1887
  1. Home
  2. A-Z Publications
  3. Journal of Emergency Medicine, Trauma and Acute Care
  4. Volume 2024, Issue 4
  5. Article
Volume 2024, Issue 4
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Unstable intertrochanteric (IT) fractures are common orthopedic injuries in the elderly people with high morbidity. The treatment of unstable IT fractures with sliding hip screw (SHS) is still controversial. The purpose of our study is to assess the outcomes of conventional SHS in unstable IT fractures in comparison to stable ones.

A total of 35 stable and 23 unstable IT fracture cases were treated with SHS between January 2017 and December 2018. Patients were evaluated for infection, revision rate, screw cut-out, development of post-traumatic arthritis or heterotopic ossification, and mortality.

The mean age of the patients at the time of surgery was 69.8 and 73.9 years for stable and unstable IT fractures, respectively, with 38 males (25 stable vs. 13 unstable) and 20 females (10 in each group). The mean follow-up was 42.2 and 49.4 weeks in stable and unstable IT fractures, respectively. We found a significant association between the occurrence of screw cut-out in unstable fractures compared to stable ones (17.4% vs. 0%, respectively, = 0.01). There was an obvious trend for nonunion and higher revision rates in unstable IT fractures (17.4% vs. 2.9%, = 0.056). Logistic regression analysis did not reveal any statistically significant confounder that might affect the rates of fracture union or revision rates. Post-traumatic arthritis and heterotopic ossification occurred in one case of unstable IT fracture. There were no reported cases of infection.

There are higher risks of screw cut-out, nonunion, and the need for revision when the SHS is used to treat unstable IT fractures.

© 2024 Asad, Younis, Abuodeh, Shiraz, Ahmed, Licensee HBKU Press.
Loading

Article metrics loading...

/content/journals/10.5339/jemtac.2024.15
2024-08-20
2024-12-22
Loading full text...

Full text loading...

/deliver/fulltext/jemtac/2024/4/jemtac.2024.15.html?itemId=/content/journals/10.5339/jemtac.2024.15&mimeType=html&fmt=ahah

References

  1. Bannister GC, Gibson AG, Ackroyd CE, Newman JH. The fixation and prognosis of trochanteric fractures. A randomized prospective controlled trial. Clin Orthop Relat Res. 1990; (254):242-6.
    [Google Scholar]
  2. Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br. 1991; 73:(2):330-4. https://doi.org/10.1302/0301-620X.73B2.2005167
     [Google Scholar]
  3. Babst R, Renner N, Biedermann M, Rosso R, Heberer M, Harder F, et al. Clinical results using the trochanter stabilizing plate (TSP): the modular extension of the dynamic hip screw (DHS) for internal fixation of selected unstable intertrochanteric fractures. J Orthop Trauma. 1998; 12:(6):392-9. https://doi.org/10.1097/00005131-199808000-00005
     [Google Scholar]
  4. Haleem S, Lutchman L, Mayahi R, Grice JE, Parker MJ. Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury. 2008; 39:(10):1157-63. https://doi.org/10.1016/j.injury.2008.03.022
     [Google Scholar]
  5. Nather A, Seow CS, Iau P, Chan A. Morbidity and mortality for elderly patients with fractured neck of femur treated by hemiarthroplasty. Injury. 1995; 26:(3):187-90. https://doi.org/10.1016/0020-1383(95)93500-h
     [Google Scholar]
  6. Adams CI, Robinson CM, Court-Brown CM, McQueen MM. Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur. J Orthop Trauma. 2001; 15:(6):394-400. https://doi.org/10.1097/00005131-200108000-00003
     [Google Scholar]
  7. Watson JT, Moed BR, Cramer KE, Karges DE. Comparison of the compression hip screw with the Medoff sliding plate for intertrochanteric fractures. Clin Orthop Relat Res. 1998; (348):79-86.
    [Google Scholar]
  8. Flores LA, Harrington IJ, Heller M. The stability of intertrochanteric fractures treated with a sliding screw-plate. J Bone Joint Surg Br. 1990; 72:(1):37-40. https://doi.org/10.1302/0301-620X.72B1.2298792
     [Google Scholar]
  9. Thomas AP. Dynamic hip screws that fail. Injury. 1991; 22:(1):45-6.
    [Google Scholar]
  10. Rha JD, Kim YH, Yoon SI, Park TS, Lee MH. Factors affecting sliding of the lag screw in intertrochanteric fractures. Int Orthop. 1993; 17:(5):320-4. https://doi.org/10.1007/BF00181709
     [Google Scholar]
  11. Bramlet DG. Use of the talon hip compression screw in intertrochanteric fractures of the hip. Clin Orthop Relat Res. 2004; (425):93-100. https://doi.org/10.1097/01.blo.0000132628.90667.e6
     [Google Scholar]
  12. Lakho MT, Jatoi AA, Azfar MK, Ali A, Javed S, Bhatti A, et al. Functional and radiological outcome of unstable intertrochanteric fracture post dynamic hip screw fixation. Cureus. 2019; 11:(4):e4360. https://doi.org/10.7759/cureus.4360
     [Google Scholar]
  13. Puram C, Pradhan C, Patil A, Sodhai V, Sancheti P, Shyam A. Outcomes of dynamic hip screw augmented with trochanteric wiring for treatment of unstable type A2 intertrochanteric femur fractures. Injury. 2017; 48:(Suppl. 2):S72-7. https://doi.org/10.1016/S0020-1383(17)30498-9
     [Google Scholar]
  14. Steinberg GG, Desai SS, Kornwitz NA, Sullivan TJ. The intertrochanteric hip fracture. A retrospective analysis. Orthopedics. 1988; 11:(2):265-73. https://doi.org/10.3928/0147-7447-19880201-06
     [Google Scholar]
  15. Baixauli F, Vicent V, Baixauli E, Serra V, Sanchez-Alepuz E, Gomez V, et al. A reinforced rigid fixation device for unstable intertrochanteric fractures. Clin Orthop Relat Res. 1999; (361)::205-15. https://doi.org/10.1097/00003086-199904000-00027
     [Google Scholar]
  16. Davis TR, Sher JL, Horsman A, Simpson M, Porter BB, Checketts RG. Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br. 1990; 72:(1):26-31. https://doi.org/10.1302/0301-620X.72B1.2298790
     [Google Scholar]
  17. Madsen JE, Naess L, Aune AK, Alho A, Ekeland A, Stromsoe K. 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. 1998; 12:(4):241-8. https://doi.org/10.1097/00005131-199805000-00005
     [Google Scholar]
  18. Radford PJ, Needoff M, Webb JK. A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg Br. 1993; 75:(5):789-93. https://doi.org/10.1302/0301-620X.75B5.8376441
     [Google Scholar]
  19. Haidukewych GJ. Intertrochanteric fractures: ten tips to improve results. J Bone Joint Surg Am. 2009; 91:(3):712-9.
    [Google Scholar]
  20. Kaplan K, Miyamoto R, Levine BR, Egol KA, Zuckerman JD. Surgical management of hip fractures: an evidence-based review of the literature. II: intertrochanteric fractures. J Am Acad Orthop Surg. 2008; 16:(11):665-73. https://doi.org/10.5435/00124635-200811000-00007
     [Google Scholar]
  21. Parker MJ. Trochanteric hip fractures. Fixation failure commoner with femoral medialization, a comparison of 101 cases. Acta Orthop Scand. 1996; 67:(4):329-32. https://doi.org/10.3109/17453679609002325
     [Google Scholar]
  22. Lu Y, Uppal HS. Hip fractures: relevant anatomy, classification, and biomechanics of fracture and fixation. Geriatr Orthop Surg Rehabil. 2019; 10:2151459319859139. https://doi.org/10.1177/2151459319859139
     [Google Scholar]
  23. Brunner A, Buttler M, Lehmann U, Frei HC, Kratter R, Di Lazzaro M, et al. What is the optimal salvage procedure for cut-out after surgical fixation of trochanteric fractures with the PFNA or TFN?: a multicentre study. Injury. 2016; 47:(2):432-8. https://doi.org/10.1016/j.injury.2015.11.027
     [Google Scholar]
  24. Lee PC, Yu SW, Hsieh PH, Chuang TY, Tai CL, Shih CH. Treatment of early cut-out of a lag screw using a trochanter supporting plate: 11 consecutive patients with unstable intertrochanteric fractures. Arch Orthop Trauma Surg. 2004; 124:(2):119-22. https://doi.org/10.1007/s00402-003-0607-8
     [Google Scholar]
  25. Augat P, Rapp S, Claes L. A modified hip screw incorporating injected cement for the fixation of osteoporotic trochanteric fractures. J Orthop Trauma. 2002; 16:(5):311-6. https://doi.org/10.1097/00005131-200205000-00004
     [Google Scholar]
  26. Szpalski M, Descamps PY, Hayez JP, Raad E, Gunzburg R, Keller TS, et al. Prevention of hip lag screw cut-out by cement augmentation: description of a new technique and preliminary clinical results. J Orthop Trauma. 2004; 18:(1):34-40. https://doi.org/10.1097/00005131-200401000-00007
     [Google Scholar]
  27. Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg Am. 1979; 61:(2):216-21.
    [Google Scholar]
  28. Rao JP, Banzon MT, Weiss AB, Rayhack J. Treatment of unstable intertrochanteric fractures with anatomic reduction and compression hip screw fixation. Clin Orthop Relat Res. 1983 (175):65-71.
    [Google Scholar]
  29. Koot VC, Kesselaer SM, Clevers GJ, de Hooge P, Weits T, van der Werken C. Evaluation of the Singh index for measuring osteoporosis. J Bone Joint Surg Br. 1996; 78:(5):831-4.
    [Google Scholar]
  30. Laros GS, Moore JF. Complications of fixation in intertrochanteric fractures. Clin Orthop Relat Res. 1974; (101):110-9.
    [Google Scholar]
  31. Jensen JS. Classification of trochanteric fractures. Acta Orthop Scand. 1980; 51:(5):803-10. https://doi.org/10.3109/17453678008990877
     [Google Scholar]
  32. Matre K, Havelin LI, Gjertsen JE, Vinje T, Espehaug B, Fevang JM. Sliding hip screw versus IM nail in reverse oblique trochanteric and subtrochanteric fractures. A study of 2716 patients in the Norwegian Hip Fracture Register. Injury. 2013; 44:(6):735-42. https://doi.org/10.1016/j.injury.2012.12.010
     [Google Scholar]
  33. Aktselis I, Kokoroghiannis C, Fragkomichalos E, Koundis G, Deligeorgis A, Daskalakis E, et al. Prospective randomised controlled trial of an intramedullary nail versus a sliding hip screw for intertrochanteric fractures of the femur. Int Orthop. 2014; 38:(1):155-61. https://doi.org/10.1007/s00264-013-2196-7
     [Google Scholar]
  34. Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2010 (9):CD000093. https://doi.org/10.1002/14651858.CD000093.pub3
     [Google Scholar]
  35. Matre K, Vinje T, Havelin LI, Gjertsen JE, Furnes O, Espehaug B, et al. TRIGEN INTERTAN intramedullary nail versus sliding hip screw: a prospective, randomized multicenter study on pain, function, and complications in 684 patients with an intertrochanteric or subtrochanteric fracture and one year of follow-up. J Bone Joint Surg Am. 2013; 95:(3):200-8. https://doi.org/10.2106/JBJS.K.01497
     [Google Scholar]
  36. Aros B, Tosteson AN, Gottlieb DJ, Koval KJ. Is a sliding hip screw or IM nail the preferred implant for intertrochanteric fracture fixation? Clin Orthop Relat Res. 2008; 466:(11):2827-32. https://doi.org/10.1007/s11999-008-0285-5
     [Google Scholar]
  37. Haidukewych GJ, Israel TA, Berry DJ. Reverse obliquity fractures of the intertrochanteric region of the femur. J Bone Joint Surg Am. 2001; 83:(5):643-50. https://doi.org/10.2106/00004623-200105000-00001
     [Google Scholar]
  38. Kregor PJ, Obremskey WT, Kreder HJ, Swiontkowski MF, Evidence-based orthopaedic trauma working G. Unstable pertrochanteric femoral fractures. J Orthop Trauma. 2005; 19:(1):63-6.
    [Google Scholar]
  39. Stern R. Are there advances in the treatment of extracapsular hip fractures in the elderly? Injury. 2007; 38:(Suppl. 3):S77-87. https://doi.org/10.1016/j.injury.2007.08.015
     [Google Scholar]
  40. Barton TM, Gleeson R, Topliss C, Greenwood R, Harries WJ, Chesser TJ. A comparison of the long gamma nail with the sliding hip screw for the treatment of AO/OTA 31-A2 fractures of the proximal part of the femur: a prospective randomized trial. J Bone Joint Surg Am. 2010; 92:(4):792-8. https://doi.org/10.2106/JBJS.I.00508
     [Google Scholar]
/content/journals/10.5339/jemtac.2024.15
Loading
Outcomes of sliding hip screw fixation in stable versus unstable intertrochanteric hip fractures
Journal of Emergency Medicine, Trauma and Acute Care 2024, 15 (2024); https://doi.org/10.5339/jemtac.2024.15
/content/journals/10.5339/jemtac.2024.15
/content/journals/10.5339/jemtac.2024.15
Loading

Data & Media loading...

  • Article Type: Research Article
Keyword(s): extracapsular hip fractures, intertrochanteric hip fracture, sliding hip screw and unstable hip fracture

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error