Abstract
Background
Hip screw cutout is among the most common causes of intertrochanteric fracture fixation failure using dynamic hip screws (DHS). This study aimed to evaluate the effect of using an additional anti-rotation screw on hip screw migration or cutout in intertrochanteric fracture fixation.
Materials and methods
We screened 488 patients with unilateral fragile intertrochanteric fractures treated with DHS between January 2001 and March 2016. The inclusion criteria were as follows: (1) age ≥ 50 years; (2) low-energy injury; (3) follow-up of at least 6 months; and (4) short barrel plate used in the operation. The exclusion criteria were as follows: (1) combination with other fracture; or (2) pathological fracture. Subsequently, 166 patients were enrolled; of them, 128 underwent surgery using DHS with an additional screw (Group 1) and 38 patients underwent surgery without an additional screw (Group 2). We compared the postoperative results and clinical outcomes while focusing on screw migration and cutout. Furthermore, we investigated the risk factors for lag screw migration.
Results
Bone union was achieved in 160 patients (96.4%) without secondary intervention. Two patients (1.6%) in Group 1 and 1 (2.6%) in Group 2 developed screw cutout, while 18 (14.1%) in Group 1 and 12 (31.6%) in Group 2 developed screw migration. Thus, Group 2 demonstrated a higher screw migration rate. Multiple logistic regression analysis revealed that the additional anti-rotation screw was the most important factor in preventing screw migration (P = 0.019).
Conclusion
The additional anti-rotation screw reduced the lag screw migration rate following DHS surgery for intertrochanteric fractures.
Level of evidence
Level IV, retrospective series.
Similar content being viewed by others
References
Kaplan K, Miyamoto R, Levine BR, Egol KA, Zuckerman JD (2008) Surgical management of hip fractures: an evidence-based review of the literature. II: intertrochanteric fractures. J Am Acad Orthop Surg 16(11):665–673
Haidukewych GJ (2009) Intertrochanteric fractures: ten tips to improve results. J Bone Jt Surg Am 91(3):712–719
Parker MJ (1992) Cutting-out of the dynamic hip screw related to its position. J Bone Joint Surg Br 74(4):625
Hsueh K-K, Fang C-K, Chen C-M, Su Y-P, Wu H-F, Chiu F-Y (2010) Risk factors in cutout of sliding hip screw in intertrochanteric fractures: an evaluation of 937 patients. Int Orthop 34(8):1273–1276
Davis TR, Sher JL, Horsman A, Simpson M, Porter BB, Checketts RG (1990) Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br 72(1):26–31
Geller JA, Saifi C, Morrison TA, Macaulay W (2010) Tip-apex distance of intramedullary devices as a predictor of cutout failure in the treatment of peritrochanteric elderly hip fractures. Int Orthop 34(5):719–722
Ehmke LW, Fitzpatrick DC, Krieg JC, Madey SM, Bottlang M (2005) Lag screws for hip fracture fixation: evaluation of migration resistance under simulated walking. J Orthop Res 23(6):1329–1335
Pervez H, Parker MJ, Vowler S (2004) Prediction of fixation failure after sliding hip screw fixation. Injury 35(10):994–998
Freitas A, Torres GM, de Souza ACAME, Maciel RA, Souto de DRM, Ferreira de GNB (2014) Analysis on the mechanical resistance of fixation of femoral neck fractures in synthetic bone, using the dynamic hip system and an anti-rotation screw. Rev Bras Ortop 49(6):586–592
Chen Z, Wang G, Lin J, Yang T, Fang Y, Liu L, Zhang H (2011) Efficacy comparison between dynamic hip screw combined with anti-rotation screw and cannulated screw in treating femoral neck fractures. Zhongguo Xiufu Chongjian Waike Zazhi Chin J Reparative Reconstr Surg 25(1):26–29
Audigé L, Cagienard F, Sprecher CM, Suhm N, Müller MA (2014) Radiographic quantification of dynamic hip screw migration. Int Orthop 38(4):839–845
Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM (1995) The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 77(7):1058–1064
Kyle RF, Ellis TJ, Templeman DC (2005) Surgical treatment of intertrochanteric hip fractures with associated femoral neck fractures using a sliding hip screw. J Orthop Trauma 19(1):1–4
Cleveland M, Bosworth DM, Thompson FR, Wilson HJ, Ishizuka T (1959) A ten-year analysis of intertrochanteric fractures of the femur. J Bone Joint Surg Am 41:1399–1408
Madsen JE, Naess L, Aune AK, Alho A, Ekeland A, Strømsøe K (1998) 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 screw. J Orthop Trauma 12(4):241–248
Mavrogenis AF, Panagopoulos GN, Megaloikonomos PD, Igoumenou VG, Galanopoulos I, Vottis CT et al (2016) Complications after hip nailing for fractures. Orthopedics 39(1):e108–e116
Murphy IG, Quinlan W, Kelly E (2008) Intraabdominal migration of a dynamic hip screw. Inj Extra 39:230–231
George B, Hashmi FR, Barlas KJ, Grant CP (2006) Dynamic hip screw migration—an unusual case. Inj Extra 37:28–30
Kuzyk PRT, Zdero R, Shah S, Olsen M, Waddell JP, Schemitsch EH (2012) Femoral head lag screw position for cephalomedullary nails: a biomechanical analysis. J Orthop Trauma 26(7):414–421
De Bruijn K, den Hartog D, Tuinebreijer W, Roukema G (2012) Reliability of predictors for screw cutout in intertrochanteric hip fractures. J Bone Joint Surg Am 94(14):1266–1272
Güven M, Yavuz U, Kadioğlu B, Akman B, Kilinçoğlu V, Unay K et al (2010) Importance of screw position in intertrochanteric femoral fractures treated by dynamic hip screw. Orthop Traumatol Surg Res OTSR 96(1):21–27
Kubiak EN, Bong M, Park SS, Kummer F, Egol K, Koval KJ (2004) Intramedullary fixation of unstable intertrochanteric hip fractures: one or two lag screws. J Orthop Trauma 18(1):12–17
Makki D, Mohamed AM, Gadiyar R, Patterson M (2013) Addition of an anti-rotation screw to the dynamic hip screw for femoral neck fractures. Orthopedics 36(7):e865–e868
Su ET, DeWal H, Kummer FJ, Koval KJ (2003) The effect of an attachable lateral support plate on the stability of intertrochanteric fracture fixation with a sliding hip screw. J Trauma 55:504–508
Hsu CE, Chiu YC, Tsai SH, Lin TC, Lee MH, Huang KC (2015) Trochanter stabilising plate improves treatment outcomes in AO/OTA 31-A2 intertrochanteric fractures with critical thin femoral lateral walls. Injury 46(6):1047–1053
Reindl R, Harvey EJ, Berry GK, Rahme E, Canadian Orthopaedic Trauma Society (COTS) (2015) Intramedullary versus extramedullary fixation for unstable intertrochanteric fractures: a prospective randomized controlled trial. J Bone Joint Surg Am 97(23):1905–1912
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The author(s) declare that they have no competing interests
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kim, CH., Chang, J.S. & Kim, J.W. Clinical outcomes of dynamic hip screw fixation of intertrochanteric fractures: comparison with additional anti-rotation screw use. Eur J Orthop Surg Traumatol 29, 1017–1023 (2019). https://doi.org/10.1007/s00590-019-02397-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-019-02397-4