Dynamic hip screw: does side make a difference?

Mohan, Raja; Karthikeyan, R; Sonanis, S.V.

doi:10.1016/s0020-1383(00)00082-6

Cited by 28 publications

(8 citation statements)

References 2 publications

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“…For stable fracture patterns, CMN has been shown to be equivalent to SHS in terms of stability [ 6 ]. However, the SHS construct has been found to provide inadequate fixation in more unstable fractures types [ 7 , 8 ], more often leading to malreduction [ 9 ] and lag screw cut-out [ 10 ]. CMN have been increasingly favored as a more reliable option for hip fracture fixation, and the utilization of CMN is increasing [ 11 ], especially among younger surgeons [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review

Dunn

Kusnezov

Bader

et al. 2016

J Orthopaed Traumatol

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BackgroundBoth long and short cephalomedullary nails (CMN) may be used to treat trochanteric femur fractures. The objective of this paper was to compare the clinical outcomes between long and short CMN in the treatment of trochanteric hip fractures.Materials and methodsA literature search was performed, identifying 135 papers; 4 of which met inclusion and exclusion criteria. Papers included were those that compared cohorts of long and short nails for stable trochanteric femur fractures of level III evidence or superior. Data was pooled and analyzed, focusing on reoperation rate, secondary femoral shaft fracture rate, estimated blood loss, transfusion rate, operative time and length of stay.ResultsIncluded in the analysis were 1276 patients, with 438 short and 838 long CMN. The average age was 82.0 years for short CMN and 79.0 years for long CMN (P = 0.0002). The average follow up was 18 months, 46 % were male, and 71 % had an ASA (American Society of Anesthesiologists score) classification ≥3. The rate of reoperation was 5.0 % and 3.8 % for short and long CMN, respectively (P = 0.31). The rate of refracture was 1.6 % and 0.95 % for short and long CMN, respectively (P = 0.41). As compared to long nails, short nails had an average blood loss of 39 mL less (P = 0.0003), an 8.8 % decrease in transfusion rate (P = 0.07), and incurred 19 min less operative time (P < 0.0001). No significant differences between short and long nails were observed for either other complications, hardware complications, non-union, or mortality.ConclusionsFor trochanteric femur fractures, short CMN have a low reoperation rate while significantly decreasing operative time and estimated blood loss with the additional benefit of being cost effective.Level of evidenceLevel 3.

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Section: Introductionmentioning

confidence: 99%

Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review

Dunn

Kusnezov

Bader

et al. 2016

J Orthopaed Traumatol

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“…Among the fractures with apex anterior angulation, 3 required revision surgery due to implant cutout. 11 There may be confounding variables affecting revision rates in left-sided and right-sided ITFFs fixed with CMNs. However, previous literature has indicated that left-sided intertrochanteric fractures fixed with CMN demonstrate less stability compared with right-sided fractures.…”

Section: Discussionmentioning

confidence: 99%

Increased 1-Year Revision Rates Among Left-Sided Intertrochanteric Femur Fractures

Gu,

Doe,

Bracey

et al. 2024

Journal of Orthopaedic Trauma

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Objectives: To compare 1-year revision rates among left and right-sided intertrochanteric femur fractures. Design: Retrospective Setting: 120+ contributing centers to Multicentered database Patient selection criteria: Patients who sustained an intertrochanteric femur fracture (ITFFs) and had a cephalomedullary nail (CMN) from 2015-2022 were identified. Patients were then stratified based on left- or right-sided fracture. Patients were excluded if <18 years old, less than 1-year follow up. The intervention investigated was CMN on left or right side. Outcome Measures and Comparisons: 1-year revision surgery, comparing CMN performed on left or right side for ITFFs Results: In total, 113,626 patients met inclusion criteria, with 55,295 in the right-sided cohort and 58,331 in the left-sided cohort. There was no difference between cohorts with respect to age, gender, diabetes, osteoporosis, chronic kidney disease, or congestive heart failure (p>0.05 for all). Patients who sustained a left intertrochanteric femur fracture (ITFFs) and treated with a CMN were more likely to have revision surgery at 1 year (Left: 1.24%, Right: 0.90%; OR: 1.24; 95% CI: 1.15-1.1.33) or develop a nonunion or malunion (Left: 1.30%, Right: 0.98%; OR: 1.31; 95% CI: 1.14-1.52). The most common revision surgery conducted for both cohorts was conversion total hip arthroplasty (Left: 70.4% and Right: 70.0%). Conclusion: Patients who sustained a left intertrochanteric femur fracture and were treated with a CMN were more likely to undergo revision 1-year due to nonunion. There were no differences in demographics and comorbidities between cohorts. Though left versus right-sided confounding variables may exist, the difference in nonunion rate may be explained by clockwise torque of the lag screw used in most implants. Increased awareness, implant design, and improved technique during fracture reduction and fixation may help lower this disproportionate nonunion rate and its associated morbidity and financial impact. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…There are several reports suggesting that the clockwise effect according to the fixation of the screw-type lag screw affects the postoperative outcome of patients with intertrochanteric fractures. 25) However, there are also reports showing that the clockwise rotational force generated by lag screw insertion does not affect the left or right side. 26 27) In the current study, additional fixation was not implemented to prevent such a clockwise effect.…”

Section: Discussionmentioning

confidence: 99%

Midterm Outcomes of Intramedullary Fixation of Intertrochanteric Femoral Fractures Using Compression Hip Nails: Radiologic and Clinical Results

et al. 2023

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Background Various implants are used to treat intertrochanteric fractures. However, the optimal implant to stabilize intertrochanteric femoral fractures is still a matter of debate. The purpose of the present study was to evaluate the midterm outcomes of patients treated using compression hip nails (CHNs). Methods Between March 2013 and April 2018, 164 patients with intertrochanteric femoral fractures who were treated with internal fixation using CHNs were enrolled in this study. The mean age of the patients was 79.6 years. We retrospectively collected and estimated information such as reduction state, implant position, operation time, blood loss, hospital stay, time to achieve union, clinical scores (Harris hip score [HHS] and EuroQol five-dimensional [EQ-5D]), intraoperative complications (such as lag jamming and drill bit breakage), failure of fixation, avascular necrosis, and surgical site infection. Results The mean follow-up period was 39.69 months. Eight percent of the patients required an open reduction. The mean operation time was 131 minutes, the mean blood loss was 221.19 mL, the mean hospital stay was 20.66 days, and the average time to union was 18 weeks. Intraoperative complications included 8 cases of breakage of the drill bit while making distal holes. The failure rate was 3.7% and revision surgery was performed in 6 cases (for cut-out in 5 and pull-out of the lag screw in 1). Asymptomatic venous thromboembolism occurred in 2 cases and hematoma requiring intervention occurred in 1 case. There were no other complications such as avascular necrosis, infection, and lateral irritation. At the 2-year follow-up, the averages of HHS and EQ-5D were 71.54 and 0.68, respectively. Conclusions Among the implants used to treat intertrochanteric femoral fractures, CHNs had a surgical failure of 3.7% and showed good radiologic and clinical results.

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Dynamic hip screw: does side make a difference?

Cited by 28 publications

References 2 publications

Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review

Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review

Increased 1-Year Revision Rates Among Left-Sided Intertrochanteric Femur Fractures

Midterm Outcomes of Intramedullary Fixation of Intertrochanteric Femoral Fractures Using Compression Hip Nails: Radiologic and Clinical Results

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