Precise placement of lag screws in operative treatment of trochanteric femoral fractures with a new guide system

Poyanlı, Oğuz; Soylemez, Salih; Ozkut, Afsar T.; Uygur, Esat; Kemah, Bahattin; Ünal, Ömer Kays

doi:10.1016/j.injury.2015.06.003

Cited by 4 publications

(6 citation statements)

References 15 publications

(1 reference statement)

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“…20 When using two lag screws besides anatomical fracture reduction, insertion of the inferior lag screw as close as possible to inferior cortex of the femoral neck is strongly recommended as the tensile and compressive trabecula of the proximal femur intersect at that area so making this place for the strongest screw purchase, but unfortunately it may not be always possible to place inferior lag screw in proper place due to anatomical and surgeon experience. 7,20 Also in patients with small femoral neck diameter it may sometimes be very hard to find enough space for two screw insertion.…”

Section: Resultsmentioning

confidence: 99%

A biomechanical comparison of two cephalomedullary nails; one using a single lag screw with antirotator blade and a nail using two lag screws for unstable intertrochanteric fractures

et al. 2016

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Background: Implant choice for fixation of intertrochanteric fractures remains controversial despite being one of the most commonly performed operations. Although use of sliding hip screws is still considered a gold standard in treatment of these fractures, there is a wide tendency in using cephalomedullary nails because of their biomechanical superiority over sliding hip screws. This trial was initiated in order to compare the biomechanical properties of two different cephalomedullary nails, aPFN and the PROFIN under axial loading, based on the questions that can a single lag screw with an antirotator blade render better rotational stability? Is there a difference between one lag screw or two lag screws with respect to superior migration or cut-out of the screws? And do different nail designs cause different types of failure and what are the pros and cons of classical and new designs from the view point of biomechanical aspects?Methods: Ten pairs of third generation synthetic bone models simulating unstable intertrochanteric fracture were used for biomechanical testing.Results: No posterior displacement of screws was recorded in both groups suggesting rotational unstability. There was not a significant difference between forces values loaded at the time of failure.Conclusions: Although there was no statistically significant difference between compressive strengths at the time of failure, aPFN may provide equal rigid fixation with less possible cut-out which may have an important consequences in real clinical applications.

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Section: Resultsmentioning

confidence: 99%

A biomechanical comparison of two cephalomedullary nails; one using a single lag screw with antirotator blade and a nail using two lag screws for unstable intertrochanteric fractures

et al. 2016

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“…In proximal femoral fractures, optimal placement of the guide wire for the lag screw is mandatory to achieve good results [ 1 , 2 ]. Often, multiple trials are needed to introduce it correctly [ 4 ]. It seems safe to assume that multiple drill holes around the final screw or blade of an implant may weaken the bone and lead to the more common screw cutout than when the bone around the implant is intact.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The placement of the implant into the femoral head is ensured by the insertion of a guide wire under fluoroscopic guidance. Misplaced wires are corrected until satisfactory position is achieved, and the final implant is inserted [ 4 ]. Every insertion of the guide wire creates a canal in the bone, often in the direct proximity to the final screw, what raises concerns about weakening of the bone [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Drill holes decrease cancellous bone strength: A comparative study of 33 paired osteoporotic human and 9 paired artificial bone samples

et al. 2020

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This study was designed to compare compressive strength of cancellous bone retrieved from the femoral head in a specimen with and without guide wire hole, with comparison to synthetic bone samples. Femoral heads retrieved from 33 patients who sustained femoral neck fractures and underwent hip arthroplasty were cut into cuboids leaving two matching samples from the same femoral head. Similar samples were prepared from synthetic femurs. One of the matching samples was chosen at random and was drilled with a guide wire for cancellous screws. The uniaxial compression tests of bone blocks were carried out using the Zwick-Roell Z020 strength testing machine. The mean loss of sample cross section area due to drilling was 24%. The force at failure in drilled specimens was significantly smaller by 18% in human (median: 26%) and by 25% in synthetic bone (median 27%). The strength of human specimens was almost 2 times greater, and their stiffness nearly 4 times greater than in synthetic samples. The study shows that the weakening of the bone after drilling is roughly proportional to the loss of sample cross section area. The percentage decrease in strength was similar in human and artificial bone, but human samples were stronger and stiffer. The comparison shows that forces measured in biomechanical studies on artificial bone cannot be directly attributed to humans, but the relative differences in mechanical properties of synthetic samples after some damage may be accurate and resemble that of human bones.

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“…Poyanli y cols. 12 presentan un método para poder mejorar y simplificar la imagen del fémur proximal en el perfil, compensando la anteversión del fémur y, por lo tanto, dejando una imagen que es paralela al piso y que contribuiría a evaluar, con más facilidad, la reducción y la colocación del implante.…”

Section: Adecuada Visualizaciónunclassified

Tratamiento de las fracturas de cuello femoral con osteosíntesis. Diez claves para el éxito

Bidolegui¹,

Pereira²,

Vindver³

2021

Rev. Asoc. Arg. Ort. y Traumatol

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Precise placement of lag screws in operative treatment of trochanteric femoral fractures with a new guide system

Cited by 4 publications

References 15 publications

A biomechanical comparison of two cephalomedullary nails; one using a single lag screw with antirotator blade and a nail using two lag screws for unstable intertrochanteric fractures

A biomechanical comparison of two cephalomedullary nails; one using a single lag screw with antirotator blade and a nail using two lag screws for unstable intertrochanteric fractures

Drill holes decrease cancellous bone strength: A comparative study of 33 paired osteoporotic human and 9 paired artificial bone samples

Tratamiento de las fracturas de cuello femoral con osteosíntesis. Diez claves para el éxito

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