Comparison of pediatric proximal femoral locking plates and dynamic hip screws in the fixation of pediatric intertrochanteric fractures, a biomechanical study

Treatment options for pediatric intertrochanteric fractures range from conservative casting in young children to surgical fixation in older patients, most commonly using dynamic hip screws (DHS) or pediatric proximal femoral locking plates (PF-LCP). As there is limited biomechanical evidence favoring one method over another, this study aimed to compare the biomechanical stability of DHS and PF-LCP for the treatment of pediatric intertrochanteric fractures using a synthetic bone model. Sixteen synthetic composite femurs were allocated into two groups stabilized with either a DHS or a PF-LCP. To simulate Delbet type IV intertrochanteric fractures, a vertical osteotomy was created in each specimen. Biomechanical evaluation was carried out using a universal testing machine, assessing axial stiffness, vertical, horizontal, and total displacement, as well as ultimate load to failure under standardized loading conditions. Comparative statistical analyses were then performed to determine differences in biomechanical performance between the two fixation methods. Group P demonstrated significantly smaller vertical and total displacements (0.15 ± 0.15 mm and 0.41 ± 0.31 mm) compared with the DHS group (0.59 ± 0.42 mm and 0.75 ± 0.33 mm) (p = 0.018 and p = 0.045), whereas horizontal displacement showed no difference (p = 0.142). Axial stiffness and ultimate failure load were comparable between groups. All specimens failed at the level of the most distal screw; however, fracture sites occurred significantly more distal in the DHS group (89.7 ± 3.1 mm) than in the PF-LCP group (62.1 ± 2.3 mm, p < 0.001). In a synthetic bone model, PF-LCP group showed less vertical and total displacement than the DHS when fixing intertrochanteric fractures. This suggests that the locking plate may offer a stronger and safer option for treating pediatric intertrochanteric fractures.