Compression Hip Screw Research Articles

Minimally invasive technique versus conventional technique of dynamic hip screws for intertrochanteric femoral fractures

Intertrochanteric fractures of femur are common in elderly patients. The compression hip screw has become the predominant method for osteosynthesis of intertrochanteric fractures. However, the conventional dynamic hip screws (CDHS) technique has some disadvantages. Recently, we have used a minimally invasive dynamic hip screws (MIDHS) technique to reduce these disadvantages. This prospective study is to compare curative effect of MIDHS with that of CDHS with open reduction on Evans type 1 intertrochanteric fractures. All 97 fractures were classified according to the Evans systems. The MIDHS group included 47 patients with an average age of 68.7 years, and the CDHS group included 50 patients with an average age of 68.7 years. The Singh index was used as a measure of osteoporosis. Both groups were similar in injury mechanism, fracture types, mean Singh index and medical diseases (all P > 0.50). All fractures were healed within 4 months in both groups except three cases who were implant failure and nonunion in the CDHS group. The MIDHS group had significantly smaller wound size, shorter surgery time, less blood loss, lower blood transfusion rate, earlier active mobilization of fractured hip joint, shorter hospital stay, lower serious complication rate and higher Harris hip score than the CDHS group (all P < 0.05). The satisfactory reduction, adequate screw position, healing time and union rate was not significantly difference between two groups (all P > 0.05). When the fractures are treated adequately, either the MIDHS or the CDHS with open reduction is an effective and safe method, but the MIDHS is superior to the CDHS with open reduction for the treatment of Evans type 1 intertrochanteric fractures of femur.

Usefulness of multi-detector CT in Boyd-Griffin type 2 intertrochanteric fractures with clinical correlation

To investigate the usefulness of multi-detector computed tomography (MDCT) in three-part intertrochanteric fractures of proximal femur. Twenty-six patients with Boyd-Griffin type 2 intertrochanteric fractures with MDCT (group 1) and 36 patients of the same type fracture without MDCT (group 2) were compared. Lesser trochanter (LT)/greater trochanter (GT) volume ratio above 0.5 or the volumetric proportion of GT in total volume of proximal femur below 25% was considered an unstable fracture. The fractures were fixed with dynamic compression hip screws (DCS). Additional greater trochanter stabilizing (GTS) plate or bone cement augmentation of the femoral head was performed in unstable fractures. Clinical outcome between the two groups by fixation failure and radiological results was compared. The volume ratio of the LT/GT was 0.33 (range, 0.13-0.73). The volume of the LT was inversely correlated with that of the GT (p < 0.001). The volume of the GT was significantly correlated with the LT/GT ratio or the head and neck (HN)/GT ratio (p < 0.001). Seven cases were regarded as unstable fractures in group 1. Fixation failures happened in one case in group 1 and five cases in group 2. There was significantly lower failure rate in group 1 than group 2 (p = 0.03). Neck-shaft angle at last follow-up was 134.8 degrees +/- 5.3 in group 1 and 131.3 degrees +/- 5.1 in group 2 (p = 0.01). The sliding length of lag screws were 5.6 degrees +/- 2.9 mm in group 1 and 8.3 degrees +/- 3.2 in group 2 (p = 0.03). Preoperative use of MDCT provides useful information about the fracture pattern and the geometry of the proximal femur in unstable intertrochanteric fractures and helps surgical planning. The ratio of the LT to the GT is inversely correlated with fracture stability.

A randomised controlled trial to compare the haemodynamic changes during the fixation of extracapsular proximal femoral fractures using the compression hip screw versus the intramedullary hip screw

A randomised controlled trial to compare the haemodynamic changes during the fixation of extracapsular proximal femoral fractures using the compression hip screw versus the intramedullary hip screw

Gamma Nails Revisited: Gamma Nails Versus Compression Hip Screws in the Management of Intertrochanteric Fractures of the Hip: A Meta-Analysis

Concerns about the Gamma nail have largely been fueled by early randomized trials and meta-analyses suggesting an increased risk of subsequent femoral shaft fractures when compared with compression hip screws. Whereas meta-analyses favor compression hip screws over first-generation Gamma nails, little is known as to whether the newer Gamma nail designs and the improved learning curve associated with the implants have reduced the risk of femoral shaft fracture. The current meta-analysis aimed to explore the effects of time and Gamma Nail design on the risks of femoral shaft fracture after treatment of extracapsular hip fractures. We searched computerized databases (Medline, Cochrane, and SciSearch) for published randomized clinical trials from 1969 to 2002, and we identified additional studies through hand searches of major orthopedic journals, bibliographies of major orthopedic texts, and personal files. Two investigators independently graded study quality and abstracted relevant data. We abstracted information on subsequent femoral shaft fracture rates from studies. We pooled data using a random-effects model and tested for heterogeneity using the I test. We conducted sensitivity analyses by date and by generation of the Gamma nail. We further conducted a cumulative meta-analysis to explore the treatment effect over time. We identified 25 relevant randomized trials from 1991 to 2005. In earlier studies (N = 1585 patients), Gamma nails increased the risk of femoral shaft fracture 4.5 times compared with a compression hip screw (95% confidence interval: 1.78-11.36, P = 0.0014, I(2) = 0%). However, among the most recent studies (2000-2005), Gamma nails did not significantly increase femoral shaft fracture risk (relative risk = 1.65, 95% confidence interval: 0.50-5.44, P = 0.41, I(2) = 0%). The most recent study (2005) found no difference in femoral fracture rates (relative risk = 1.03, 95% confidence interval = 0.06-16.2, P = 0.99). Our meta-analysis of randomized trials suggests that previous concerns about increased femoral shaft fracture risk with Gamma nails have been resolved with improved implant design and improved learning curves with the device. Earlier meta-analyses and randomized trials should be interpreted with caution in light of more recent evidence.

Intramedullary Hip Screw Versus Standard Compression Hip Screw: Early Postoperative Rehabilitation Comparisons

Studies comparing the intramedullary hip screw and the compression hip screw for fixation of intertrochanteric hip fractures have shown little difference in final functional outcome. However, the characteristics of the rehabilitation process for these implants have not been analyzed. This study used the Functional Independence Measure (FIM Instrument; Uniform Data System for Medical Rehabilitation, Amherst, New York) to better characterize the subtle differences of the perioperative, clinical, and rehabilitative treatment of intertrochanteric fractures using the intramedullary hip screw or compression hip screw. Ninety-four patients with isolated intertrochanteric fractures were treated with either an intramedullary hip screw or compression hip screw at our institution. To reduce technical bias, only experienced surgeons were used and patient allocation was surgeon based (eg, surgeons consistently used the same preferred implant). We evaluated the following FIM categories: bed mobility, bed transfer, gait independence, and distance ambulated. Length of stay and level of discharge disposition were also evaluated. The intramedullary hip screw group performed better with bed transfers (P<.05), demonstrated better ambulatory ability at discharge (P<.06), and had an increased gait distance at discharge (P<.07). Skin-to-skin operative time and estimated blood loss was significantly less for the intramedullary hip screw group. Length of hospital stay and discharge disposition failed to reach statistical significance. Our study found that when using the FIM scores, some differences were noted in the acute rehabilitation characteristics in patients between the intramedullary hip screw and the compression hip screw. These findings may have medical and social importance as well as significant economic implications. Further study with a larger sample size and more stringent study design are recommended.

Treatment of Unstable Intertrochanteric Fracture in Elderly Patients: Comparison between the Results of Internal Fixation Using Compression Hip Screw and Cemented Bipolar Hemiarthroplasty

138 통신저자:임 영 진 전남 순천시 조례동 1742 성가롤로병원 정형외과 Tel:061-720-2500ᆞFax:061-720-6000 E-mail:lyj2834@naver.com 접수: 2008. 11. 20 심사 (수정): 1차 2009. 1. 22, 2차 2009. 4. 27, 3차 2009. 5. 27 게재확정: 2009. 6. 24 Address reprint requests to:Young-Jin Lim, M.D. Department of Orthopedic Surgery, Saint Carollo Hospital, 1742, Jo-ray-dong, Sunchon 540-718, Korea Tel:82-61-720-2500ᆞFax:82-61-720-6000 E-mail:lyj2834@naver.com 고령 환자의 대퇴 전자간부 불안정성 골절의 치료 -압박 고 나사를 이용한 내고정술과 시멘트 양극성 반치환술의 결과 비교-

Treatment of Intertrochanteric Fractures in Patients with Severe Osteoporosis with Dynamic Compression Hip Screws

Treatment of Intertrochanteric Fractures in Patients with Severe Osteoporosis with Dynamic Compression Hip Screws

A prospective, randomised study comparing the percutaneous compression plate and the compression hip screw for the treatment of intertrochanteric fractures of the hip

A prospective, randomised study comparing the percutaneous compression plate and the compression hip screw for the treatment of intertrochanteric fractures of the hip

Comparison of the Targon® Proximal Femoral Nail and the Compression Hip Screw for Treating Intertrochateric Fracture of the Femur

Comparison of the Targon^® Proximal Femoral Nail and the Compression Hip Screw for Treating Intertrochateric Fracture of the Femur

Dynamic hip fracture modelling

A treatment of neck of femur fractures is internal fixation using a dynamic hip screw. This article investigates the effect of the angle of such a dynamic hip screw on the stresses developed under loading in a human femur. The modelling is informed by an examination of Medicare Australia data which indicates that women aged 65~years or over are the primary recipients of an internal fixation of the neck of femur. Development of a series of finite element models with incremental changes in angle allows determination of the stresses developed in use. Regression analysis of the data obtained from the finite element analysis reveals a strong negative association between angle and stress. The results obtained will assist in the selection of dynamic hip screw angles appropriate for individual patients. References Cosmosworks, Structural research and analysis corporation, Santa Monica, USA, 2007. [2 Oct 2008] http://www.cosmosm.com. Edwards, T. R., Tevelen, G., English, H. and Crawford, R., Stripping torque as a predictor of successful internal fracture fixation, ANZ J. Surg., 75, 2005, 1096--1099. Hip fracture, Wikimedia Commons, [5 Aug 2008] http://commons.wikimedia.org/wiki/Hip_fracture. Johansson, T., Bachrach-Lindstrom, M., Aspenberg, P., Jonsson, D. and Wahlstroem, O., The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement, International Orthopaedics, 30, 2006, 1--6. doi:10.1007/s00264-005-0037-z Kemler, M. A., de Vries, M., Gerard, W. J., van Raay, J. J. A. and Van der Tol, A., Can we predict failure of internal fixation when treating femoral neck fractures? Eur. J Orthop. Surg. Traumatolo., 17, 2007, 67--70. Marieb, E. N. Human anatomy and physiology, 6th ed., Pearson Benjamin Cummings, San Francisco, 2004. Medicare Benefits Schedule (MBS) Item Statistics Reports 2007, Medicare Australia, [31 May 2007] http://www.medicareaustralia.gov.au/statistics/dyn_mbs/forms/mbs_tab4.shtml Nissen, N., Hauge, E. M., Abrahamsen, B., Jensen, J. E., Mosekilde, L. and Brixen, K., Geometry of the proximal femur in relation to age and sex: a cross-sectional study in healthy adult Danes, Acta Radiologica, 46, 2005, 514--518. doi:10.1080/02841850510021562 Solidworks, SolidWorks Corporation, Concord, Mass, 2007, [2 Oct 2008] www.solidworks.com. Stryker, Omega3 compression hip screw system, [5 August,2008] http://www.stryker.com/en-us/products/Trauma/HipFracture/Omega3CHS/index.htm Synthes, North America, dhs/dhs Dynamic hip and condylar screw system: Technique Guide 1990, [26 October 2007] http://products.synthes.com/prod_support/Product%0Support %0Materials/Technique%0Guides/SUSA/SUTGDHS-DCSJ3045B.pdf. Weinrauch, P. Intra-operative error during Austin Moore hemiarthroplasty, J. Orthopaedic Surgery, 14, 2006, 249--252.

大腿骨転子部骨折に対するcompression hip screw法の不良症例

大腿骨転子部骨折に対するcompression hip screw法の不良症例

The Norwegian Hip Fracture Register: Experiences after the first 2 years and 15,576 reported operations

Background and purpose The Norwegian Hip Fracture Register was established in January 2005 to collect nationwide information as a basis for improved management of patients with hip fractures. We now report our experience after the first 2 years.Methods After both primary operations and reoperations, the surgeons fill in a standardized 1-page form with information about the patient, the fracture, and the operation. Fractures treated with a total hip arthroplasty are reported to the national arthroplasty register, but are added to the hip fracture register before analyses are performed. 4, 12, and 36 months postoperatively, a standardized questionnaire including health-related quality of life (EQ-5D), visual analog scales concerning pain and patient satisfaction, and Charnley class for functional assessment is sent directly from the register to the patients. To evaluate the completeness of registration, our data were compared with data from the Norwegian Patient Registry (NPR).Results During the first year of registration, all 55 hospitals treating hip fractures in Norway started to report their hip fracture operations. During 2005, the monthly reporting increased and it stabilized in 2006. 13,251 primary-operated hips (mean age of patients: 80 years; 72% females) and 2,325 reoperations were reported during 2005 and 2006. Compared to the NPR, the completeness of registration was 64% in 2005 and 79% in 2006. 58% of the patients who were alive answered the 4-month questionnaire. The non-responders were older, were more often cognitively impaired, and had a higher degree of comorbidity than the responders. Undisplaced femoral neck fractures (19% of all fractures) were almost exclusively operated with screw osteosynthesis (95%). Dislocated femoral neck fractures (38% of all fractures) were operated with a hemiarthroplasty in 52% of the cases. Osteosynthesis with a hip compression screw was the predominant operation method for trochanteric fractures (81%).Interpretation After only 2 years, our nationwide system for surveillance of demographics, treatment, and outcome of hip fractures is functioning well. As expected, the response rate for the 4-month questionnaires was relatively low due to the old population with high comorbidity and cognitive impairment. The different treatment methods used for patients in the same groups of fracture types show that there is still no consensus in Norway regarding the treatment of hip fractures.

Factors affecting Fixation Failure in Treatment of Intertrochanteric Fracture of the Femur by Dynamic Compression Hip Screw

Factors affecting Fixation Failure in Treatment of Intertrochanteric Fracture of the Femur by Dynamic Compression Hip Screw

The dynamic condylar screw in the management of subtrochanteric fractures: does judicious use of biological fixation enhance overall results?

Subtrochanteric fractures are fraught with certain anatomic, biologic and biomechanical challenges. Evolution of implants like the Gamma nail, fixed-angle nail plates, compression hip screws and dynamic hip screws with trochanteric stabilization plates underlines a persistent quest for a better implant. We studied the dynamic condylar screw DCS as an implant on a series of 30 consecutive patients with subtrochanteric fractures. Our purpose was to assess this implant as a panacea for subtrochanteric fractures. All cases of AO type A and B were anatomically fixed, whereas type C was biologically plated. The idea was to assess the applicability and adaptability of the DCS. Fractures in 29 cases united, with one patient suffering from an implant failure. There were 17 excellent, 5 good, 5 fair and 3 poor results. The DCS is a definite advance over previous methods of treatment; when combined with the utilization of biological fixation techniques for comminuted fractures, can be relied upon to treat all types of subtrochanteric fractures.

不安定型大腿骨転子部骨折に対するつば付きcompression hip screw固定法の治療成績

不安定型大腿骨転子部骨折に対するつば付きcompression hip screw固定法の治療成績

A prospective, randomised study comparing the percutaneous compression plate and the compression hip screw for the treatment of intertrochanteric fractures of the hip

Limited access surgery is thought to reduce post-operative morbidity and provide faster recovery of function. The percutaneous compression plate (PCCP) is a recently introduced device for the fixation of intertrochanteric fractures with minimal exposure. It has several potential mechanical advantages over the conventional compression hip screw (CHS). Our aim in this prospective, randomised, controlled study was to compare the outcome of patients operated on using these two devices. We randomised 104 patients with intertrochanteric fractures (AO/OTA 31.A1-A2) to surgical treatment with either the PCCP or CHS and followed them for one year postoperatively. The mean operating blood loss was 161.0 ml (8 to 450) in the PCCP group and 374.0 ml (11 to 980) in the CHS group (Student's t-test, p < 0.0001). The pain score and ability to bear weight were significantly better in the PCCP group at six weeks post-operatively. Analysis of the radiographs in a proportion of the patients revealed a reduced amount of medial displacement in the PCCP group (two patients, 4%) compared with the CHS group (10 patients, 18.9%); Fisher's exact test, p < 0.02. The PCCP device was associated with reduced intra-operative blood loss, less postoperative pain and a reduced incidence of collapse of the fracture.

Excessive Sliding of Compression Hip Screw For the Treatment of Intertrochanteric Fracture in Elderly

Excessive Sliding of Compression Hip Screw For the Treatment of Intertrochanteric Fracture in Elderly

Integrity of the Lateral Femoral Wall in Intertrochanteric Hip Fractures

Reoperations after intertrochanteric fractures are often necessitated by fracture displacement following mobilization of the patient. The biomechanical complexity of the fracture, the position of the implant, and the patient's characteristics are known to influence postoperative outcome. We investigated the importance of an intact lateral femoral wall as a factor in postoperative fracture displacement after fixation with a sliding compression hip screw. Two hundred and fourteen consecutive patients with an intertrochanteric fracture were treated with a 135 degrees sliding compression hip screw with a four-hole side-plate between 2002 and 2004. The fractures were classified on preoperative radiographs according to the AO/OTA classification system. The status of the greater and lesser trochanters, the integrity of the lateral femoral wall, and the position of the implant were assessed postoperatively. Reoperations due to technical failure were recorded for six months postoperatively. Only 3% (five) of 168 patients with an intact lateral femoral wall postoperatively underwent a reoperation within six months, whereas 22% (ten) of forty-six patients with a fractured lateral femoral wall were operated on again (p < 0.001). Multivariate logistic regression analyses combining demographic and biomechanical parameters showed a compromised lateral femoral wall to be a significant predictor of a reoperation (p = 0.010). Seventy-four percent (thirty-four) of the forty-six fractures of the lateral femoral wall occurred during the operative procedure itself. A fracture of the lateral femoral wall occurred in only 3% (three) of the 103 patients with an AO/OTA type-31-A1.1, A1.2, A1.3, or A2.1 intertrochanteric fracture compared with 31% (thirty-one) of the ninety-nine with an AO/OTA type 31-A2.2 or A2.3 fracture (p < 0.001). A postoperative fracture of the lateral femoral wall was found to be the main predictor for a reoperation after an intertrochanteric fracture. Consequently, we concluded that patients with preoperative or intraoperative fracture of the lateral femoral wall are not treated adequately with a sliding compression hip-screw device, and intertrochanteric fractures should therefore be classified according to the integrity of the lateral femoral wall, especially in randomized trials comparing fracture implants.

Vissage versus enclouage gamma dans les fractures de la hanche

This is a retrospective study of 102 patients with intertrochanteric hip fractures comparing the operative results of short gamma nail™ fixation with the sliding hip screw. The average patient age in the study is 83 years (range 52–94 years) with 87% females. The transfusion requirements between the two groups did not differ but a slightly larger decrease in hemoglobin levels was seen at 48 h in the gamma nail group. In neither group were there any intra-operative fractures or infections which led to a return to the operating room. The average length of stay for both groups was identical at 6.9 days. Twenty-seven short gamma nail patients and 18 compression hip screw patients were followed for 6 months. There were no instances of cut-out in either group but the short gamma nail group had middle/middle lag screw placement on the AP and lateral views more often than the compression hip screw (50%) group at 6 months. We conclude that the short gamma nail can be used effectively for the fixation of intertrochanteric hip fractures without the occurrence of potentially devastating complications such as intraoperative femur fracture, periprosthetic fracture or lag screw cut-out.

Are intramedullary nails more useful than compression hip screws at surgical intervention of trochanteric fracture?

Are intramedullary nails more useful than compression hip screws at surgical intervention of trochanteric fracture?