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. A TAD 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.
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. A TAD 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.
Authors: Klaas A Hartholt; Ed F van Beeck; Suzanne Polinder; Nathalie van der Velde; Esther M M van Lieshout; Martien J M Panneman; Tischa J M van der Cammen; Peter Patka Journal: J Trauma Date: 2011-09
Authors: Tristan M Barton; Robert Gleeson; Claire Topliss; Rosemary Greenwood; William J Harries; Timothy J S Chesser Journal: J Bone Joint Surg Am Date: 2010-04 Impact factor: 5.284
Authors: J L Marsh; Theddy F Slongo; Julie Agel; J Scott Broderick; William Creevey; Thomas A DeCoster; Laura Prokuski; Michael S Sirkin; Bruce Ziran; Brad Henley; Laurent Audigé Journal: J Orthop Trauma Date: 2007 Nov-Dec Impact factor: 2.512
Authors: Christoph Kolja Boese; Benjamin Buecking; Tim Schwarting; Florian Debus; Steffen Ruchholtz; Christoph Bliemel; Michael Frink; Philipp Lechler Journal: Int Orthop Date: 2015-01-21 Impact factor: 3.075
Authors: Simcha G Fichman; Tatu J Mäkinen; Oleg Safir; Alex Vincent; Benjamin Lozano; Aidin Kashigar; Paul R T Kuzyk Journal: Int Orthop Date: 2015-05-07 Impact factor: 3.075
Authors: Laurent Audigé; Flurin Cagienard; Christoph Martin Sprecher; Norbert Suhm; Marc Andreas Müller Journal: Int Orthop Date: 2013-10-22 Impact factor: 3.075
Authors: R Pascarella; R Fantasia; A Maresca; C Bettuzzi; L Amendola; S Violini; F Cuoghi; P Sangiovanni; S Cerbasi; S Boriani; D S Tigani Journal: Musculoskelet Surg Date: 2015-12-14