Additional use of anti-rotation U-blade (RC) decreases lag screw sliding and limb length inequality in the treatment of intertrochanteric fractures

Seungbae Oh,Soon-Yong Kwon,Jiyoung Jung,Yong-Sik Kim,Chiyoung Yoon,Joo-Hyoun Song

doi:10.1038/s41598-021-96988-z

Seungbae Oh, Soon-Yong Kwon + Show 4 more

Open Access

https://doi.org/10.1038/s41598-021-96988-z

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Abstract

The purpose of this study is to compare the cut-out rate and sliding distance associated with limb length inequality between operations using a standard non-sliding lag screw versus those using a non-sliding lag screw with U-blade (RC) in the Gamma3 nail. This is a retrospective review of two case series involving different lag screws for the Gamma3 nail. Propensity score matching analysis was used to adjust the confounding factors. A comparative analysis of 304 patients who treated with Gamma3 nail with either a standard non-sliding lag screw or a U-Blade (RC) lag screw was performed. Between 2014 and 2018, 152 patients were treated with U-blade (RC) lag screws, and these patients were matched with those treated with standard lag screws. There was no significant difference in cut-out rate between groups. However, additional use of anti-rotation U-blade (RC) could significantly decrease lag screw sliding, with the group treated with U-Blade (RC) lag screws exhibiting shorter sliding, especially in AO/OTA31 A2 and A3 fractures. Also, in A2 and A3 fractures, the mean lag screw sliding distance was greater than that seen in A1 fractures in both groups. These findings can help trauma surgeons choose the proper implant to reduce leg length inequality.

Highlights

Hip fractures are the most common type of fractures requiring hospitalization, followed by distal radius fractures and ankle fractures[1]
Intertrochanteric fracture and femoral neck fracture represent the majority of hip fractures and occur with similar frequency[4]
Proximal femur intramedullary nails are frequently used for fixation of intertrochanteric fracture

Summary

Introduction

Hip fractures are the most common type of fractures requiring hospitalization, followed by distal radius fractures and ankle fractures[1]. Evidence-based management of intertrochanteric fractures includes internal fixation with intramedullary nails or sliding hip screws. The use of an RC hip screw significantly increased the resistance of the Gamma[3] hip screw by almost 15%5 In another biomechanical study, a screw-blade hybrid type lag screw was more effective in minimizing rotation instability of the proximal fragment. The cut-out rate and sliding distance of the Gamma[3] U-blade lag screw were not superior to those associated with other lag screws in other studies, and the study was not detailed according to the classification of fractures[8,9] According to these clinical studies, the best intramedullary nail for femur trochanteric region fractures remains controversial

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