The trochanteric gamma nail versus the dynamic hip screw: a prospective randomised study. One-year follow-up of 146 intertrochanteric fractures

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.

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Comparative study between dynamic hip screw and plate with proximal femoral nailing in trochanteric fractures of femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171909 ◽

2017 ◽

Vol 3 (3) ◽

pp. 602

Author(s):

M. K. Nizamoddin Khateeb ◽

Satish Babu D. G.

Keyword(s):

Early Mobilization ◽

Dynamic Hip Screw ◽

Care Hospital ◽

Intertrochanteric Fractures ◽

Sliding Hip Screw ◽

Medical College ◽

Femoral Nailing ◽

Hip Screw ◽

One Year ◽

Proximal Femoral Nailing

Background: Incidence of intertrochanteric fractures has increased significantly during recent years and it will probably continue to rise in near future due to increased longevity of life. Closed methods of treatment for intertrochanteric fractures have increased mortality rates & have largely been abandoned. Rigid internal fixation and early mobilization has been the standard protocol of treatment nowadays. This study was intended to compare the results of Intertrochanteric fractures treated by dynamic hip screw (DHS) over proximal femoral nailing (PFN).Methods: This is a randomized prospective study of 102 cases of intertrochanteric fractures, admitted to Mysore Medical College & Hospital, Mysore and ESIC medical college and hospital Kalaburagi and Kamareddy Ortho & Trauma care Hospital Kalaburagi; treated with proximal femoral nailing and DHS. The patients were divided randomly into two groups, each of 51 patients, 51 were treated by Dynamic Hip Screw & 51 were treated with proximal femoral nail (PFN).All patients were followed up for one year.Results: In our series of 102 patients of Intertrochanteric fractures, 51 were treated with sliding hip screw with plate and 51 were treated by an intra-medullary hip screw. Most of the patients were between 51 to 80 years. Slip and trivial fall accounted for 70% cases. Right side was more common accounted for 58.34% of cases. Conclusions: From our study, we consider PFN as better alternative to DHS in more unstable fractures with technically difficulty and require more experience. Sliding hip screw remains the implant of choice for stable type fractures. We noticed less operative time, less blood loss, fewer intra-op complications in PFN group. The quality of the reduction achieved & proper positioning of the implant are important to achieve the best post-operative outcome.

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Postoperative follow up in the management of intertrochanteric fractures of femur a comparative study using dynamic hip screw and proximal femoral nail

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2020.v6.i1m.1954 ◽

2020 ◽

Vol 6 (1) ◽

pp. 1030-1032

Author(s):

Dr. Rawate Praful

Keyword(s):

Comparative Study ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Intertrochanteric Fractures ◽

Femoral Nail ◽

Hip Screw

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INTER-TROCHANTERIC FRACTURES;

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.03.3307 ◽

2019 ◽

Vol 26 (03) ◽

Author(s):

Farhad Alam ◽

Mudassar Jabeen

Keyword(s):

Internal Fixation ◽

Case Series ◽

Deep Infection ◽

Dynamic Hip Screw ◽

Intertrochanteric Fractures ◽

Superficial Infection ◽

Group A ◽

Hip Screw ◽

Group B

Introduction: Hip fractures are a leading cause of death and disability among elderly. Approximately half of these injuries are intertrochanteric fractures and the incidence is continuously increasing. These fractures are the most common injuries around the hip region and are more common in elderly people. Different types of implants were tried at different times for internal fixation of these fractures, of which dynamic hip screw has remained the most popular one. But with the advent of some newer implants, the efficacy of dynamic hip screw is being questioned. Objectives: To determine the results of dynamic hip screw as a method of internal fixation in closed stable as well as unstable intertrochanteric fractures of femur in adults. Design: Descriptive case series. Setting: The study was conducted in orthopedic department Allied Hospital Faisalabad. Period: 11months (from 26th, march, 2015 to 25th Feb, 2016). Subjects and Methods: Sixty cases of intertrochanteric fractures were included and operated for internal fixation with dynamic hip screw under fluoroscopic guidance. Pre, per and post-operative findings during hospital stay and follow-up period were recorded. Results: We had a total 60 cases, 20 patients in group A stable intertrochanteric fractures and 40 patients in group B unstable intertrochanteric fractures. We have reported the follow up study up to 20 weeks. There were 10 (50%) male and 10 (50%) female in group A. In group B 27 (67.5%) males and 13 (32.5%) females. The youngest pt was 25 years in group A and 16 years in group B. The mean age in group A was 59.10 and st/deviation 16.942. In group B mean age was 54.85 and st/ deviation 14.123. Infection rate in group A was 5%. In group B superficial infection was 5% and deep infection was 2.5%. Nonunion in both groups was 5%. The failure rate was 5% in group A and 20% in group B. Conclusion: The use of Dynamic hip screw with aside plate is associated with good results and acceptable complication rate. Dynamic hip screw is implant of choice in both stable and unstable intertrochanteric fractures.

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Treatment of Intertrochanteric Fractures of the Femur: Comparison of the Gamma Nail and the Dynamic Hip Screw

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.1993.28.5.1666 ◽

1993 ◽

Vol 28 (5) ◽

pp. 1666 ◽

Cited By ~ 3

Author(s):

Koing Woo Kwun ◽

Shin Kun Kim ◽

Sang Wook Lee ◽

Ki Hyun Youn

Keyword(s):

Gamma Nail ◽

Dynamic Hip Screw ◽

Intertrochanteric Fractures ◽

Hip Screw ◽

Fractures Of The Femur

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Evaluation of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20163121 ◽

2016 ◽

Vol 2 (3) ◽

pp. 147

Author(s):

Rahul Kumar Chandan ◽

Dharampal Verma ◽

R. C. Meena ◽

Jakir Husain

Keyword(s):

Weight Bearing ◽

Trochanteric Fracture ◽

Fracture Site ◽

Dynamic Hip Screw ◽

Intertrochanteric Fractures ◽

Partial Weight Bearing ◽

Hip Screw ◽

Lost To Follow Up ◽

Partial Weight

Background: Dynamic hip screw (DHS) has been the standard treatment for stable trochanteric fracture patterns. However, primary stabilization with dynamic/sliding hip screw is not always successful, especially in osteoporotic fractures. Internal fixation in such a situation may achieve a satisfactory initial fracture site reduction, but late fracture collapse into varus during weight bearing, can lead to a high failure rate. Since 1975, polymethylmethacrylate (PMMA) cement-augmented DHS have been used as a solution in unstable ITFs by adding an anchoring ability to the lag screw.Methods: A series of 33 osteoporotic intertrochanteric fractures were operated with cement augmented dynamic hip screw. One patient lost to follow up. All patients were then allowed partial weight bearing walker aided ambulation under the guidance of physiotherapist on the second or third postoperative day. The patients were followed radio logically and clinically at regular intervals (1st month, than at 3rd month and then at 6th month interval after surgery). Results were graded as excellent (score >31), good (score 24-31), fair (score 16-23), and poor (score <16). Clinical result was given according to Salvati and Wilson scoring.Results: Total 33 patients were taken for the study they were followed for minimum 6 months and at 6 months the clinical outcome was rated as per the Salvati and Wilson scoring system. One patient lost to follow-up. Final clinical results as evaluated by Salvati and Wilson scoring were; excellent in 24 cases (75%), good in 7 cases (21.88%), fair in 1 case (3.12%) and poor in 0 cases (0%). There were no non-union, AVN, implant failure and screw cut-out in our study.Conclusions: The surgical management of intertrochanteric fractures with PMMA augmented DHS provide a stable fixation with moderate pain free early mobilisation and better outcome in osteoporotic patients without the complications of superior screw cut-out, sliding collapse, and with the appropriate placement of bone cement along with proper amount (4-5 ml) of cement we can also reduce the cement related complications such as delayed healing, nonunion, heat necrosis and avascular necrosis.

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Increased Fracture Collapse after Intertrochanteric Fractures Treated by the Dynamic Hip Screw Adversely Affects Walking Ability but Not Survival

BioMed Research International ◽

10.1155/2016/4175092 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Christian Fang ◽

Paata Gudushauri ◽

Tak-Man Wong ◽

Tak-Wing Lau ◽

Terence Pun ◽

...

Keyword(s):

Survival Data ◽

Dynamic Contact ◽

Dynamic Hip Screw ◽

Walking Ability ◽

Intertrochanteric Fractures ◽

Term Survival ◽

Kaplan Meier ◽

Screw Position ◽

Hip Screw

In osteoporotic hip fractures, fracture collapse is deliberately allowed by commonly used implants to improve dynamic contact and healing. The muscle lever arm is, however, compromised by shortening. We evaluated a cohort of 361 patients with AO/OTA 31.A1 or 31.A2 intertrochanteric fracture treated by the dynamic hip screw (DHS) who had a minimal follow-up of 3 months and an average follow-up of 14.6 months and long term survival data. The amount of fracture collapse and shortening due to sliding of the DHS was determined at the latest follow-up and graded as minimal (<1 cm), moderate (1-2 cm), or severe (>2 cm). With increased severity of collapse, more patients were unable to maintain their premorbid walking function (minimal collapse = 34.2%, moderate = 33.3%, severe = 62.8%, andp=0.028). Based on ordinal regression of risk factors, increased fracture collapse was significantly and independently related to increasing age (p=0.037), female sex (p=0.024), A2 fracture class (p=0.010), increased operative duration (p=0.011), poor reduction quality (p=0.000), and suboptimal tip-apex distance of >25 mm (p=0.050). Patients who had better outcome in terms of walking function were independently predicted by younger age (p=0.036), higher MMSE marks (p=0.000), higher MBI marks (p=0.010), better premorbid walking status (p=0.000), less fracture collapse (p=0.011), and optimal lag screw position in centre-centre or centre-inferior position (p=0.020). According to Kaplan-Meier analysis, fracture collapse had no association with mortality from 2.4 to 7.6 years after surgery. In conclusion, increased fracture collapse after fixation of geriatric intertrochanteric fractures adversely affected walking but not survival.

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