Clinical outcomes of dynamic hip screw fixation of intertrochanteric fractures: comparison with additional anti-rotation
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ORIGINAL ARTICLE • HIP - TRAUMA
Clinical outcomes of dynamic hip screw fixation of intertrochanteric fractures: comparison with additional anti‑rotation screw use Chul‑Ho Kim1 · Jae Suk Chang1 · Ji Wan Kim1 Received: 1 November 2018 / Accepted: 8 February 2019 © Springer-Verlag France SAS, part of Springer Nature 2019
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. Keywords Intertrochanteric fracture · Anti-rotation screw · Dynamic hip screw · Cutout · Mechanical failure
Introduction Several implants have been invented to fix femoral intertrochanteric fractures; among them, the dynamic hip screw (DHS) fixation system is one of the most widely used [1, 2]. Although DHS fixation is an improved system, it can lead to postoperative failure. The most common mechanical complication of DHS surgery is lag screw migration and subsequent hip screw cutout [3–8]. A technique using an additional anti-rotation screw for fixation was introduced to strengthen proximal fixation in
DHS. Several studies have reported its efficacy, especially in the treatment of femoral neck fracture [9, 10]. However, its efficacy in the fixation of femoral intertrochanteric fractures using the DHS system has not yet been investigated. Additionally, the relationship between the use of an additional screw and hip screw failure rates has not been studied. We hypothesiz
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