Similarities between Inferior-Center and Center-Center Lag Screw Positions in Femoral Intertrochanteric Fracture Surgeries

2020 ◽  
Author(s):  
Yu-Cheng Yeh ◽  
Chang-Heng Liu ◽  
Ying-Chao Chou ◽  
Yung-Heng Hsu ◽  
Yi-Hsun Yu
Keyword(s):  
Intertrochanteric Fracture ◽  
Intertrochanteric Fractures ◽  
Fixation Failure ◽  
Radiographic Findings ◽  
Lag Screw ◽  
Helical Blade ◽  
Femoral Intertrochanteric Fracture ◽  
Screw Position ◽  
Standard Value ◽  
Tip Apex Distance

Abstract Background: The center-center lag screw position has been widely accepted as the optimal lag screw/helical blade position in femoral intertrochanteric fracture surgery to achieve a tip-apex distance (TAD) less than 25 mm. Despite the inferior-center lag screw/helical blade position having some biomechanical advantages, and the emergence of calcar-referenced tip-apex distance (CalTAD), the clinical differences between the two commonly placed lag screw/helical blade positions remain unclear. This study aimed to (1) report radiological outcomes in managing geriatric femoral intertrochanteric fractures, (2) identify the influences of positions of lag screw/helical blade, and (3) identify the relationship between implants and the values of TAD and CalTAD.Methods: We retrospectively assessed the clinical and radiographic findings of geriatric patients (age ≥ 55 years) who underwent surgery for acute closed femoral intertrochanteric fractures during 1-year period and were followed up a minimum of 6 months. The radiographic parameters and incidences of fixation failure were compared between the different lag screw and helical blade positions (center-center vs. inferior-center). Subgroup analyses of different implant types (extramedullary and intramedullary) were also performed for comparisons for different lag screw positions, and TAD and CalTAD beyond the normal standard value of 25 mm.Results: A total of 206 patients were included during the study period, with a 7.8% fixation failure. There were no differences in incidences of fixation failure between the commonly inserted lag screw/helical blade positions (center-center vs. inferior-center), regardless of the implant types. Those with a TAD > 25 mm had significantly higher incidence of fixation failure than those with a TAD ≤ 25 mm in the extramedullary plate (17.0% vs. 1.2%, p = 0.001), but not in the intramedullary nails (16.1% vs. 4.4%, p = 0.08). There were no significant differences in incidences of fixation failure between CalTAD ≤ 25 mm and CalTAD > 25 mm in either extramedullary or intramedullary implants. Conclusion: Although TAD > 25 mm might increase the fixation failure rate in extramedullary plates, an inferior-center lag screw/helical blade position could achieve comparable radiographic results as a center-center position after osteosynthesis for geriatric femoral intertrochanteric fractures.

scholarly journals Intertrochanteric fracture fixation with Dynamic Hip Screw: Is tip-apex distance measurement useful for predicting fixation failure?

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Goh KL ◽  
Zamzuri Z ◽  
Mohd Ariff S ◽  
Mohamed Azril MA
Keyword(s):  
Intertrochanteric Fracture ◽  
Demographic Data ◽  
Dynamic Hip Screw ◽  
Optimal Placement ◽  
Fixation Failure ◽  
Lag Screw ◽  
Hip Screw ◽  
Tip Apex Distance ◽  
One Year

Introduction: Application of dynamic hip screw (DHS) implant for the treatment of unstable intertrochanteric fractures continues to raise concern related to risk of lag screw cut-out with or without subsequent damage to the acetabulum. Measurement of tip-apex distances (TAD) has been recommended to guide the optimal placement of lag screw and to predict subsequent risk of screw cut-out. In this study, the value of TAD was evaluated to verify its usefulness. Methods: This is a retrospective study of 33 consecutive patients with intertrochanteric fracture treated with DHS. Demographic data of the patients were traced from their case notes. Post-operative radiographs were reviewed by focusing on measurement of TAD on anteroposterior and lateral radiographs. Radiographs at one year follow-up were reviewed to depict any fixation-related failure or complication. Results: Fifty two percent of patients did not achieved the recommended TAD of ≤ 25mm. The mean post-operative TAD was 25.9mm and elderly patients were likely to achieve TAD of ≤ 25mm. The overall complication rate of 6% was attributed to screw cut-out in two cases. The unstable left-sided fracture was identified to be a potential risk for screw cut-out or migration. Conclusion: TAD is a valuable measurement to guide optimal placement of lag screw during DHS fixation of intertrochanteric fracture.

scholarly journals Lag screw cutout in intertrochanteric fractures fixed with DHS.

2020 ◽  
Vol 27 (09) ◽  
pp. 1862-1866
Author(s):  
Muhammad Nasir Ali ◽  
Muhammad Khalid Chishti ◽  
Kashif Siddiq ◽  
Muhammad Hamayun Hameed ◽  
Muhammad Tayyab Waheed ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Intertrochanteric Fractures ◽  
Cross Sectional ◽  
Middle Position ◽  
Lag Screw ◽  
Screw Position ◽  
Hip Screw ◽  
The Mean ◽  
Study Setting

Objectives: To determine the failure of DHS (dynamic hip screw) in terms of lag screw cutout. Study Design: Hospital Based Cross Sectional study. Setting: BVH and Civil Hospital Bahawalpur. Period: From 2013 to 2018. Material & Methods: 273 patients of both genders with age more than 50 years having stable intertrochanteric fractures were included in this study. With the help of C arm, the best possible anatomical reduction and rigid internal fixation was done with 135 degree DHS. Lag screw position and TAD determined on first postoperative day on radiographs (Anteroposterior & Lateral). Failure of fixation was determined on the radiographs during follow up. Lag screw cut-out was the projection of the screw from the femoral head by more than 1mm. Results: The mean age of the patients was 68.6 years (50-88). There were 132 (51.1 %) males and 126 (48.8%) females. Overall lag screw cutout rate was 11.2%. 21(30.8%) had screw cutout while 47 (69.1%) healed successfully among 68 patients with TAD ≥ 25mm. On the other hand 8(4.2%) had screw cutout while 182 (95.7%) healed successfully among 190 patients with TAD < 25mm. Middle middle and inferior middle position had highest success rate (˃ 92%) while inferior posterior position had highest cutout rate (36.2%). Among different age categories high failure rate (17.8%) seen in patients more than 70 years. Conclusion: The incidence of lag screw cutout is 11.2 % and risk of cutout can be minimized by placing lag screw in middle middle or inferior middle position and keeping the TAD < 25mm. More attention during follow up should be paid to patients with age ˃ 70 years.

scholarly journals Application of Wire-Assisted Reduction Guided by Minimally Invasive Wire Introducer in the Treatment of Irreducible Femoral Intertrochanteric Fractures

2020 ◽  
Author(s):  
Xiaocong Lin ◽  
Xiuxi Huang ◽  
Kaibin Fang ◽  
Qingfeng Ke ◽  
Shaojian Shi ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Open Reduction ◽  
Intertrochanteric Fracture ◽  
Operation Time ◽  
Fracture Reduction ◽  
Control Group ◽  
Intertrochanteric Fractures ◽  
Observation Group ◽  
Reduction Operation ◽  
Femoral Intertrochanteric Fracture

Abstract Background: Open reduction was often required in the treatment of irreducible femoral intertrochanteric fractures. A minimally invasive wire introducer was designed to assist the reduction of such fractures. The aim of our study was to investigate the clinical outcomes of this technique.Methods: Between 2013 and 2018, 92 femoral intertrochanteric fracture patients who were treated with intramedullary nail fixation and difficult reduction using the traction beds were retrospectively reviewed. Decision for surgery was based on the displacement of the fracture. The patients was divided into two groups, 31 in the control group and 61 in the observation group. The control group were received open reduction operation. And the observation group still received the closed reduction operation, using minimally invasive wire introducer to guide the wire and assist the fracture reduction. The operation time, blood loss, VAS scores, angulation, reduction, neck-shaft angle, redisplacement, limb length discrepancy, and union time were recorded.Results: All patients of two groups were successfully operated and were followed up for an average of 23.8 months. There was no statistical difference in baseline data between the two groups. The observation group had shorter operation time, lower VAS score and less intraoperative bleeding. And the datas are statistically different.Conclusion: Minimally invasive wire introducer is a good technology to guide the wire for irreduciblr femoral intertrochanteric fracture reduction. Using this technique, irreduciblr femoral intertrochanteric fractures could be restored and good clinical outcome was achieved.Level of evidence: Level IV; Case Series; Treatment Study

scholarly journals Proximal femoral nail anti-rotation versus cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture in the elderly: a retrospective study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Shenghu Zhou ◽  
Jun Liu ◽  
Ping Zhen ◽  
Weiwei Shen ◽  
Yanfeng Chang ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Elderly Patients ◽  
Intertrochanteric Fracture ◽  
Operation Time ◽  
The Elderly ◽  
Proximal Femoral Nail ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Fractures ◽  
Intraoperative Bleeding ◽  
Femoral Intertrochanteric Fracture

Abstract Background The treatment for unstable intertrochanteric fractures in the elderly has always been a controversial issue. The aim in this study was to compare the curative effects of proximal femoral nail anti-rotation (PFNA) and cementless bipolar hemiarthroplasty (CPH) on femoral intertrochanteric fracture in the elderly. Methods From March 2008 to December 2012, 108 elderly patients with femoral intertrochanteric fractures were treated by PFNA or CPH. There were 63 males and 45 females, aged 75.3–99.1 years [(83.7 ± 5.6) years]. The patients’ bone mineral density was routinely measured, and the fractures were classified according to Evans-Jensen. The patients were divided into CPH group and PFNA group. The differences in operation time, intraoperative bleeding, immobilization duration, hospitalization time, Harris scores and postoperative complications including deep venous thrombosis, lung and urinary infection were analyzed. Results All patients were followed for 12.5–36.2 months [(28.0 ± 6.3) months)]. The operation time was (53.7 ± 15.2) min and (77.5 ± 16.8) min in PFNA group and CPH group, respectively (P < 0.05); intraoperative bleeding was (132.5 ± 33.2) mL and (286.3 ± 43.2) mL, respectively (P < 0.05); immobilization duration was (28.2 ± 3.7) days and (3.1 ± 1.2) days, respectively (P < 0.05); hospitalization time was (7.6 ± 1.8) days and (6.9 ± 2.2) days, respectively (P > 0.05); and the Harris scores after 1 year were (87.7 ± 7.9) points and (88.3 ± 9.2) points, respectively (P > 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05). Conclusion Both PFNA and CPH are safe and effective treatments for femoral intertrochanteric fracture in elderly patients. Nonetheless, CPH allows faster mobilization and recovery. Trial registration Registration Number: ChiCTR1900022846. Reg Date:2019-04-26 00:27:33 Retrospective registration

scholarly journals Factors determining failure of intertrochanteric fracture fixation with a dynamic hip screw: a retrospective analysis

2018 ◽  
Vol 4 (5) ◽  
pp. 720
Author(s):  
Ravi K. Jain ◽  
Abhineet Verma ◽  
Arjun Jain ◽  
Yogesh Patel
Keyword(s):  
Femoral Head ◽  
Intertrochanteric Fracture ◽  
Dynamic Hip Screw ◽  
P Value ◽  
Unstable Fracture ◽  
Intertrochanteric Fractures ◽  
High Positive Correlation ◽  
Lag Screw ◽  
Loss Of Reduction ◽  
Hip Screw

<p class="abstract"><strong>Background:</strong> The intertrochanteric fractures are extra capsular fractures of proximal femur in the trochanteric region. Different fixation techniques were tried for intertrochanteric fractures, with variety of implants but the dynamic hip screw fixation is most widely accepted treatment. However, several authors have concluded that sliding compression screws may be associated with several complications such as perforation of the femoral head, loss of reduction caused by excessive sliding of the lag screw, non-union, shortening of the affected limb and pain. This study was carried out to ascertain the factors that contributed to mechanical failure at our institute.</p><p class="abstract"><strong>Methods:</strong> We retrospectively reviewed 92 patients with unilateral intertrochanteric fracture treated with a sliding hip screw between July 2015 and April 2017. Postoperative radiographs were studied for any loss of reduction, which was defined as a varus deformity greater than 10°, perforation of the femoral head, extrusion of the lag screw of more than 20 mm, or metal failure. The Pearson chi-square test was used to assess the relationship between failure and osteoporosis. A p value of less than 0.05 was considered to be significant.<strong></strong></p><p class="abstract"><strong>Results:</strong> Results revealed a significant relationship between failure and osteoporosis. A possible relationship between the stability of the fracture on Evans’ classification and osteoporosis on Singh’s index was investigated which revealed a high positive correlation between the failure rates of unstable fractures with osteoporosis.</p><p><strong>Conclusions:</strong> An unstable fracture combined with osteoporosis, has higher percentage of fixation failure leading to other methods of treatment like hemiarthroplasty. </p>

scholarly journals A RETROSPECTIVE STUDY COMPARING PROXIMAL FEMORAL NAIL ANTI-ROTATION WITH CEMENTLESS BIPOLAR HEMIARTHROPLASTY FOR UNSTABLE FEMORAL INTERTROCHANTERIC FRACTURE

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Satish Bobade ◽  
Sandesh Bobade ◽  
Pravin Deokate
Keyword(s):  
Retrospective Study ◽  
Hospital Stay ◽  
Intertrochanteric Fracture ◽  
Proximal Femoral Nail ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Fractures ◽  
Number Of Patients ◽  
Significant Difference ◽  
Femoral Intertrochanteric Fracture ◽  
The Mean

Background: Intertrochanteric femoral fractures are one of the most common types of bone fractures that are usually caused by severe direct or indirect force. It has also been estimated that nearly 50% of all the fractures are intertrochanteric fractures and the remaining are unstable fractures. Also, it has been found that the mortality related to hip fractures is as high as 15-20%. With an increase in the life expectancy of people, there has been a substantial increase in the number of patients with postmenopausal or senile osteoporosis. Aim: To compare Proximal femoral nail anti-rotation with cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture Methods: It was a retrospective study carried out at the Government Medical College, Baramati for a period of 1 year. One hundred patients were included for the scope of the study. Out of which 50 patients belonged to the PFNA group, and 50 patients belonged to the CPH group. Results: The number of patients in the PFNA group was 50 and that in the CPH group was 50. Both groups show male preponderance. The mean age among both the groups was almost the same, and there was no statistically significant difference among the two groups regarding the mean age. The mean operation time for PFNA was 54.15±16.1 mins, and that of the CPH group was 76.69±15.89 mins. The mean bleeding time for PFNA was 133.12±33.16 ml, and that of the CPH group was 289.25±44.01 ml. There was no statistically significant difference among the ASAA grade scores of the two groups. There was no statistically significant difference among the Evans-Jensen classification of the two groups. The mean length of hospital stay for PFNA group was 7.89±2.0 days, and the mean hospital stay for CPH group was 6.54±1.9 days. Conclusion: The current study depicted that CPH and PFNA are both safe and effective methods of treating elderly patients suffering from intertrochanteric fractures. However, it was found in the current study that CPH was found to have more mean operative time and increased blood loss. Still, the recovery and hospitalization time was almost similar in both the groups. Both the groups had almost similar ASA and Evans Jensen scores that made both the techniques equally safe

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