Correlation between femoral offset loss and dynamic hip screw cut-out complications after pertrochanteric fractures: a case-control study.

Abstract

Screw-plates disassembly incidence after pertrochanteric fracture (PF) amounts to 1 and 16% among the elderly population. The main occurrence is early cervical screw cut-out. The population at highest risk of disassembly remains difficult to identify. The correlation between femoral offset loss and disassembly occurrence has never been surveyed. A radiological prognosis score for screw plate disassembly was defined to reflect trochanteric impaction (TI); it was based on a femoral offset ratio. Our single-centre retrospective case-control study surveyed patients suffering from Dynamic Hip Screw (DHS, Synthes®) disassembly following osteosynthesis of non-pathological osteoporotic PF between 2004 and 2014. All cases were categorised by age and gender and paired to three patients in the control group. The primary endpoint was TI measurement, corresponding to offset loss on the operated hip compared to healthy hip offset and expressed as a percentage. The measurement was done on an immediate postoperative X-ray. The secondary endpoints were tip apex distance (TAD) measurement, Ender and AO classifications, as well as postoperative weight-bearing prescription. Twenty-three cases and 69 controls were surveyed. The case group's average age was 87; 70% of the cases were women. The main disassembly occurrence delay was after 27days. Average TI was 26% within the patients global group and 12% within the control group (p < 10-5). Over a 21% impaction percentage, disassembly occurrence represents a greater risk: OR = 21.95% CI [5.4-104.3], p < 10-5. Ender 3 type fractures were the most frequent indication for surgerywithin the case group. Average TAD was 20mm within the case group, and 17mm within the control group (p = 0.03). The weight-bearing prescription rate was 52% within the control group and 21% within the case group (p = 0.014). 14.5% of the control group had a TI > 21%. Using the offset ratio tool, TI measurement was associated with a greater risk of DHS disassembly when it was higher than 21%. The exclusive use of a DHS device does not seem optimal for a TI > 21%. Weight-bearing may be prescribed for all the patients with a TI < 21%, provided good implant positioning is secured.