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.