Fixation of basicervical and related fractures

Abstract

We prospectively studied 42 patients in order to identify a group of proximal femoral fractures having liability for axial and rotational instability, and to present results of their fixation using the dynamic hip screw (DHS) with derotation screw (DRS). At 12 months postoperatively, patients were functionally evaluated and the radiological outcome was analysed. All fractures united within an average period of 11.5 weeks. The mean sliding distance was 5.5 mm and mean shortening of the limbs was 2 mm. According to the criteria of Kyle et al. (J Bone Joint Surg [Am] 61-A:216-221), 39 patients obtained excellent results, two good and one fair. We conclude that the AO types B2.1, A1.1, A2.1, A2.2 and A2.3 have a common instability denominator and therefore should be treated alike. The sliding component of the DHS allows solid fixation of the two major fragments in two planes and the DRS in the third plane.

High reliability of an algorithm for choice of implants in hip fracture patients

“…The simplicity of grouping into fewer choices also improves agreement, as shown in previous studies of the Garden and AO/OTA classifications [5][6][7][8]. The main disagreements in the algorithm were seen among vertical, basocervical and A1.1 trochanteric fractures [3,[9][10][11][12]. Vertical and basocervical fractures must be separated from the common femoral-neck fracture, as they lack varus calcar support for parallel implants and theoretically need a fixed-angle device [1,12,15].…”

“…Vertical, basocervical and A1.1 trochanteric fractures were most difficult to determine differences [3,[9][10][11][12]. Both hospital consensus decisions classified into the same fracture types in 70 of the 100 patients (Table 2), giving a kappa value for interobserver variation between hospitals of 0.65.…”

“…Also, the AO/OTA classification for trochanteric fractures has shown only a fair reliability, improving to substantial if using the three main groups only [6][7][8]. Classifying into vertical and basocervical fractures among all types of hip fractures has not previously been evaluated, but the vertical fracture could be seen as the third of the three types in the Pauwel classification, which shows only fair reliability [9][10][11][12].…”

“…The main disagreements in the algorithm were seen among vertical, basocervical and A1.1 trochanteric fractures [3,[9][10][11][12]. Vertical and basocervical fractures must be separated from the common femoral-neck fracture, as they lack varus calcar support for parallel implants and theoretically need a fixed-angle device [1,12,15]. For simplifying the algorithm and potentially raising the agreement even further, treating these fractures with the four-hole sliding hip screw could be considered, despite the longer incision.…”

“…1). The algorithm allows classification into 15 different hip fracture types: the four stages of femoral neck fractures in Gardens classification, which are commonly termed Garden type I-IV fractures [1,2], the vertical femoral neck fracture [9,10], the basocervical fracture [11,12] and the nine trochanteric fractures 31A1.1 to A3.3 in the AO/OTA classification [3]. If any observer classified a fracture as a Garden type I or II, all observers also measured the posterior tilt [13].…”