Systematic effects of surgical treatment of hip fractures: Gliding screw-plating vs intramedullary nailing

Does PFNA II Avoid Lateral Cortex Impingement for Unstable Peritrochanteric Fractures?

“…Sporadic reports [11,21] support the use of intramedullary implants instead of dynamic screws for treating peritrochanteric fractures in general and suggest there may be major benefits regarding rehabilitation services in the first 6 months after discharge and total expenditures for hospital services [4,44]. However, other studies [2,7,22,40] have concluded there is no clear benefit of cephalomedullary nailing versus extramedullary implants. It seems that intramedullary implants are beneficial in subtrochanteric and unstable fracture types [19,31].…”

“…Furthermore, given controlled impaction of the metaphyseal fracture zone, immediate full weightbearing is allowed. Despite the fact that PFNA provides high union rates with low major complication rates [13,14,42], it has been associated with lateral cortex impingement [40] that causes lateral cortex fracture and fracture displacement during insertion. The round profile of the nail creates pressure to the lateral wall and the headneck fragment (Fig.…”

Intertrochanteric Fractures; Frequency of Lag Screw Cut Out Fixed With Dynamic Hip Screw

“…Dynamic hip screw(DHS) is an extramedullary implant which is relatively simple, safe and favored device to fix these fractures. 4,5 Although dynamic hip screw is a time tested device, lag screw cut out is the most common mechanical failure of this implant reported in 8% of cases in the literature. 6 In 1995 Baumgaertner 7 in his classical landmark study showed that although multiple risk factors like old age and osteoporosis, unstable fracture type, poor fracture reduction or fixation and use of 150 degree angle implants were responsible for screw cut out but the most important and the gold standard predictor of lag screw cut out he identified was the tip apex distance (TAD)which is the sum of distances from the tip of the lag screw to the apex of femoral head measured on anterio-posterior view (X ap ) and lateral view (X lat ) after magnification is corrected by using the true diameter (D true ) of the shaft of lag screw as a reference.…”

Is distal locking of long nails for intertrochanteric fractures necessary? A clinical study

“…4 For stable intertrochanteric hip fractures (AO classification A1.1, A1.2, A1.3) a fixed angle device in combination with a dynamic sliding lag screw is the favored treatment. 5 The sliding lag screw can be used in combination with an intramedullary nail i.e "cephalomedullary nail" or an extramedullary side plate i.e. "dynamic hip screw".…”