Treating peri-trochanteric hip fractures with intramedullary nail, when a second anti-rotational screw is necessary?
Antirotation hip screw
Fracture complications
Fragility fractures
Hip fractures
Unstable intertrochanteric fractures
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
04 Oct 2023
04 Oct 2023
Historique:
received:
28
02
2023
accepted:
16
09
2023
medline:
6
10
2023
pubmed:
5
10
2023
entrez:
4
10
2023
Statut:
epublish
Résumé
Fragility fractures around the proximal end of the femur have increased in recent years due to an aging population, adding to the pressure on national health care systems and to hospital expenses. Peri-trochanteric fractures have historically been treated successfully with anatomic intramedullary nails, giving stable fixation in order to allow early for mobilisation of these frail patients. Some of these nails allow a second (anti-rotational) screw through the nail into the femoral head. We assessed the use of this additional screw in terms of quality of reduction, post-operative mobilization and complications. All patients who were treated in the same hospital for peri-trochanteric fracture between January 2017 and December 2019 were included in the study. The patients were randomly assigned into group A, where the treatment included intramedullary nailing using one femoral hip screw, and group B, where the treatment additionally included a second anti-rotational screw. The patients were followed up clinically and radiologically, for at least 3 months post-operatively. Demographic and operative data were collected alongside radiographic and clinical data. A total of 118 patients with an average age of 82.7 years were included in the study after exclusion criteria was applied. There were no statistically significant differences between the two groups regarding the ASA grade, Nottingham Hip fracture score, Koval score, Mental score, operation time, transfusion requirements, and operative radiation dose and time (p > 0.05). In group A, more complications were observed (p < 0.05). The radiographic measurements were statistically significantly different. CART analysis revealed that the use of a single screw in the femoral head for the subgroup of the unstable peri-trochanteric fractures (Jensen Type 4-5 - AO31A2.2 and above), has a tendency toward developing more post-operative complications, though this was not statistically significant. The use of an additional anti-rotational screw for unstable peri-trochanteric fractures (Jensen Type 4-5 and AO 31A2.2 and above) could prevent complications such as varus collapse and cut-out.
Identifiants
pubmed: 37794410
doi: 10.1186/s12891-023-06892-y
pii: 10.1186/s12891-023-06892-y
pmc: PMC10548656
doi:
Types de publication
Randomized Controlled Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
787Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
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