Comparison and analysis of reoperations in two different treatment protocols for trochanteric hip fractures – postoperative technical complications with dynamic hip screw, intramedullary nail and Medoff sliding plate

Background Femoral head collapse and coxa vara lead to internal fixator failure in elderly patients with hip fracture. External fixator application is an optimal choice; however, the existing methods have many disadvantages. Methods Type 31-A1.3 hip fracture models were developed in nine pairs of 1-year-old fresh bovine corpse femur specimens. Each left femur specimen was fixed by a dynamic hip screw (control group), and each right femur specimen was fixed by the slide-poking external fixator (experimental group). Vertical loading and torsion tests were then performed in both groups. Results In the vertical loading experiment, a 1000-N load was implemented. The mean vertical downward displacement of the femoral head in the experimental and control groups was 1.49322 ± 0.116280 and 2.13656 ± 0.166374 mm, respectively. In the torsion experiment, when the torsion was increased to 10.0 Nm, the mean torsion angle in the experimental and control groups was 7.9733° ± 1.65704° and 15.4889° ± 0.73228°, respectively. The slide-poking external fixator was significantly more resistant to compression and rotation than the dynamic hip screw. Conclusion The slide-poking external fixator for hip fractures that was designed and developed in this study can provide sufficient stability to resist compression and rotation in hip fractures.

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Gotfried percutaneous compression plating (PCCP) versus dynamic hip screw (DHS) in hip fractures: blood loss and 1-year mortality

Aging Clinical and Experimental Research ◽

10.1007/s40520-014-0205-3 ◽

2014 ◽

Vol 26 (5) ◽

pp. 497-503 ◽

Cited By ~ 2

Author(s):

Diego Gaddi ◽

Giorgio Piarulli ◽

Andrea Angeloni ◽

Marta Gandolla ◽

Daniele Munegato ◽

...

Keyword(s):

Blood Loss ◽

Hip Fractures ◽

Dynamic Hip Screw ◽

Hip Screw ◽

Compression Plating

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Biomechanical analysis of the treatment of intertrochanteric hip fracture with different lengths of dynamic hip screw side plates

Technology and Health Care ◽

10.3233/thc-202248 ◽

2020 ◽

Vol 28 (6) ◽

pp. 593-602

Author(s):

Cheng-Chi Wang ◽

Cheng-Hung Lee ◽

Ning-Chien Chin ◽

Kun-Hui Chen ◽

Chien-Chou Pan ◽

...

Keyword(s):

Hip Fractures ◽

Dynamic Hip Screw ◽

Biomechanical Analysis ◽

Element Analysis ◽

Side Plate ◽

Lag Screw ◽

Pull Out ◽

Cortical Screw ◽

Hip Screw ◽

Biomechanical Effect

BACKGROUND: Dynamic hip screw (DHS) is a common implant used to treat stable-type intertrochanteric hip fractures. There are many factors that can affect the success rate of the surgery, including the length of side plates. It is therefore important to investigate the biomechanical effect of different DHS side plates on bones. OBJECTIVE: In order to reduce the likelihood of an implant failure, the aim of this study was to use finite element analysis (FEA) to investigate and understand the effect of side plates with different lengths in DHS. METHODS: In this FEA study, a 3D model with cortical bone, cancellous bone, side plate, lag screw, and cortical screws to simulate the implantation of DHS with different lengths of side plate (2-hole, 4-hole, and 6-hole) for intertrochanteric hip fractures was constructed. The loading condition was used to simulate the force (400 N) on the femoral head and the stress distribution on the lag screw, side plate, cortical screws, and femur was measured. RESULTS: The highest stress points occured around the region of contact between the screw and the cortical bones. The stress on the femur at the most distal cortical screw was the greatest. The shorter the length of the side plate, the greater the stress on the cortical screws, resulting in an increased stress on the femur surrounding the cortical screws. CONCLUSIONS: The use of DHS with 2-hole side plate may increase the risk of side plate pull-out. The results of this study provide a biomechanical analysis for selection of DHS implant lengths that can be useful for orthopaedic surgeons.

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EFFECTS OF DIFFERENT LATERAL FEMORAL WALL THICKNESSES IN INTERTROCHANTERIC HIP FRACTURE TREATED WITH DYNAMIC HIP SCREW

Journal of Mechanics in Medicine and Biology ◽

10.1142/s0219519419400220 ◽

2019 ◽

Vol 19 (02) ◽

pp. 1940022

Author(s):

CHENG-CHI WANG ◽

CHENG-HUNG LEE ◽

KUN-HUI CHEN ◽

CHIEN-CHOU PAN ◽

KUO-CHIH SU

Keyword(s):

Hip Fractures ◽

Stress Shielding ◽

Simulation Models ◽

Lateral Wall ◽

Dynamic Hip Screw ◽

Shielding Effect ◽

Element Analysis ◽

Lag Screw ◽

Hip Screw ◽

Biomechanical Effect

Dynamic hip screw (DHS) is commonly used for stable-type intertrochanteric hip fractures. The importance of lateral femoral wall has been mentioned while treating intertrochanteric hip fractures with DHS. The aim of this study was mainly to investigate the biomechanical effect of different thickness of lateral femoral wall using finite element analysis (FEA). This study constructed FEA simulation models for five different lateral femoral wall thicknesses, and demonstrated the stress distribution on the femoral bone, the cortical screws, the cancellous bone around the lag screw, and the lag screw. The main results showed that when the DHS is implanted, less stress will be distributed at the implantation site on the femur due to the stress-shielding effect. The stress on the cortical screws will be greater at the junction of the cortical screws and the cortical bone. Intertrochanteric hip fractures with a thinner lateral wall thickness may cause higher stress on the femur after DHS is implanted.

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Randomised controlled trial of the dynamic hip screw (DHS) versus the proximal femoral nail (PFN) for unstable hip fractures

http://isrctn.org/> ◽

10.1186/isrctn43959180 ◽

2012 ◽

Author(s):

J White

Keyword(s):

Randomised Controlled Trial ◽

Hip Fractures ◽

Controlled Trial ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Femoral Nail ◽

Hip Screw ◽

Randomised Controlled

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Is There Evidence that the Percutaneous Compression Plate Method of Internal Fixation for Intertrochanteric Hip Fractures Leads to Better Intraoperative and Postoperative Outcomes than the Dynamic Hip Screw?

Clinical Medicine Insights Trauma and Intensive Medicine ◽

10.1177/1179560318777750 ◽

2018 ◽

Vol 9 ◽

pp. 117956031877775 ◽

Cited By ~ 1

Author(s):

James M Halle-Smith ◽

Alasdair JA Carnegy ◽

Richard Carr ◽

Arhfat Ahmed ◽

Robert Wooley ◽

...

Keyword(s):

Cost Effectiveness ◽

Blood Loss ◽

Systematic Reviews ◽

Hip Fractures ◽

Mortality Rates ◽

Dynamic Hip Screw ◽

Postoperative Outcomes ◽

Compression Plate ◽

Hip Screw ◽

Percutaneous Compression Plate

Background: Hip fractures are common, expensive and lead to considerable morbidity and mortality. An ageing population in the United Kingdom means that rates of this injury are increasing, making them a pressing public health issue. The National Institute of Health and Care Excellence (NICE) recommends that extramedullary implants are used over intramedullary nails to fix intertrochanteric fractures, which make up half of all hip fractures. However, there is currently no guidance on the preferred type of extramedullary device whether this be the commonly used dynamic hip screw (DHS) or another newer device. It has been suggested that a percutaneous compression plate (PCCP) can reduce complications and improve functional outcome compared with the traditional DHS. Review Question: In patients with intertrochanteric hip fractures, is the PCCP more effective than the DHS in terms of relevant intraoperative and postoperative outcomes such as blood loss, implant failure, and mortality? Literature Search: We first searched for relevant information in the NICE Clinical Guideline on Hip Fracture Management (CG124), then National Health Service (NHS) evidence for Clinical Knowledge Summaries, then the Cochrane library for systematic reviews. Finally, we conducted an electronic search of the PubMed database. Review Findings: We selected five systematic reviews and eight primary studies for review. The main findings were that the PCCP was associated with significantly less blood loss, fewer blood transfusions, and shorter operating times compared with the DHS. However, no significant differences were found in postoperative pain, orthopaedic performance, and mortality rates between the two methods. There was no comparison of cost-effectiveness between the two methods. Conclusions: The PCCP is superior to the DHS in terms of intraoperative blood loss and, potentially, non-orthopaedic postoperative complications such as deep vein thrombosis and nosocomial infection. However, there was no significant difference in mortality rates between the two methods. Current studies on this topic have several methodological issues and some are of relatively poor quality. Further higher quality research and cost-effectiveness are necessary to further evaluate the efficacy of these methods.

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