RESULTS OF PROXIMAL FEMORAL LOCKING PLATES FOR PROXIMAL FEMORAL NON-UNIONS

Purpose (a): Objective: Review clinical reports from multiple centers that have used Proximal Femoral Locking Compression Plates (PFLCPs) for non-unions of the proximal femur to elicit reasons for failure in an effort to prevent similar failures in the future. Methods (b): Retrospective chart review of 21 adult patients at 3 separate regional Level I and Level II institutions who underwent open treatment of non9nionos of the proximal femur with PFLCPs. Outcomes measured was mechanical failure defined by hardware failure and secondary outcomes including patient and construct variables that may act as predictors for mechanical failure. These included time to failure, bony union, nonunion, time to union, need for additional procedures, type of additional procedures, BMI. Results (c): At 22 months follow up, 5 hardware failures occurred (24%) and 1 persistent nonunion (5%)occurred requiring hardware removal and conversion to total hip arthroplasty. There was no statistically significant association between hardware failure and patient BMI, quality of reduction, plating technique, or bone graft use. A significant difference between cases with and without failure was medial column stability; only 40% of those with hardware failure achieved medial column stability versus 94% of those without hardware failure. Conclusions (d): Proximal Femoral Locking Compression Plates have a high rate of mechanical failure with use for non-union of the proximal femur. Our experience shows a similar rate of mechanical failure compared to previously reported experiences with the use of PFLCPs in acute fractures. Medial column instability was the only significant association of failure with the use of PFLCPs in nonunion surgery.