Importance of screw position in intertrochanteric femoral fractures treated by dynamic hip screw

Güven, Melih; Yavuz, Umut; Kadioğlu, Barış; Akman, Budak; Kılınçoğlu, Volkan; Unay, Koray; Altıntaş, Faik

doi:10.1016/j.rcot.2009.11.004

Cited by 24 publications

(27 citation statements)

References 20 publications

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“…TAD is the only validated clinical outcome that was measured (Baumgaertner et al 1995, Güven et al 2010, Hsueh et al 2010, Andruszkow et al 2012). Baumgaertner et al (1995) demonstrated that a TAD of less than 25 mm was the most important factor to minimize the cut-out rate.…”

Section: Discussionmentioning

confidence: 99%

Training effect of a virtual reality haptics-enabled dynamic hip screw simulator

et al. 2015

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Background and purpose — Virtual reality (VR) simulation offers a safe, controlled, and effective environment to complement training but requires extensive validation before it can be implemented within the curriculum. The main objective was to assess whether VR dynamic hip screw (DHS) simulation has a training effect to improve objective performance metrics.Patients and methods — 52 surgical trainees who were naïve to DHS procedures were randomized to 2 groups: the training group, which had 5 attempts, and the control group, which had only one attempt. After 1 week, both cohorts repeated the same number of attempts. Objective performance metrics included total procedural time (sec), fluoroscopy time (sec), number of radiographs (n), tip-apex distance (TAD; mm), attempts at guide-wire insertion (n), and probability of cut-out (%). Mean scores (with SD) and learning curves were calculated. Significance was set as p < 0.05.Results — The training group was 68% quicker than the control group, used 75% less fluoroscopy, took 66% fewer radiographs, had 82% less retries at guide-wire insertion, achieved a reduced TAD (by 41%), had lower probability of cut-out (by 85%), and obtained an increased global score (by 63%). All these results were statistically significant (p < 0.001). The participants agreed that the simulator provided a realistic learning environment, they stated that they had enjoyed using the simulator, and they recognized the need for the simulator in formal training.Interpretation — We found a significant training effect on the VR DHS simulator in improving objective performance metrics of naïve surgical trainees. Patient safety, an important priority, was not compromised.

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Section: Discussionmentioning

confidence: 99%

Training effect of a virtual reality haptics-enabled dynamic hip screw simulator

et al. 2015

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“…To prevent complications of immobilization, fracture fixation should allow early mobilization of the patient with immediate full weight bearing [3]. Since the 1960s, the sliding hip screw and side plate (DHS) has become the standard implant for surgical treatment of intertrochanteric fractures as it allows controlled fracture compression [4,5]. Despite additional modifications, such as trochanteric support plates and antirotational screws, unstable fractures are less successfully treated by this method [3,6].…”

Section: Introductionmentioning

confidence: 99%

“…In summary, a central-posterior placement of the implanted hip screw in the lateral radiographic view and a central-inferior position in the anteroposterior view are recommended by most authors [2,5,11,12]. Furthermore, the quality of fracture reduction described by the neck shaft angle (NSA) has been evaluated [13,14].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the quality of fracture reduction described by the neck shaft angle (NSA) has been evaluated [13,14]. In general a varus displacement of 3.9°to 5.3°within the first six weeks after surgery compared to initial postoperative measurements is a common finding [3,5,12]. This suggests that an optimal fracture reduction should be performed in a slightly valgus position [3,5,12].…”

Section: Introductionmentioning

confidence: 99%

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Tip apex distance, hip screw placement, and neck shaft angle as potential risk factors for cut-out failure of hip screws after surgical treatment of intertrochanteric fractures

Andruszkow

Frink

Frömke

et al. 2012

International Orthopaedics (SICOT)

144

104

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Purpose To describe the quality of osteosynthesis after intertrochanteric fractures evaluation of tip apex distance (TAD) and position of the hip screw have been established. Furthermore, a slightly valgus fracture reduction has been suggested to reduce the risk of cut-out failure. However, uniform recommendations for optimal screw positioning and fracture reduction are still missing. The purpose of our study was to confirm potential risk factors for cut-out of hip screws of intertrochanteric fractures and to provide recommendations for practical clinical use. Methods A retrospective analysis of all patients with intertrochanteric fractures treated with a DHS or a gamma nail between January of 2007 and May of 2010 was performed at a level I trauma center. Results Two hundred thirty-five patients with intertrochanteric fractures after intra-and extramedullary stabilization were analyzed. ATAD of more than 25 mm was demonstrated to be the most important factor for cut-out in stable and unstable fractures. Fracture reduction with a valgus NSA of 5-10°was associated with a trend towards a lower rate of screw cut-out while an anterior placement of the screw (Parker's ratio index of <40) significantly increased cut-out incidence. Conclusions According to our results, the TAD should not exceed 25 mm in stable (AO/OTA A1) as well as unstable (AO/OTA A2) fractures. An increased anterior hip screw placement should be avoided while fracture reduction with a slight valgus Neck Shaft seems favorable.

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“…Although this peripheral placement of the helical blade increases the TAD, the TAD is not related with cutout failure 32. In our study, the mean TAD in the I-C group was more than the C-C group and TAD had a positive linear correlation with cyclic loading which leads to fracture displacement and ultimate load to failure 1631–33…”

Section: Discussionmentioning

confidence: 53%

A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study

Hwang

Garg²,

et al. 2012

IJOO

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Objective:Despite new developments in the management of osteoporotic fractures, complications like screw cutout are still found in the fixation of proximal femur fractures even with biomechanically proven better implants like proximal femoral nail antirotation (PFNA). The purpose of this cadaveric study was to investigate the biomechanical stability of this device in relation to two common positions (center-center and inferior-center) of the helical blade in the femoral head in unstable trochanteric fractures.Materials and Methods:Eight pairs of human cadaveric femurs were used; in one group [center-center (C-C) group], the helical blade of PFNA was fixed randomly in central position both in anteroposterior and lateral view, whereas in the other group it was fixed in inferior one-third position in anteroposterior and in central position in lateral view [inferior-center (I-C) group]. Unstable intertrochanteric fracture was created and each specimen was loaded cyclically till load to failureResults:Angular and rotational displacements were significantly higher within the C-C group compared to the I-C group in both unloaded and loaded condition. Loading to failure was higher in the I-C group compared to the C-C group. No statistical significance was found for this parameter. Correlations between tip apex distance, cyclic loading which lead to femoral head displacement, and ultimate load to failure showed a significant positive relationship.Conclusion:The I-C group was superior to the C-C group and provided better biomechanical stability for angular and rotational displacement. This study would be a stimulus for further experimental studies with larger number specimens and complex loading protocols at multicentres.

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Importance of screw position in intertrochanteric femoral fractures treated by dynamic hip screw

Cited by 24 publications

References 20 publications

Training effect of a virtual reality haptics-enabled dynamic hip screw simulator

Training effect of a virtual reality haptics-enabled dynamic hip screw simulator

Tip apex distance, hip screw placement, and neck shaft angle as potential risk factors for cut-out failure of hip screws after surgical treatment of intertrochanteric fractures

A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study

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