure, and hips treated with fixation devices other than a wedge plate or DHS were excluded from this comparison. One DHS-treated hip that was converted to partial arthroplasty after implant failure and loss of reduction was excluded during cohort construction. Demographic characteristics, fracture patterns, perioperative findings, postoperative complications, and Harris Hip Score (HHS) outcomes were compared.Results: The mean patient age was 47.89±14.66 years, and 92.2% of the patients were male. Unstable fractures accounted for 73.4% of all fractures and were more frequent in the wedge plate group than in the DHS group (84.2% vs 57.7%; P=.018). The overall mean HHS was 89.85±12.47, with excellent or good functional outcomes in 86.0% of hips. No statistically significant between-group differences were detected in HHS, the overall distribution of functional outcome categories, or the individual recorded postoperative complication categories. Within the retained comparison cohort, revision surgery was required in five wedge plate cases because of mechanical failure involving plate bending and/or breakage and in none of the 26 DHS cases (Fisher exact P=.074).Conclusion: In this selected, retrospective, and relatively small cohort, no statistically significant difference in HHS-based functional outcomes was detected between wedge plate and DHS fixation. The significant imbalance in fracture stability, the five mechanical failures in the wedge plate group, and exclusion of a DHS-treated hip converted to arthroplasty limit comparative inference. These findings should not be interpreted as evidence of equivalence.