Additional Fixations for Sliding Hip Screws in Treating Unstable Pertrochanteric Femoral Fractures (AO Type 31-A2): Short-Term Clinical Results

Abstract

BackgroundTo evaluate the utility of additional fixation methods and to suggest a method of reduction in the treatment of unstable pertrochanteric femur fractures with a sliding hip screw (SHS).MethodsA retrospective study was performed on thirty patients with unstable pertrochanteric femur fractures, who were operated on with a SHS between September 2004 and September 2009 and were followed up for at least 6 months. The additional fixation devices were as follows; antirotation screw (21 cases), fixation of displaced fractures of the posteromedial bone fragment (cerclage wiring, 21 cases and screw, 2 cases) and trochanter stabilizing plate (27 cases). Clinically, the Palmer's mobility score and Jensen's social function group were used. Radiologically, alignment and displacement were observed. The tip-apex distance (TAD) and sliding of the lag screw were measured, and the position of the lag screw within the femoral head was also examined.ResultsThe mean age at the time of surgery was 76 years (range, 56 to 89 years) and the average follow-up period was 25 months (range, 6 to 48 months). At the last follow-up, the average mobility and social function score was 6.2 (± 3.5) and 2.3 (± 1.5). Postoperatively, the alignment and displacement indices were adequate in almost all the cases. The mean amount of lag screw sliding and the mean TAD was 5.1 mm (range, 2 to 16 mm) and 6 mm (range, 3 to 11 mm) respectively. The lag screws were located in the center-center zone in 21 cases. The average period to union was 18.7 weeks without any cases of nonunion or malunion. Mechanical failure was noted in one case with breakage of the lag screw and clinical failure was noted in another case with persistent hip pain related to excessive sliding (16 mm).ConclusionsWith additional fixations, the unstable pertrochanteric femur fractures could be well stabilized by SHS until bone union.

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

“…23 In our study there was no sliding collapse in cemented DHS in accordance with the study of Gupta et al, by Lee et al and previous other studies. 23,25 In our study there was no varus collapse accordance with the studies by Lee et al, Kim et al 25,26 Cement-augmented DHS have a different failure mode than screw cut-out in conventional DHS. Failures tended to be more related to delayed union, non-union and resultant side plate construct failure as concluded by Wu MH et al 27 In our study there were no cases of nonunion, the average time to union was 14.12 (12)(13)(14)(15)(16)(17) 28,29 They concluded no risk of thermal necrosis at the PMMA/bone interface or in the surrounding bone upto 6.0 cc PMMA.…”

“…23,25,28 Final clinical results as evaluated by Salvati and Wilson score were excellent in 24 cases (75%), good in 7 cases (21.88%) fair in 1 case (3.12%) and poor in 0 case (0%).…”

“…In a study by Lee et al using cement augmentation with DHS, with an average amount 13.7 ml of PMMA. 25 It has been recognized that bone necrosis is dose dependent, so it is advisable to use a minimum amount of bone cement. In our study we have used 4-5 ml of PMMA and there were no cases of thermal necrosis and avascular necrosis.…”

Assessment of postoperative short-term and long-term mortality risk in Chinese geriatric patients for hip fracture using the Charlson comorbidity score

“…These include type of injury and surgery, 7 postoperative delirium, 8 timing of rehabilitation, 9 and surgical technique. 10,11 In addition, many other preoperative indicators have been found to affect postoperative mortality. The most commonly identified factors include advanced age, [16][17][18] male gender, 16,18,19 poor premorbid functional capability, 18,20 and presence of multiple comorbidities.…”

“…[6][7][8][9][10][11] Among all these scores, the Nottingham Hip Fracture Score (NHFS) is one of the most well-known for the prediction of short-and long-term mortality in geriatric hip fracture patients, and has been validated in both western and Asian populations. [12][13][14] This excellent score includes patient age, sex, admission haemoglobin level, Mini-Mental State Examination (MMSE) score, previous institution, number of comorbidities, and also presence of malignancy.…”