Failed internal fixation of intertrochanteric hip fractures with dynamic hip screws
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Published:
Nov 12, 2019
Keywords:
Fracture, hip, plate, dynamic screw, pitfalls
Main Article Content
Abstract
Introduction: The use of Dynamic Hip/Sliding Screw (DHS) for intertrochanteric fractures has proven to be an effective fixation method, but it also has its failures.
The purpose of this study was to evaluate the reason of failures in patients with lateral hip fractures that were treated with a DHS.
Method:177 patients were treated in our center for lateral hip fracture. In 151 of them we used a DHS. The adequate postoperative reduction, the measurement of the tip-to-apex distance, the position of the cephalic screw in the femoral head and the possible complications were analyzed.
Results: The series was made up of 143 patients. The average follow-up was 18 months (range 12-48). The failure rate was 8.4% (n = 12): 7 (4.8%) due to cephalic migration (cut-out) of the proximal screw, 2 (1.4%) due to medial migration (cut-through) , 2 (1.4%) presented pseudoarthrosis and one case (0.70%) of inadequate reduction in varus. The percentage of a second operation was 7.7% (n = 11). The worst position was the superior / posterior with 100% migration (n = 4) (p <0.001, statistically significant difference).
Conclusion: The superior / posterior positioning of the head screw could increase the possibility of migration and, consequently, the failure rate of the system.
The purpose of this study was to evaluate the reason of failures in patients with lateral hip fractures that were treated with a DHS.
Method:177 patients were treated in our center for lateral hip fracture. In 151 of them we used a DHS. The adequate postoperative reduction, the measurement of the tip-to-apex distance, the position of the cephalic screw in the femoral head and the possible complications were analyzed.
Results: The series was made up of 143 patients. The average follow-up was 18 months (range 12-48). The failure rate was 8.4% (n = 12): 7 (4.8%) due to cephalic migration (cut-out) of the proximal screw, 2 (1.4%) due to medial migration (cut-through) , 2 (1.4%) presented pseudoarthrosis and one case (0.70%) of inadequate reduction in varus. The percentage of a second operation was 7.7% (n = 11). The worst position was the superior / posterior with 100% migration (n = 4) (p <0.001, statistically significant difference).
Conclusion: The superior / posterior positioning of the head screw could increase the possibility of migration and, consequently, the failure rate of the system.
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How to Cite
Pesciallo, C. Ángel, Pérez Alamino, L., Garabano, G., & del Sel, H. (2019). Failed internal fixation of intertrochanteric hip fractures with dynamic hip screws. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 84(4), 328-335. https://doi.org/10.15417/issn.1852-7434.2019.84.4.961
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Clinical Research
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References
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7. Barton MT, Gleeson R, Topliss C, Greenwood R, Harries W, Cheeser JST. A comparison of the long gamma nail with the sliding hip screw for the treatment of AO/OTA 31-A2 fractures of the proximal femur: a prospective randomized trial. J Bone Joint Surg Am 2014;92(4):792-8. https://doi.org/10.2106/JBJS.I.00508
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9. Hsue KK, Fang CK, Chen CM, Su YP, Wu HF, Chiu FY. Risk factors in cutout of sliding hip screw in intertrochanteric fractures: an evaluation of 937 patients. Int Orthop 2010;34(8):1273-6. https://doi.org/10.1007/s00264-009-0866-2
10. Jensen JS, Tondevold E, Mossing N. Unstable trochanteric fractures treated with the sliding screw plate system. Acta Orthop Scand 1978;49(4):392-7. https://doi.org/10.3109/17453677809050094
11. Parker MJ, Handoll HHG. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures. Cochrane Database Syst Rev 2008;(3):CD000093. https://doi.org/10.1002/14651858.CD000093.pub4
12. Wu CC, Shih CH, Lee MY, Tai TCL. Biomechanical analysis of location of lag screw of a dynamic hip screw in treatment of unstable intertrochanteric fracture. J Trauma 1996;41(4):669-702. https://doi.org/10.1097/00005373-199610000-00017
13. Mainds CC, Newman RJ. Implant failures in patients with proximal fractures of the femur treated with a sliding screw device. Injury 1989;20(2):98-100. https://doi.org/10.1016/0020-1383(89)90151-4
14. Parker MJ. Cutting-out of the dynamic hip screw related to its position. J Bone Joint Surg Br 1992;74(4):625. PMID:1624529
15. Parker MJ. Valgus reduction of trochanteric fractures. Injury 1993;24(5):313-6. https://doi.org/10.1016/0020-1383(93)90053-9
16. Geller JA, Saifi C, Morrison TA, Macaulay W. Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures. Int Orthop 2010;34(5):719-22. https://doi.org/10.1007/s00264-009-0837-7
17. Lindskog DM, Baumgaertner MR. Unstable intertrochanteric hip fractures in the elderly. J Am Acad Orthop Surg 2004;12(3):179-90. PMID: 15161171
18. Shukla S, Johnston P, Ahmad MA, Wynn-Jones, Patel AD, Walton NP. Outcome of traumatic subtrochanteric femoral fractures fixed using cephalo-medullary nails. Injury 2007;38(11):1286-93. https://doi.org/10.1016/j.injury.2007.05.013
19. Kumar R, Singh R N. Comparative prospective study of proximal femoral nail and dynamic hip screw in treatment of intertrochanteric fracture femur. J Clin Orthop Trauma 2012;3(1):28-36. https://doi.org/10.1016/j.jcot.2011.12.001
2. Loterzo LG, Santamarta L. Aporte al manejo traumatológico de la osteoporosis. Rev Asoc Argent Ortop Traumatol 1997;62(4):519-23.
3. Jacobs RR, McClain O, Armstrong HJ. Internal fixation of intertrochanteric hip fractures: a clinical and biomechanical study. Clin Orthop Relat Res 1980;146:62-70. PMID: 7371270
4. Baumgaertner MR, Solberg BD. Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip. J Bone Joint Surg Br 1997;79(6)969-71. https://doi.org/ 10.1302/0301-620x.79b6.7949
5. Jensen JS. Classification of trochanteric fractures. Acta Orthop Scand 1980;51:1-6, 803-810. https://doi.org/10.3109/17453678008990877
6. Shen L, Zhang Y, Shen Y, Cui Z. Antirotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures: A meta-analyses of randomized controlled trials. Orthop Traumatol Surg Res 2013;99(4):377-83. https://doi.org/10.1016/j.otsr.2012.12.019
7. Barton MT, Gleeson R, Topliss C, Greenwood R, Harries W, Cheeser JST. A comparison of the long gamma nail with the sliding hip screw for the treatment of AO/OTA 31-A2 fractures of the proximal femur: a prospective randomized trial. J Bone Joint Surg Am 2014;92(4):792-8. https://doi.org/10.2106/JBJS.I.00508
8. Kim WY, Han CH, Park JI, Kim JY. Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop 2001;25:360-2. https://doi.org/10.1007/s002640100287
9. Hsue KK, Fang CK, Chen CM, Su YP, Wu HF, Chiu FY. Risk factors in cutout of sliding hip screw in intertrochanteric fractures: an evaluation of 937 patients. Int Orthop 2010;34(8):1273-6. https://doi.org/10.1007/s00264-009-0866-2
10. Jensen JS, Tondevold E, Mossing N. Unstable trochanteric fractures treated with the sliding screw plate system. Acta Orthop Scand 1978;49(4):392-7. https://doi.org/10.3109/17453677809050094
11. Parker MJ, Handoll HHG. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures. Cochrane Database Syst Rev 2008;(3):CD000093. https://doi.org/10.1002/14651858.CD000093.pub4
12. Wu CC, Shih CH, Lee MY, Tai TCL. Biomechanical analysis of location of lag screw of a dynamic hip screw in treatment of unstable intertrochanteric fracture. J Trauma 1996;41(4):669-702. https://doi.org/10.1097/00005373-199610000-00017
13. Mainds CC, Newman RJ. Implant failures in patients with proximal fractures of the femur treated with a sliding screw device. Injury 1989;20(2):98-100. https://doi.org/10.1016/0020-1383(89)90151-4
14. Parker MJ. Cutting-out of the dynamic hip screw related to its position. J Bone Joint Surg Br 1992;74(4):625. PMID:1624529
15. Parker MJ. Valgus reduction of trochanteric fractures. Injury 1993;24(5):313-6. https://doi.org/10.1016/0020-1383(93)90053-9
16. Geller JA, Saifi C, Morrison TA, Macaulay W. Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures. Int Orthop 2010;34(5):719-22. https://doi.org/10.1007/s00264-009-0837-7
17. Lindskog DM, Baumgaertner MR. Unstable intertrochanteric hip fractures in the elderly. J Am Acad Orthop Surg 2004;12(3):179-90. PMID: 15161171
18. Shukla S, Johnston P, Ahmad MA, Wynn-Jones, Patel AD, Walton NP. Outcome of traumatic subtrochanteric femoral fractures fixed using cephalo-medullary nails. Injury 2007;38(11):1286-93. https://doi.org/10.1016/j.injury.2007.05.013
19. Kumar R, Singh R N. Comparative prospective study of proximal femoral nail and dynamic hip screw in treatment of intertrochanteric fracture femur. J Clin Orthop Trauma 2012;3(1):28-36. https://doi.org/10.1016/j.jcot.2011.12.001