Outcomes of dynamic hip screw augmented with trochanteric wiring for treatment of unstable type A2 intertrochanteric femur fractures

Puram, Chetan; Pradhan, Chetan; Patil, Atul; Sodhai, Vivek; Sancheti, Parag; Shyam, Ashok

doi:10.1016/s0020-1383(17)30498-9

Cited by 19 publications

(21 citation statements)

References 27 publications

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“…[ 19 ] Therefore, many scholars have attempted to improve stability and reconstructed the medial buttress of femur by means of augmentation technique such as lesser trochanter cerclage. [ 20 ] However, these methods have prolonged operation time, but fail to fill the void in the medial femur and prevent the medial migration of femur, resulting in the implant failure. After stabilized with MSN-II, the head neck fragment will be difficult to slide along the fracture line because it was supported by the supporting screw locked in the nail from the medullary cavity.…”

Section: Discussionmentioning

confidence: 99%

Medial support nail and proximal femoral nail antirotation in the treatment of reverse obliquity inter-trochanteric fractures (Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association 31-A3.1): a finite-element analysis

Nie

Zhao

et al. 2020

Chinese Medical Journal

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Background The reverse obliquity inter-trochanteric fracture is a distinct fracture pattern that is mechanically different from most inter-trochanteric fractures and the optional treatment of it is still controversial. The purpose of this study was to compare differences in the efficacy of a novel nail (medial support nail [MSN-II]) and proximal femoral nail anti-rotation (PFNA-II) in the treatment of reverse obliquity inter-trochanteric fractures (Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association [AO/OTA] 31-A3.1) using finite-element analysis. Methods Modeling software was used to establish a three-dimensional model of MSN-II and PFNA-II and an A3.1 inter-trochanteric fracture model. Abaqus software was used to implement different force loads to compare finite-element biomechanical parameters such as the maximum stress in implant and the displacement of fracture site. Results The femoral stress, implant stress and fracture site displacement of MSN-II was less than that of PFNA-II. The results indicated that the maximal femoral stress was 581 MPa for PFNA-II and 443 MPa for the MSN-II. The maximum stress values in the PFNA-II and MSN-II models were 291 and 241 MPa, respectively. The maximal displacements of the fracture site were 1.47 and 1.16 mm in the PFNA-II and MSN-II models, respectively. Conclusion Compared with PFNA-II for inter-trochanteric fracture (AO/OTA 31-A3.1), MSN-II which was designed with a triangular stability structure can provide better biomechanical stability. The MSN-II may be a feasible option for the treatment of reverse obliquity inter-trochanteric fracture.

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Section: Discussionmentioning

confidence: 99%

Medial support nail and proximal femoral nail antirotation in the treatment of reverse obliquity inter-trochanteric fractures (Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association 31-A3.1): a finite-element analysis

Nie

Zhao

et al. 2020

Chinese Medical Journal

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“…Thus, for a DHS to work efficiently without excessive collapse the contact area between the ends has to be maximum and to attain that, the well-known regions are posterior medial calcar, the lateral wall and the anteromedial region. Thus, excessive fracture collapse in varus position following loss of bony support is due to severe fracture angulation, medialisation of proximal fragment and lateral wall fracture (1,11) . Anatomical reduction at the time of surgery is achieved by buttressing the lateral wall14.…”

Section: Discussionmentioning

confidence: 99%

“…Nearly one-half of proximal femur fractures are intertrochanteric fractures (ITF) out of which one-third are unstable. Elderly population tends to suffer from a trivial falldue to decline in bone density whereas road traffic accidents (RTA) are the leading cause in the younger ones (1) . The Dynamic Hip Screw (DHS) introduced by Clawson in1964 (2) provides rigid fixation (3,4) and encourages fracture impaction.…”

Section: Introductionmentioning

confidence: 99%

Various factors influencing the outcome in DHS fixation of Intertrochanteric fractures

Singh¹,

Chandersekharan²

2020

IJOTSS

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Background: Dynamic hip screw (DHS) is a standard device for intertrochanteric fractures (ITF). Implant failure in form of screw cut out leading to varus collapse of neck shaft angle is associated with various factors like bone quality, fracture pattern, fracture reduction, lateral femoral wall thickness (LFWT), screw position and tip-apex distance (TAD). But there has been no clear consensus to the relative importance of each factor. The purpose of our study is to assess individual factors for a favorable outcome in DHS fixation of ITF. Materials and methods: 121 hips sustaining ITF treated with DHS between-June 2014 and July 2016 were reviewed in our prospective study with a mean period of 12 months. Factors under study were bone quality, fracture pattern, fracture reduction, LFWT, screw position and TAD, which were recorded and used for statistical analysis using SPSS. Chi-square test, Independent t-test and Paired t-test were used to evaluate the significance of the differences. Final analysis involved clinical and radiological assessment using Harris Hip Score (HHS) and radiographs respectively. Results and Analysis: The mean age of patient at the time of surgery was 65.27±3.21 years (range 24-85) with 80 males and 41 females. There was no statistical significant relation found between implant failure and osteoporosis even though cases of failure were found in weak osteoporotic bones. Implant failure in relation to unstable fracture pattern, non-anatomical fracture reduction, LFWT< 21.77 mm, screw placement in position apart from centre-centre or centre-inferior and TAD greater than 25mm was found to be statistically significant (p<0.05).The final functional and radiological assessment revealed 68.85% and 86.88% of hips respectively in good to excellent category. Conclusion: DHS is a well-accepted implant for ITF with lower rate of complications only if proper surgical technique is followed. Good fracture reduction, adequate LFWT, ideal screw position and TAD less than 25mm are must to prevent implant failure. Level of Evidence: Level IV

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“…All of these factors may have influenced the identification of the osseous union and affected the assessment of complications. Third, we also could not clearly document when the patient started weight bearing even though some studies regard the time to weight bearing as an important parameter for evaluating the stability of implant fixation [25,26]. A comparison of surgical incision length between the two implants was also not performed in our study.…”

Section: Study Limitationsmentioning

confidence: 90%

Dynamic Hip Screw with Trochanter-Stabilizing Plate Compared with Proximal Femoral Nail Antirotation as a Treatment for Unstable AO/OTA 31-A2 and 31-A3 Intertrochanteric Fractures

Chen

Liu

et al. 2020

BioMed Research International

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Background. The dynamic hip screw (DHS) with the addition of an angular stable trochanter-stabilizing plate (TSP) has been considered the ideal treatment for the unstable intertrochanteric fracture type. However, there have been few comparisons between DHS+TSP augmentation with intramedullary (IM) nailing. The aim of this retrospectively registered study was to compare the clinical outcomes of patients with the unstable type of intertrochanteric fractures treated with DHS+TSP or IM nailing (proximal femoral nail antirotation (PFNA)). Methods. From June 2013 to April 2018, 358 patients with proximal femur fracture AO/OTA type 31A2 and 31A3 treated with PFNA or DHS+TSP and followed for ≥10 months postoperatively were included. The surgical-dependent outcome evaluation included the operation time, intraoperative blood loss, postoperative decrease in hemoglobin, and blood transfusion amount. Functional status was also measured. Radiographic findings and postoperative complications were recorded and analyzed. Result. The operation time was significantly shorter in the DHS+TSP group than that in the PFNA group for both A2 and A3 fractures (A2 type: 84.0 vs.96.4 min; p<0.05; A3 type: 102.4 vs.116.1 min; p<0.05). Postoperative decrease in hemoglobin was more significant in the PFNA group than that in the DHS+TSP group for both fracture types (A2 type: −1.88 vs. −1.29 (mg/dL); p<0.05; A3 type: −1.63 vs. −1.04 (mg/dL); p<0.05). However, the patients treated with DHS+TSP had significantly more residual pain than those treated with PFNA during the final follow-up (Visual Analog Scale score, A2 type: 28.4 vs.23.2; p<0.05; A3 type: 27.5 vs.23.6; p<0.05) and complained of greater implant irritation. Conclusion. We found that DHS+TSP was associated with less operation time and less postoperative decrease in hemoglobin but more residual pain and implant irritation than those of PFNA. As a treatment for unstable intertrochanteric fracture, DHS+TSP provided ideal surgical outcomes which were not inferior to the PFNA.

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Outcomes of dynamic hip screw augmented with trochanteric wiring for treatment of unstable type A2 intertrochanteric femur fractures

Cited by 19 publications

References 27 publications

Medial support nail and proximal femoral nail antirotation in the treatment of reverse obliquity inter-trochanteric fractures (Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association 31-A3.1): a finite-element analysis

Medial support nail and proximal femoral nail antirotation in the treatment of reverse obliquity inter-trochanteric fractures (Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association 31-A3.1): a finite-element analysis

Various factors influencing the outcome in DHS fixation of Intertrochanteric fractures

Dynamic Hip Screw with Trochanter-Stabilizing Plate Compared with Proximal Femoral Nail Antirotation as a Treatment for Unstable AO/OTA 31-A2 and 31-A3 Intertrochanteric Fractures

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