Risk factors in cutout of sliding hip screw in intertrochanteric fractures: an evaluation of 937 patients
- 26 September 2009
- journal article
- clinical trial
- Published by Springer Science and Business Media LLC in International Orthopaedics
- Vol. 34 (8), 1273-1276
- https://doi.org/10.1007/s00264-009-0866-2
Abstract
The aim of this study was designed to assess the risk factors of lag-screw cutout in the treatment of intertrochanteric fracture with a dynamic hip screw (DHS). From 2003 to 2007, 1,150 patients who had acute unilateral intertrochanteric fractures of the femur were enrolled to the study. All fractures were managed by closed reduction and internal fixation with 135° DHS devices. Patient demographics, fracture patterns, reduction and fixation and perioperative course parameters were all recorded. The follow-up period was 38 months on average (range 16–60 months). Finally, 937 patients were available for evaluation of final results in which we focused on lag-screw cutout. Excluding complications not related to screw position, 64 patients (6.8%) with screw cutout were encountered, and the remaining 873 patients had uneventful union, with the average union time of 17.5 weeks (range15–24 weeks). Upon analysis with logistic regression, the tip−apex distance (TAD) was shown to be the most important predictive factor for cutout, followed by screw position, fracture pattern, reduction and patient age. In order to decrease the risk of lag-screw cutout, it is important to ensure good fracture reduction and to place the lag screw in either the middle/middle or inferior/middle position with appropriate TAD.Keywords
This publication has 28 references indexed in Scilit:
- Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adultsEmergencias, 2010
- Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fracturesInternational Orthopaedics, 2009
- A meta-analysis of the Gamma nail and dynamic hip screw in treating peritrochanteric fracturesInternational Orthopaedics, 2009
- Functional comparison of the dynamic hip screw and the Gamma locking nail in trochanteric hip fractures: a matched-pair study of 268 patientsInternational Orthopaedics, 2007
- Dynamic Hip Screw With Trochanteric Stabilizing Plate in the Treatment of Unstable Proximal Femoral Fractures: A Comparative Study With the Gamma Nail and Compression Hip ScrewJournal of Orthopaedic Trauma, 1998
- Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hipThe Journal of Bone and Joint Surgery. British volume, 1997
- Biomechanical Analysis of Location of Lag Screw of a Dynamic Hip Screw in Treatment of Unstable Intertrochanteric FractureThe Journal of Trauma and Acute Care Surgery, 1996
- Trochanteric FracturesClinical Orthopaedics and Related Research, 1990
- Sliding hip screws: modes of failureInjury, 1989
- Treatment of Intertrochanteric Fractures with a Sliding Nail-plateThe Journal of Trauma and Acute Care Surgery, 1982