Sliding hip screw versus sliding helical blade for intertrochanteric fractures

Abstract

The spiral blade modification of the Dynamic Hip Screw (DHS) was designed for superior biomechanical fixation in the osteoporotic femoral head. Our objective was to compare clinical outcomes and in particular the incidence of loss of fixation. In a series of 197 consecutive patients over the age of 50 years treated with DHS-blades (blades) and 242 patients treated with conventional DHS (screw) for AO/OTA 31.A1 or A2 intertrochanteric fractures were identified from a prospectively compiled database in a level 1 trauma centre. Using propensity score matching, two groups comprising 177 matched patients were compiled and radiological and clinical outcomes compared. In each group there were 66 males and 111 females. Mean age was 83.6 (54 to 100) for the conventional DHS group and 83.8 (52 to 101) for the blade group. Loss of fixation occurred in two blades and 13 DHSs. None of the blades had observable migration while nine DHSs had gross migration within the femoral head before the fracture healed. There were two versus four implant cut-outs respectively and one side plate pull-out in the DHS group. There was no significant difference in mortality and eventual walking ability between the groups. Multiple logistic regression suggested that poor reduction (odds ratio (OR) 11.49, 95% confidence intervals (CI) 1.45 to 90.9, p = 0.021) and fixation by DHS (OR 15.85, 95%CI 2.50 to 100.3, p = 0.003) were independent predictors of loss of fixation. The spiral blade design may decrease the risk of implant migration in the femoral head but does not reduce the incidence of cut-out and reoperation. Reduction of the fracture is of paramount importance since poor reduction was an independent predictor for loss of fixation regardless of the implant being used. Cite this article: Bone Joint J 2015;97-B:398-404.

Increased Fracture Collapse after Intertrochanteric Fractures Treated by the Dynamic Hip Screw Adversely Affects Walking Ability but Not Survival

“…Of these factors, good fracture reduction appears to be of paramount importance. This is logical because doing so also effectively restores maximal contact of any available bony buttress [ 15 , 21 , 22 ]. For a dynamic device to work without excessive collapse, a majority of bone along the femur's circumference should remain intact and in contact.…”

“…Our objective was to test the hypothesis on whether patients with increasing degree of fracture collapse and shortening after DHS had impaired walking and increased incidence of adverse events. We carried out a secondary analysis of a consecutive prospective cohort of patients with trochanteric fractures treated with two similar DHS designs [ 15 ].…”

Trochanteric Fixation Nail® with Helical Blade Compared with Femoral Neck Screw for Operative Treatment of Intertrochanteric Femoral Fractures

“…The helical blade received regulatory approval in 2005 and was designed to provide stronger fixation through impaction of the cancellous bone which should increase resistance to cut-out67). However, several randomized controlled trials comparing helical blade with the lag screw in intramedullary fixations have demonstrated greatly different outcomes compared with published data and theoretical concepts789101112).…”

Outcomes of Internal Fixation with Compression Hip Screws in Lateral Decubitus Position for Treatment of Femoral Intertrochanteric Fractures

“…Data for TAD and cut-out complication were reported in five studies involving femoral intertrochanteric fractures treated with CHS in supine position with a traction table ( Table 4 ). They were compared with this study 22 23 24 25 26) and the results were superior for patients with femoral intertrochanteric fractures treated in the lateral decubitus position. Adequate TAD means accurate screw position associated with less cut-out failure 25) .…”