130‐ versus 135‐degree sliding hip screws and failure in pertrochanteric hip fractures

Radic, Ross; Yates, Piers; Lim, Tao Shan; Burrows, Sally

doi:10.1111/ans.12713

Cited by 3 publications

(4 citation statements)

References 25 publications

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“…The well-known concept of the sliding hip screw was first popularized by Schumpelick et al [ 13 ] in 1955 as a fixed-angle device with variable length. The sliding barrel is designed to provide compression through a tension band mechanism and transmit the forces through the medial cortex of the proximal femur [ 14 ]. Controlled fracture impaction and union are more reliably achieved when the lag screw is positioned in the subchondral bone, and progressive load sharing with the bone is maintained; this is usually accomplished when the lag screw is perpendicular to the fracture line of the femoral neck [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…The present study confirmed that using a lower angle (125° or 130°) implant allows for better positioning of the lag screw and, consequently, better TAD and less chance of cutout. Radic et al [ 14 ] suggested that a 130° angle more closely matches “normal” proximal femoral anatomy and would allow for a more straightforward trajectory for screw placement to achieve the desired TAD of 25 mm or less. They compared 130° DHS plates versus 135° DHS plates, and their study showed a statistically significant difference in TAD between them.…”

Section: Discussionmentioning

confidence: 99%

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A Comparison of Tip-Apex Distance at Various Angles of Fixation Devices in Hip Fractures

Ali¹,

Al‐Dadah²

2023

Cureus

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BackgroundIntertrochanteric neck of the femur (NOF) fractures are very common, and the majority are fixed using dynamic hip screws (DHS) or intramedullary (IM) nails with a fixed angle. The aim of this study was to assess which angle of fixation has a better tip-apex distance (TAD) on X-ray and lower complication rates. MethodsWe included patients with intertrochanteric hip fractures fixed using a DHS or an IM nail. We included patients who had complete radiological and clinical records and a minimum follow-up of 24 months. We measured the TAD and recorded the number of implant cutouts, fracture site nonunions, and periprosthetic fractures. ResultsA total of 107 patients were included, 35 IM nails and 72 DHS. There were four cases of implant cutouts within the DHS group and none in the IM nail group. All four cutout cases were fixed using 135° angle DHS, and two had TAD of more than 25 mm. Multivariable regression analysis revealed that the implant fixation device (p=0.002) and the angle of fixation (p<0.001) are the most important predictors of TAD. ConclusionSmaller angle (130° or 125°) fixation devices allow better positioning of the lag screw and consequently better TAD, which leads to a lower probability of implant cutout in patients undergoing fracture of the neck of the femur surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Comparison of Tip-Apex Distance at Various Angles of Fixation Devices in Hip Fractures

Ali¹,

Al‐Dadah²

2023

Cureus

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“…The 250,000 proximal femoral fractures reported per year in the US are projected to increase to 500,000 by the year 2040 [2]. Intertrochanteric hip fractures, which are particularly deadly and expensive, account for as much as 50% of all proximal femoral fractures [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…DHS failure rates as high as 16-23% have been reported [1,2]. The most common form of failure is screw cut-out, in which the neck-shaft angle collapses into varus, causing the screw to penetrate the femoral head and possibly enter the joint space [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Measuring hip fracture fixation guide wire placement for performance assessment in simulation and the operating room

Rink¹

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ACKNOWLEDGEMENTSThis work would not be possible without the help, knowledge, and mentoring of my advisors, Donald D. Anderson and Geb W. Thomas. I would also like to express my thanks to David G. Wilder for serving on my thesis committee and as my academic advisor throughout graduate school and to Dr. Matthew Karam and Dr. Larry Marsh for their valuable clinical insight throughout this process. Additionally, thank you to Steven Long for spending countless hours fine-tuning the simulator, Andrew Kern for providing me with his MATLAB code and tutorials, and Clarence Kreiter for his help with statistics. iii ABSTRACTThe purpose of this study was to define a more accurate way of assessing guide wire navigation performance, which is a crucial first step in fixing an intertrochanteric femoral fracture. This study introduces a new measurement technique called the trajectory accuracy metric (TAM) to quantify the placement of a guide wire with respect to an ideal trajectory. A total of seventy-two cases were collected in which a Post Graduate Year 1 (PGY1) resident was instructed to place a guide wire through the neck and head of a synthetic femur as close to a center-center position as possible. Each resident was guided by the use of fluoroscopic anteroposterior (AP) and lateral images. A simple geometrical model of a femur was used to define an ideal wire trajectory in which the wire was inserted at a neck-shaft angle (NSA) of 130° and placed centrally through the femoral neck. 3D models of the femur and wire were created for each case, and the wire trajectory was compared with respect to ideal by calculating TAM, which is the average distance between the two wires. The average TAM across all cases was 8.62mm, with a minimum value of 3.35mm and a maximum value of 24.17mm. Since this is a novel measurement, further studies should be done to evaluate its reliability and validity.Additionally, more wire trajectories should be incorporated into this measurement because successful placement of a guide wire is not restricted to one correct trajectory.Another application of assessing guide wire navigation performance can be applied to a surgical simulation study, in particular, if skills obtained during surgical simulation carry over to a setting that closely resembled the OR. A cross-over experimental design was used for two groups, and metrics used to determine improvement included tip-apex distance (TAD), procedural time, number of fluoroscopic

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Lacking evidence for performance of implants used for proximal femoral fractures – A systematic review

Nyholm

Palm

Malchau

et al. 2016

Injury

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130‐ versus 135‐degree sliding hip screws and failure in pertrochanteric hip fractures

Abstract: We believe the improved trajectory for lag screw placement using 130-degree angled plates leads to a lower TAD and improved fixation in pertrochanteric fractures.

Cited by 3 publications

References 25 publications

A Comparison of Tip-Apex Distance at Various Angles of Fixation Devices in Hip Fractures

A Comparison of Tip-Apex Distance at Various Angles of Fixation Devices in Hip Fractures

Measuring hip fracture fixation guide wire placement for performance assessment in simulation and the operating room

Lacking evidence for performance of implants used for proximal femoral fractures – A systematic review

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