Factors determining failure of intertrochanteric fracture fixation with a dynamic hip screw: a retrospective analysis
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20183422Keywords:
Intertrochanteric fractures, Dynamic hip screw, Failure, OsteoporosisAbstract
Background: The intertrochanteric fractures are extra capsular fractures of proximal femur in the trochanteric region. Different fixation techniques were tried for intertrochanteric fractures, with variety of implants but the dynamic hip screw fixation is most widely accepted treatment. However, several authors have concluded that sliding compression screws may be associated with several complications such as perforation of the femoral head, loss of reduction caused by excessive sliding of the lag screw, non-union, shortening of the affected limb and pain. This study was carried out to ascertain the factors that contributed to mechanical failure at our institute.
Methods: We retrospectively reviewed 92 patients with unilateral intertrochanteric fracture treated with a sliding hip screw between July 2015 and April 2017. Postoperative radiographs were studied for any loss of reduction, which was defined as a varus deformity greater than 10°, perforation of the femoral head, extrusion of the lag screw of more than 20 mm, or metal failure. The Pearson chi-square test was used to assess the relationship between failure and osteoporosis. A p value of less than 0.05 was considered to be significant.
Results: Results revealed a significant relationship between failure and osteoporosis. A possible relationship between the stability of the fracture on Evans’ classification and osteoporosis on Singh’s index was investigated which revealed a high positive correlation between the failure rates of unstable fractures with osteoporosis.
Conclusions: An unstable fracture combined with osteoporosis, has higher percentage of fixation failure leading to other methods of treatment like hemiarthroplasty.
References
Melton LJ. Who has osteoporosis? A conflict between clinical and public health perspectives. J Bone Miner Res. 2000;15:2309-14.
Cummings SR, Rubin SM, Black D. The future of hip fractures in the United States: numbers, costs and potential effects of postmenopausal estrogen. Clin Orthop. 1990;252:163-6.
Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359:1761-7.
Cranney A, Guyatt G, Griffith L, Wells G, Tugwell P, Rosen C. Meta- analysis of therapies for postmenopausal osteoporosis. Endocr Rev. 2002;23:570-8.
Hay D, Parker MJ. Hip fracture in the immobile patients. J Bone Joint Surg. 2003;85:1037-9.
Vossinakis IC, Badras LS. Management of pertrochanteric fractures in high risk patients with an external fixation. Int Orthop. 2001;25:219-22.
Kalteis T, Handel M, Herold T, Perlick L, Baethis H, Grifka J. Greater accuracy in positioning of acetabular hip by using image-free navigation system. Int Orthop. 2005;29:272-6.
De Wal H, Su E, Di Cesare PE. Instability following total hip arthroplasty. Am J Orthop. 2003;32:377-82.
Davis TRC, Sher JL, Horsman A, Simpson M, Porter BB, Cheketts RG. Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br. 1990;72:26–31.
Kaufer H, Mattews LS, Sonstegard D. Stable fixation of intertrochanteric fractures. A biomechanical evaluation. J Bone Joint Surg Am. 1974;56:899–907.
Madsen JE, Naess L, Aune AK, Alho A, Ekelenad A, Stromsoe K. Dynamic hip screw with trochanteric stabilising plate in the treatment of unstable proximal femoral fractures. A comparative study with Gamma nail and compression hip screw. J Orthop Trauma. 1998;12(4):241–8.
Flores LA, Harrington IJ, Martin H. The stability of intertrochanteric fractures treated with a sliding screw plate. J Bone Joint Surg Br. 1990;72:37–40.
Parker MJ. Trochanteric hip fracture. Fixation failure commoner with femoral medialization– a comparison of 101 cases. Acta Orthop Scand. 1996;67:329–32.
Thomas AP. Dynamic hip screws that fail. Injury. 1991;22(1):45–6.
Boyd HB, Griffin LL. Classification and treatment of trochanteric fractures. Arch Surg. 1949;58:853–63.
Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg Br. 1949;31:190–203.
Jensen JS. Classification of trochanteric fractures. Acta Orthop Scand. 1980;51:803–10.
Muller ME, Allgower M, Schneider R, Willenegger H. Manual of internal fixation: techniques recommended by the AO-ASIF group. 3rd ed. New York, NY: Springer, Berlin Heidelberg; 1991: 270–281.
Koot VC, Kesselaer SM, Clevers GJ, Hooge PD, Weits T, Werken C. Evaluation of the Singh index for measuring osteoporosis. J Bone Joint Surg Br. 1996;78:831–4.
Singh M, Nagraph AR, Maini PS. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg Am. 1970;52:457–67.
Madsen JE, Naess L, Aune AK, Alho A, Ekelenad A, Stromsoe K. Dynamic hip screw with trochanteric stabilising plate in the treatment of unstable proximal femoral fractures. A comparative study with Gamma nail and compression hip screw. J Orthop Trauma. 1998;12(4):241–8.
Oger P, Katz V, Lecorre N, Beaufils P. Fracture of the greater trochanter treated by dynamic hip screw plate: measure of impaction according to fracture type. Rev Chir Orthop Reparatrice Appar Mot. 1998;84(6):539–45.
Rha JD, Kim YH, Yoon SI, Park TS, Lee MH. Factors affecting sliding of the lag screw in intertrochanteric fractures. Int Orthop. 1993;17:320-4.
Thomas AP. Dynamic hip screws that fail. Injury. 1991;22(1):45–6.
Parker MJ. Hip fracture management. Oxford: Blackwell; 1993: 9-16.
Kenzora JE, McCarthy RE, Lowell JD. Hip fracture mortality: Relation to age, treatment, preoperative illness, time of surgery and complications. Clin Orthop. 1984;186:45-56.
Gallagher JC, Melton LJ, Riggs BL. Examination of prevalence rate of possible risk factors in a population with fracture of the proximal femur. Clin Orthop. 1980;150:163.
Dahl E. Mortality and life expectancy after hip fracture. Acta Orthop Scan. 1980;51:163-70.
Simon HB, Patel AD, Martin B, Calvert PT. Fixation of intertrochanteric fracture of the femur: A randomized prospective comparison of the Gama Nail and Dynamic Hip Screw. J Bone Joint Surg. 1991;73:330-4.
Leung KS, So WS, Shen WY, Hui PW. Gama Nail and Dynamic Hip Screws for peritrochanteric fractures: A randomized prospective study in elderly patient. J. Bone Joint Surg. 1992;74:345-51.
Kyle RF, Gustilo RB, Premer RF. Analysis of six-hundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg Am. 1979;61:216–21.
Rao JP, Banzon MT, Weiss AB, Rayhack J. Treatment of unstable intertrochanteric fractures with anatomic reduction and compression hip screw fixation. Clin Orthop. 1983;175:65–71.
Steinberg GG, Desai SS, Kornwitz NA, Sullivan TJ. The intertrochanteric hip fracture. A retrospective analysis. Orthopedics. 1988;11:265–73.
Jahng JS, Yoo JH, Sohn JS. The relationship between the fractures of the hip and the bone mineral density over fifty years. J Korean Orthop Surg. 1997;32:46–52.
Laros GS, Moore JF. Complications of fixation in intertrochanteric fractures. Clin Orthop. 1974;101:110–9.
Shin SJ, Jahng SJ. Predicting risk factors in fractures from simple radiologic measurements of the proximal femur. J Korean Orthop Surg. 1999;34:559–64.
Chan KC, Gill GS. Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures. Clin Orthop. 2000;371:206–15.