Chinese Journal of Traumatology 2014;17(5):249-255
Original articles
Minimally invasive percutaneous compression plating
versus dynamic hip screw for intertrochanteric
fractures: a randomized control trial
Cheng Qiang, Huang Wei, Gong Xuan, Wang Changdong, Liang Xi, Hu Ning*
【Abstract】Objective: Intertrochanteric femur
fracture is a common injury in elderly patients. The
dynamic hip screw (DHS) has served as the standard
choice for fixation; however it has several drawbacks.
Studies of the percutaneous compression plate (PCCP)
are still inconclusive in regards to its efficacy and safety.
By comparing the two methods, we assessed their clinical
therapeutic outcome.
Methods: A total of 121 elderly patients with
intertrochanteric femur fractures (type AO/OTA 31.A1-
A2, Evans type 1) were divided randomly into two groups
undergoing either a minimally invasive PCCP procedure
or a conventional DHS fixation.
Results: The mean operation duration was
significantly shorter in the PCCP group (55.2 min versus
88.5 min, P<0.01). The blood loss was 156.5 ml±18.3 ml
in the PCCP group and 513.2 ml±66.2 ml in the DHS
A
high incidence of osteoporotic proximal
femoral fractures among the elderly is a
‘‘modern epidemic’’ and is leading to severe
medical and socioeconomic consequences as both
life expectancy and population size are increasing.1
Of all hip fractures, intertrochanteric fractures
DOI: 10.3760/cma.j.issn.1008-1275.2014.05.001
Department of Orthopaedic Surgery, The First Affiliated
Hospital, Chongqing Medical University, Chongqing
400016, China (Cheng Q, Huang W, Liang X, Hu N)
Outpatient Department, Chongqing Zhongshan
Hospital, Chongqing 400000, China (Gong X)
Department of Biochemistry and Molecular Biology,
Molecular Medicine and Cancer Research Center,
Chongqing Medical University, Chongqing 400016, China
(Wang CD)
*Corresponding author: Tel/Fax: 86-23-89011212, 86-
18696761022, Email: 1276321387@qq.com
. 249 .
group (P<0.01). Among the patients treated with PCCP,
3.1% needed blood transfusions, compared with 44.6% of
those that had DHS surgery (P<0.01). The PCCP group
displayed less postoperative complications (P<0.05). The
mean American Society of Anesthesiologists score and
Harris hip score in the PCCP group were better than those
in the DHS group. There were no significant differences
in the mean hospital stay, mortality rates, or fracture
healing.
Conclusion: Due to several advantages, PCCP
has the potential to become the ideal choice for treating
intertrochanteric fractures (type AO/OTA 31.A1-A2,
Evans type 1), particularly in the elderly.
Key words: Hip fractures; Osteoporotic fractures;
Surgical procedures, minimally invasive; Fracture
fixation, internal
Chin J Traumatol 2014;17(5):249-255
account for approximately 50%.2 Ninety percent of
these patients are over the age of 65 at the time of
hip fracture and a large proportion already suffer
from other major comorbidities.3 Of all fall-related
fractures, hip fractures cause the greatest number
of deaths and lead to the most severe health
problems and reduced quality of life. Maintaining
the patients’ quality of life is the treatment goal of
intertrochanteric fractures, and remains a subject of
great interest.
At present, the dynamic hip screw (DHS) serves
as the standard and is the most common device
for fixation of intertrochanteric femoral fractures.4
For this conventional procedure, the lateral vastus
muscle must be split broadly, which is associated
with significant soft tissue damage and inevitable
blood loss, both of which may worsen multiple
. 250 .
existing comorbidities of elderly patients. 3 More
importantly, relatively high failure rates (5%-20%)
of re-displacement or collapse treated with DHS
for unstable intertrochanteric hip fractures are
reported.5,6
Minimally invasive surgery is gaining popularity
in modern orthopedic trauma, as it has shown some
potential benefits including decreased blood loss
and postoperative pain, lower risk of postoperative
morbidity and faster recovery of function.7 These
factors are particularly important for elderly patients
to allow early weight-bearing and reduce related
complications.8 The percutaneous compression plate
(PCCP) device, which was developed by Gotfried
in the late 90’s, is a relatively new system for the
osteosynthesis of intertrochanteric hip fracture.9,10
The design of the implant offers minimal operative
trauma, and only requires two small (2 cm) incisions
in order to insert a plate with a distal beveled end
through the vastus lateralis muscle. The device
provides rotational stability and compression of
fractures by means of two telescoping neck screws of
relatively small diameter (9.3 mm) and area (68 mm2
each), as opposed to the single bigger screw used
in the DHS. Lateral cortical support is conferred
by a proximal extension of the locking plate. This
minimizes soft tissue damage and blood loss, avoids
excessive periosteal stripping and devascularization
of fracture segments.11
There are only a few studies evaluating the
efficacy of PCCP, and comparative studies are
still inconclusive. This study aims to answer the
following questions: Is there any difference in blood
loss, transfusion, operation duration, incidence of
postoperative comlications, length of hospital stay,
fracture healing and Harris hip score between the
PCCP and DHS groups?
METHODS
All study procedures were approved by the
hospital ethics committee. All patients gave the
required written informed consent preoperatively. The
study only recruited patients with an intertrochanteric
fracture who were mentally competent and gave
their consent to participate.
Chinese Journal of Traumatology 2014;17(5):249-255
Surgery using the PCCP device was introduced
in our hospital in 2004. The first three years were
considered the “learning curve” period, and patients
treated at that time were not included in our study.
A total of 152 elderly patients with intertrochanteric
hip fracture were admitted to our department and
were considered for this prospective, randomized
and controlled trial during the period of October
2007 to February 2011. The acquisition of all
patients was consecutive. Inclusion criteria were: (1)
age of 60 years or greater; (2) an intertrochanteric
fracture amenable to satisfactory reduction (type
AO/OTA 31.A1-A2, Evans type 1); (3) ability to
ambulate independently prior to the fracture with
or without assistive devices. 12 Exclusion criteria
were: (1) reversed oblique fractures (type AO/OTA
31.A3 or Evans type 2); (2) nonunion, pathological
fractures, or the presence of metastatic disease;
(3) bilateral hip fractures, previous ipsilateral lower-
limb surgery, or contralateral hip fracture within the
last year; (4) patients who required intensive care
or treatment in other departments; 13 (5) patients
with diabetes difficult to control. Randomization
was done by nurses who drew a sealed, numbered
envelope containing the treatment method for each
patient prior to surgery. There were 133 patients
who met these criteria, including 5 patients who
used aspirin for many years. We replaced aspirin
with low-molecular-weight heparin one week before
surgery and stopped its use one day before surgery.
No patient used warfarin or other anticoagulants
for a long time. For the patients with diabetes, the
surgeries were performed until fasting blood-glucose
dropped to 7 mmol/L. No patient was excluded
for death in the perioperative period. However, 12
patients could not be followed up postoperatively
due to death from other diseases (2 cases) or
changing residence (10 cases). Therefore, 121
patients were included in our study, of which there
were 65 patients in the PCCP group and 56 in
the DHS group. All the patients were followed up
postoperatively for 15 months on average (range
6-26 months).
Baseline data included gender, age, injury
mechanism, and fracture type according to the
AO classification, main comorbidities and the
American Society of Anesthesiologists (ASA) grade
of operative risk.14 We reviewed the AP films of the
Chinese Journal of Traumatology 2014;17(5):249-255 . 251 .

pelvis of all patients to record their bone quality on (Richards Inc. USA) were operated upon via a
the opposite, non-fractured hip, as defined by the standard lateral approach in accordance with the
Singh index (Figure 1).15 Preoperative characteristics manufacturer’s instructions. The PCCP (Orthofix
of patients were recorded in detail in Table 1. Inc. USA) plate was implanted using the technique
described by Gotfried in 2000 (Figure 2).9 A guiding
Table 1. Preoperative characteristics of patients frame was connected parallel to the plate through
PCCP DHS P value which all drills and screws were introduced. A 2-3 cm
Gender (M/F) 28/37 22/34 0.609 incision was made under fluoroscopic guidance by
Age (years) 72.4±4.18 78.6±3.92 0.852 identification of the site opposite to the proximal
border of the lesser trochanter on the lateral aspect
Fracture etiology 0.866
of the thigh. The plate, with its cutting distal edge,
Simple falling 47 40
was inserted beneath the vastus lateralis muscle
Falling from a height 6 7
and attached subperiosteally to the proximal femur
Vehicular trauma 12 9 under fluoroscopic guidance. Through a second
Fracture type (AO/ASIF) 0.790 incision of similar length, a bone clamp was
31 A 1.1 18 15 attached to the guiding frame and the plate was
31 A 1.2 28 24 fixed to the femur under radiographic control. The
first 9.3 mm telescoping hip screw was inserted at
31 A 1.3 3 4
an angle of 135° in the inferior neck border, adjacent
31 A 2.1 10 8
to the calcar femorale. Three self-tapping 4.5 mm
31 A 2.2 4 2
biocortical screws were inserted through the frame
31 A 2.3 2 3 to fix the plate to the femur, followed by the second
Singh index 3.35±0.87 3.24±0.46 0.723 9.3 mm hip screw finally inserted in superior and
Osteoporosis 53 45 0.881 parallel position to the first screw.
Main comorbidity 0.795
The wounds were irrigated with abundant normal
Hypertension 18 15
saline and closed in layers with a drainage system
Coronary heart disease 6 7
in place (Figure 3). The drain was maintained for
Diabetes 8 6
no more than 48 h. Prophylactic antibiotics were
COPD* 3 1 administered and prophylactic low-molecular-weight
ASA grade* 0.841 heparin was given subcutaneously for 6 weeks
I 6 5 postoperatively. Ambulation with partial weight
II 39 31 bearing from the second or third postoperative day
was routine for the patients with stable fractures; but
III 18 19
for all patients with unstable fractures, partial weight
IV 2 1
bearing was delayed until at least 2 weeks after
COPD: chronic obstructive pulmonary disease, ASA: American
surgery. Physical therapy was initiated when each
Society of Anesthesiologists.
patient’s medical condition was stable.
In both groups, patients were positioned in a
standard fashion on the radiolucent orthopaedic The outcome measurements collected for
table to obtain satisfactory closed fracture reduction each patient were operation time, total blood loss
with fluoroscopy control prior to osteosynthesis. A (intraoperative and postoperative drainage) and
posterior reduction device was connected to the transfusion necessity, pain evaluation (using a
table under the patients’ hip to prevent posterior 10-point Visual Analogue Scale, VAS) and length
sagging of the fracture. After successful closed of hospital stay. The criteria for blood transfusion
reduction, assignment to treatment was performed were: hemoglobin lower than 90 g/L with signs
as described above. All participating surgeons and symptoms of low perfusion. The pain-killer
were experienced in both techniques. Patients protocols for the two groups were similar. The VAS
randomized to receive the conventional DHS scores were measured within the first three days.
. 252 .
In addition, postoperative complications during
hospitalization and within the first six months
following the surgery were collected. Implant-related
failures and mortality were also recorded.
Each patient was reviewed monthly for the
initial 6 months, then 9, 12, 18 and 24 months after
surgery. The follow-up study included both clinical
and radiologic evaluations. X-ray films were taken
for evaluation of position as well as healing of the
fracture and implant (Figure 4). The criteria for
fracture union were defined as full weight bearing
Figure 1. Initial radiograph of one representative case showing intertrochanteric fracture of the right femur. Figure 2. Implant introduced
through separate proximal and distal incisions. Figure 3. Incisions measured during operation. Figure 4. Postoperative radiograph of the
intertrochanteric fracture stabilized by PCCP.
RESULTS
The preoperative characteristics of both groups
are shown in Table 1. The PCCP group included
65 patients with an average age of 72.4 years (49
patients with type AO/OTA 31.A1 and 16 patients
with type AO/OTA 31.A2). The DHS group included
56 patients with an average age of 78.6 years (43
patients with type AO/OTA 31.A1 and 13 patients
with type AO/OTA 31.A2). Both groups are similar in
gender, age, fracture etiology, fracture type, Singh
index and major comorbidity (all P>0.50). Pre-
morbid conditions of the patients were assessed
using the preoperative ASA classification. Although
there was a trend towards fewer patients in ASA
grade II in the DHS group, this difference was not
statistically significant (P=0.841).
Data concerning the hospitalization of the
patients are summarized in Table 2. The average
surgery time was shorter in the PCCP group (55.2 min±
8.4 min) than in the DHS group (88.5 min±14.7 min,
P<0.01). The average total blood loss was 156.5 ml±
18.3 ml in the PCCP group and 513.2 ml±66.2 ml
Chinese Journal of Traumatology 2014;17(5):249-255
on the affected limb with evidence of bridging
callus across the fracture sites on X-ray films. We
evaluated functional recovery of the affected limb
using the Harris hip scoring system 6 months after
surgery.
Statistical analysis
Comparison of the differences between the two
groups was obtained by Pearson X 2 test, Fisher
exact test and independent t-test. SPSS 10.0
statistical software was used to analyze the data. P
values less than 0.05 were considered significant.
in the DHS group (P<0.01). Two patients (3.1%)
treated with PCCP needed transfusions compared
with 25 patients (44.6%) that had DHS surgery. All
fractures in both groups had satisfactory reduction.
Fifty-three of 65 (81.5%) PCCP and 47 of 56 (83.9%)
DHS had adequate screw positions. There were no
significant differences in the rates of satisfactory
reduction and adequate screw position between
the two groups (P=1.0 and P=0.887, respectively).
Although the same postoperative analgesia was
used in the two groups, the mean VAS score in the
PCCP group was lower than that in the DHS group
(P=0.028), which demonstrated that there was less
pain in the former. The hospital stay of the PCCP
and DHS group was (7.85±1.82) and (8.20±2.58)
days, respectively. Harris hip score of each patient
was evaluated six months after surgery. The mean
value was (89.6±3.51) points for the PCCP group
and (84.7±2.65) points for the DHS group (P<0.05).
These outcome measures, including surgery time,
blood loss, blood transfusion rate, mean VAS score
and Harris hip score, were more favorable in the
PCCP group than in the DHS group.
Chinese Journal of Traumatology 2014;17(5):249-255 . 253 .

Table 2. Comparison of main clinical parameters DISCUSSION

PCCP DHS
P value
(χ± s) (χ± s) As a result of an aging population, hip fractures
Operation duration (min) 55.2±8.4 88.5±14.7 <0.01 have become an increasing public health issue.
Blood loss (ml) <0.01 At present, the DHS remains the gold standard for
Intraoperative 64.7±15.3 255.6±30.4 treating intertrochanteric fractures. However, the
Drain 90.8±35.5 227.8±45.5 conventional DHS technique has several drawbacks.
Total 156.5±18.3 513.2±66.2
Without minimally invasive techniques, its insertion
demands a wider incision, causing considerable
Patients receiving blood
bleeding and damage of soft tissues, which could
transfusion 2/65 25/56
increase pain and aggravate comorbidities.16 The
Mean VAS score 2.65±1.00 4.93±1.16 0.028 single-axis lag-screw fixation in the femoral head
Length of hospital stay (d) 7.85±1.82 8.20±2.58 0.240 may provide insufficient rotational stability and
Satisfactory reduction 65/65 56/56 1.000 contribute to the risk of cut-out of the screw.17 It is
Adequate screw position 53/65 47/56 0.887 also known to lead to fracture collapse upon weight
Fracture healing 65/65 54/56 0.924
bearing, resulting in posteromedial discontinuity,
followed by poor functional outcome.18
Harris hip score 89.6±3.51 84.7±2.65 0.027

Elderly patients susceptible to intertrochanteric

Serious postoperative complications included
femur fractures often have poor bone quality as
wound infection, pulmonary embolism, cardiac,
well as other major comorbidities. In an attempt to
implant-related failure, etc. Superficial infections
reduce comorbidities and create faster rehabilitation,
were found in five DHS patients (3 patients with
the PCCP, a device for minimally invasive treatment
type AO/OTA 31.A1.2, 2 patients with type AO/
of intertrochanteric hip fractures was developed.19
OTA 31.A2.1) and short term antibiotic regimens
The PCCP is performed using a no-touch technique
cleared all infections. There were no superficial
with decreased tissue exposure. 20 Percutaneous
infections in the PCCP patients. There were no
insertion of PCCP beneath the vastus lateralis by
cases of deep infection or pulmonary embolism in
means of minimizing tissue dissection results in
the two groups. Major cardiovascular complications
less bleeding, reduced wound hematomas and less
including arrhythmia, myocardial ischemia, or
infectious complications, as well as earlier, more
cardiac decompensation and failure were more
rapid and more effective rehabilitation.21
frequent in the DHS group. Two of 56 patients (3.6%)
in the DHS group showed evidence of implant-
The results of this trial demonstrate that the
related failure. One patient (type AO/OTA 31.A1.3)
relatively novel minimally invasive technique
developed a vascular necrosis of the femoral head
and PCCP are effective and provide favorable
following screw cut-out, while the other failure (type
outcomes. We found less blood loss and fewer
AO/OTA 31.A2.1) was a femoral head collapse as a
blood transfusions in the PCCP group, which could
result of lag screw breakage. A hip arthroplasty was
be attributed to the reduced surgical exposure.
required for the first patient, while open reduction
However, the hidden blood loss was not considered
with internal fixation and bone grafting was needed
in our study which may influence the total blood loss.
for the second. Bone healing was achieved within
But the tendency of less blood loss in the PCCP
8 months for both subjects. There was no implant-
group was obvious. Patients in the PCCP group
related failure in the PCCP group. The difference
experienced less postoperative complications such
in fracture healing rate between both groups was
as infection, cardiac events, and implant-related
not significant (P=0.924). In the PCCP group, 64
failure within six months following the surgery in
(98.4%) of the patients had no serious postoperative
this trial. The tendency towards more infectious
complications, compared to 45 (80.3%) of the
complications in the DHS group could be attributed
patients in the DHS group. Overall, the PCCP group
to considerable damage of soft tissues. Other
displayed less postoperative morbidity (P<0.05).
studies indicate that the minimal tissue dissection
. 254 .
and damage characteristic of the PCCP technique is
a possible explanation for a decreased trend toward
the incidence of postoperative infections in the
PCCP group.16 Cardiac events have been reported
as the most common and hazardous complications
of hip fracture surgery, with a rate of 27% in patients
undergoing DHS surgery.22 However, a large-scale
retrospective study showed a conspicuous decrease
in cardiovascular events in the PCCP group.19 There
is an inevitable correlation between reduced pain
and fewer cardiovascular complications in elderly
patients treated with the PCCP.23 It is possible that
reduced pain and a higher level of comfort after
PCCP surgery may facilitate easier postoperative
mobilization, and reduce postoperative morbidity
and mortality.24 These results show fewer incidences
of implant-related failures in the PCCP group. The
most obvious difference from the DHS is that the
PCCP comprises double telescoping screws, rather
than a single lag screw. Although the union of this
double axis fixation decreases sliding, it can allow
more efficient control of fracture impaction, providing
greater primary stability and better fracture healing.10
It is also hypothesized that the small diameter of the
holes at the drilling site used with the PCCP may
be responsible for preservation of the lateral wall
and reduction of fracture collapse.9 Many authors
have also published beneficial outcomes with less
pain and improved weight bearing using PCCP,
supporting this idea of better stability in the early
phase of fracture healing.9,13,16
Due to its percutaneous method of insertion,
it is thought that minimal exposure and periosteal
stripping and preservation of soft tissue coverage
would provide optimum conditions for fracture
union. 25 These factors may decrease bleeding
and postoperative pain, provide faster recovery of
function and result in lower postoperative morbidity.
Strict adherence to each detail of performing the
PCCP procedure is crucial to prevent possible
mechanical problems.16 The correct positioning of
the patient, maintenance of posterior reduction,
correct alignment of the aiming guide and inserting
of the two telescoping screws, are all crucial steps to
ensure long-term fixation.
In conclusion, the present study demonstrates
that, when compared with the conventional DHS
Chinese Journal of Traumatology 2014;17(5):249-255
approach, the PCCP procedure provides significant
advantages such as less blood loss, fewer blood
transfusions, decreased pain, faster recovery of
function and less postoperative morbidity. The PCCP
should be considered as a minimally invasive and
viable therapeutic alternative for intertrochanteric
fractures (type AO/OTA 31. A1-A2, Evans type 1) in
elderly patients.
REFERENCES
1. Cumming RG, Nevitt MC, Cummings SR. Epidemiology
of hip fractures [J]. Epidemiol Rev 1997;19(2):244-57.
2. Krischak GD, Augat P, Beck A, et al. Biomechanical
comparison of two side plate fixation techniques in an
unstable intertrochanteric osteotomy model: sliding hip
screw and percutaneous compression plate [J]. Clin Biomech
2007;22(10):1112-8.
3. Morris AH, Zuckerman JD. National consensus
conference on improving the continuum of care for patients with
hip fracture [J]. J Bone Joint Surg Am 2002;84(3):670-4.
4. Janzing HM, Houben BJ, Brandt SE, et al. The Gotfried
percutaneous compression plate versus the dynamic hip screw in
the treatment of pertrochanteric hip fractures: minimal invasive
treatment reduces operative time and postoperative pain [J]. J
Trauma 2002;52(2):293-8.
5. Ahrengart L, Tornkvist H, Fornander P, et al. A
randomized study of the compression hip screw and Gamma
nail in 426 fractures [J]. Clin Orthop Relat Res 2002;(401):209-
22.
6. Dujardin FH, Benez C, Polle G, et al. Prospective
randomized comparison between a dynamic hip screw and a
mini-invasive static nail in fractures of the trochanteric area:
preliminary results [J]. J Orthop Trauma 2001;15(6):401-6.
7. Browner BD, Alberta FG, Mastella DJ. A new
era in orthopedic trauma care [J]. Surg Clin North Am
1999;79(6):1431-48.
8. Ropars M, Mitton D, Skalli W. Minimally invasive
screw plates for surgery of unstable intertrochanteric femoral
fractures: a biomechanical comparative study [J]. Clin Biomech
2008;23(8):1012-7.
9. Gotfried Y. Percutaneous compression plating
of intertrochanteric hip fractures [J]. J Orthop Trauma
2000;14(7):490-5.
10. Gotfried Y. Percutaneous compression plating
for intertrochanteric hip fractures: treatment rationale [J].
Orthopedics 2002;25(6):647-52.
11. Yang E, DeLaMora S. Minimally invasive treatment of
intertrochanteric hip fractures with the Gotfried percutaneous
Chinese Journal of Traumatology 2014;17(5):249-255
compression plate [J]. Orthopedics 2008;31(1):29-36.
12. Adams CI, Robinson CM, Court-Brown CM, et al.
Prospective randomized controlled trial of an intramedullary nail
versus dynamic screw and plate for intetrochanteric fractures of
the femur [J]. J Orthop Trauma 2001;15(6):394-400.
13. Peyser A, Weil YA, Brocke L, et al. A prospective,
randomised study comparing the percutaneous compression
plate and the compression hip screw for the treatment of
intertrochanteric fractures of the hip [J]. J Bone Joint Surg Br
2007;89(9):1210-7.
14. Owens WD, Felts JA, Spitznagel EL Jr. ASA physical
status classification: a study of consistency of ratings [J].
Anesthesiology 1978;49(4):239-43.
15. Singh M, Nagrath AR, Maini PS. Changes in trabecular
pattern of the upper end of the femur as an index of osteoporosis
[J]. J Bone Joint Surg Am 1970;52(3):457-67.
16. Panesar SS, Mirza S, Bharadwaj G, et al. The
percutaneous compression plate versus the dynamic hip screw: a
meta-analysis [J]. Acta Orthop Belg 2008;74(1):38-48.
17. Kuzyk PR, Guy P, Kreder HJ, et al. Minimally invasive
hip fracture surgery: are outcomes better [J]? J Orthop Trauma
2009;23(6):447-53.
18. Varela-Egocheaga JR, Iglesias-Colao R, Suarez-
Suarez MA, et al. Minimally invasive osteosynthesis in stable
trochanteric fractures: a comparative study between Gotfried
percutaneous compression plate and Gamma 3 intramedullary
nail [J]. Arch Orthop Trauma Surg 2009;129(10):1401-7.
19. Brandt SE, Lefever S, Janzing HM, et al. Percutaneous
. 255 .
compression plating (PCCP) versus the dynamic hip screw for
pertrochanteric hip fractures: preliminary results [J]. Injury
2002;33(5):413-8.
20. Peyser A, Weil Y, Brocke L, et al. Percutaneous
compression plating versus compression hip screw fixation
for the treatment of intertrochanteric hip fractures [J]. Injury
2005;36(11):1343-9.
21. Bensafi H, Laffosse JM, Giordano G, et al. The
percutaneous compression plate (PCCP) in the treatment of
trochanteric hip fractures in elderly patients [J]. Acta Orthop
Belg 2006;72(3):314-9.
22. Lawrence VA, Hilsenbeck SG, Noveck H, et al. Medical
complications and outcomes after hip fracture repair [J]. Arch
Intern Med 2002;162(18):2053-7.
23. Matot I, Oppenheim-Eden A, Ratrot R, et al.
Preoperative cardiac events in elderly patients with hip
fracture randomized to epidural or conventional analgesia [J].
Anesthesiology 2003;98(1):156-63.
24. Mnif H, Koubaa M, Zrig M, et al. Elderly patient’s
mortality and morbidity following trochanteric fracture. A
prospective study of 100 cases [J]. Orthop Traumatol Surg Res
2009;95(7):505-10.
25. Kosygan KP, Mohan R, Newman RJ. The Gotfried
percutaneous compression plate compared with the conventional
classic hip screw for the fixation of intertrochanteric fractures of
the hip [J]. J Bone Joint Surg Br 2002;84(1):19-22.
(Received December 20, 2013)
Edited by Song Shuangming