scholarly journals Fixation with Cephalic Intramedullary Nail Versus Sliding Hip Screw for Fractured Lesser Trochanter with Completeness of Lateral Wall

2021 ◽  
Author(s):  
Yu-Lien Lin ◽  
Chien-Shun Wang ◽  
Chao-Ching Chiang ◽  
Ming-Chau Chang ◽  
Chun Cheng Lin
Keyword(s):  
Callus Formation ◽  
Lateral Wall ◽  
Real World Data ◽  
Retrospective Case ◽  
Neck Shaft Angle ◽  
Lag Screw ◽  
Intramedullary Device ◽  
Unstable Intertrochanteric Fracture ◽  
Femoral Shortening ◽  
Hip Screw

Abstract Our study provides references and guidelines, backed by evidence and real world data, in determining if and which certain surgical devices are more applicable to improve the outcome of unstable intertrochanteric fracture treatments. This retrospective case-crossover study compares the clinical and radiographic outcomes of 177 elderly patients from 2010 to 2014, who underwent procedures for unstable intertrochanteric fractures, specifically, AO/OTA type 31-A1.3 fractures using either the cephalic intramedullary device (Gamma3 IM nail system, Stryker®); or the fixation with sliding hip screws method (Dynamic Hip Screw, DHS, Synthes®). Clinical outcome conclusions were based on the union rates of the fractures during the patient’s one year follow-up. Radiographic conclusions were drawn from various factors, including neck shortening, neck-shaft angle, neck medialization, posterior tilting, callus formation time, Tip-apex distance (TAD), implant failure, and modified TAD, an additional factor further explained in the paper. The study shows evidence that the cephalic intramedullary device had significantly shorter union time, and significantly reduced rates of lag screw sliding and femoral shortening as well. No significant differences with regard to malunion and cut-out of the lag screw were found. The use of the intramedullary devices led to better clinical and radiographical outcomes for this specific fracture.

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

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.

scholarly journals Radiological and functional outcome of unstable intertrochanteric fractures treated with proximal femoral locking plate

2021 ◽  
Vol 7 (5) ◽  
pp. 968
Author(s):  
Chanchal Kumar Singh ◽  
Juhi Deshpande
Keyword(s):  
Functional Outcome ◽  
Intertrochanteric Fracture ◽  
Locking Plate ◽  
Lateral Wall ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Systemic Complications ◽  
Neck Shaft Angle ◽  
Loss Of Reduction ◽  
Unstable Intertrochanteric Fracture

<p class="abstract"><strong>Background:</strong> Intertrochanteric fracture is a common orthopaedic injury sustained in elderly population because of osteoporosis and trivial fall. Life threatening systemic complications occur mainly due to immobility.</p><p class="abstract"><strong>Methods:</strong> We included 62 patients (40 males and 22 females) of unstable intertrochanteric fracture (AO 31 A2 and A3) attending Department of Orthopaedics. They were all subjected to surgical treatment with proximal femoral locking plate. Patients were followed up at 3rd, 6th and 12th month for outcomes variables i.e.; functional (Harris hip score, Palmer and Parker mobility score) and radiological outcomes (neck shaft angle, loss of reduction, union and implant related complications). Statistical analysis was done using Friedman’s test after calculating the data in terms of mean and median using SPSS 20 software.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean age of our patients was 64 years, 40 were males and 22 females. 50 patients sustained fracture due to trivial fall and 12 due to RTA. 35 out of 62 patients had medical co-morbidites. 26 patients needed open reduction of fracture and 36 were close reduced. 22 of patients had severe comminution (AO A 3 III type). Average blood loss was 254 ml. Mean degree of loss of reduction was 5 degrees in 6th month and 4 degrees in 12th month. Union was achieved in 48 out of 50 patients at 12th month.  Most of the patients achieved fair to good functional outcome scores at 12th month of follow up. We noticed difficulties in fracture reduction as well as complications related to implant.</p><p class="abstract"><strong>Conclusions:</strong> PFLP is an effective implant in comminuted intertrochanteric fractures with broken lateral wall. Complications can be minimised by following principles of locking plate meticulously.</p>

Which AO/OTA 31-A2 pertrochanteric fractures can be treated with a dynamic hip screw without developing a lateral wall fracture? A CT-based study

2015 ◽  
Vol 40 (5) ◽  
pp. 1009-1017 ◽  
Author(s):  
Gaurav Sharma ◽  
Ravijot Singh ◽  
Kiran Kumar GN ◽  
Vaibhav Jain ◽  
Ankit Gupta ◽  
...  
Keyword(s):  
Lateral Wall ◽  
Dynamic Hip Screw ◽  
Pertrochanteric Fractures ◽  
Hip Screw

Common Modes of Fixation Failure with a Sliding Hip Screw encountered Unstable Intertrochanteric Fracture

2003 ◽  
Vol 16 (1) ◽  
pp. 15 ◽  
Author(s):  
Byung Soon Kim ◽  
Duck Yun Cho ◽  
Hyung Ku Yoon ◽  
Dong Eun Sin ◽  
Soo Hong Han ◽  
...  
Keyword(s):  
Intertrochanteric Fracture ◽  
Sliding Hip Screw ◽  
Fixation Failure ◽  
Unstable Intertrochanteric Fracture ◽  
Hip Screw

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.

Treatment of an Unstable Intertrochanteric Fracture of The Femur Using a PMMA Augmented Compression Hip Screw

2004 ◽  
Vol 39 (6) ◽  
pp. 668
Author(s):  
Soon Yong Kwon ◽  
Do Hyun Chung ◽  
Kyung Jin Rhee ◽  
Young Kyun Woo ◽  
Yong Sik Kim
Keyword(s):  
Intertrochanteric Fracture ◽  
Unstable Intertrochanteric Fracture ◽  
Hip Screw
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