Fixation stability scoring in inter-trochanteric femur fractures treated with osteosynthesis: A retrospective observational study

Abstract

To find out the validity of a newly proposed fixation stability scoring system in IT fractures treated with osteosynthesis and its limitations if any.: Retrospective analysis of hospital records of patients with various types of intertrochanteric fractures treated surgically at Sri Siddhartha medical college, Tumkur from January 2021 till August 2022. The exclusion criteria were non-ambulatory patients prior to fall, non surgically treated patients, patients loosing follow up or patients who are not alive at the time of study. The scoring was done by three different observers for each patient’s immediate post operative x-ray, repeated at 1 month interval. Radiographs at the final follow up were assessed for fracture union or fixation failure. Parameters of the scoring system: 1) cortical buttress in AP view radiograph, 2) cortical buttress in lateral view radiograph, 3) Tip apex distance (TAD) of principle lag screw, 4) Entry point (in case of IM nail), 5) Location of tip of principle screw in the desired Cleveland zone. 6) Placement of Richard screw in the inferior half of neck (in case of DHS), 7) Use of additional derotation screw (DRS) (in case of DHS). Scores of all the observers showed statistically significant correlation with fixation failure rates. Results were good with the score of 7.5 and above, fair with 6.5 and above and poor when the score was below 6.5. The minimum acceptable score was 6.5 for extra-medullary devices and 7 for intra-medullary devices.: The newly proposed scoring system appears to be valid and promising intra operative guide for fixation of intertrochanteric fractures with a few limitations. Large scale multi centre prospective studies are needed in the future to support the current study or to further simplify this scoring system.