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Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures

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Abstract

Purpose

The purpose of this study was to compare femoral head placement, rates of reoperation and cephalic implant cut-out of a screw versus a blade for patients over age 60 with low energy trochanteric fractures (AO/OTA 31-A1, A2, and A3) treated either with sliding hip screw or cephalomedullary nail.

Methods

After surgeon selection of either hip screw or nail, hip screw patients were randomised to either a DHS (dynamic hip system screw) or DHS blade (dynamic hip system blade), while nail patients were randomised to either a Gamma3 Trochanteric Nail or a PFNA (proximal femoral nail antirotation). This resulted in a screw group (DHS and Gamma nail), and a blade group (DHS blade and PFNA). Outcome measures included tip-apex distance and zone location of the cephalic implant, as well as reoperation and implant cut-out within the first postoperative year.

Results

A total of 335 patients were randomised, 172 to a screw and 163 to a blade. There was no significant difference concerning mean tip-apex distance, percentage of patients with a tip-apex distance >25 mm, and patients with a centre–centre position of the cephalic implant. There were 137 patients in the screw group and 132 in the blade group available for follow-up. They did not differ regarding rates of reoperation or cut-out (screw group = 2.9%; blade group = 1.5%).

Conclusions

Both a screw and a blade performed equally well in terms of implant placement in the femoral head and outcome.

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References

  1. Barton TM, Gleeson R, Topliss C, Greenwood R, Harries WJ, Chesser TJ (2010) A comparison of the long gamma nail with the sliding hip screw for the treatment of AO/OTA 31-A2 fractures of the proximal part of the femur: a prospective randomized trial. J Bone Joint Surg Am 92:792–798

    Article  PubMed  Google Scholar 

  2. Baumgaertner MR, Solberg BD (1997) Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip. J Bone Joint Surg Br 79:969–971

    Article  PubMed  CAS  Google Scholar 

  3. Davis TR, Sher JL, Horsman A, Simpson M, Porter BB, Checketts RG (1990) Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br 72:26–31

    PubMed  CAS  Google Scholar 

  4. Geller JA, Saifi C, Morrison TA, Macaulay W (2010) Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures. Int Orthop 34:719–722

    Article  PubMed  Google Scholar 

  5. Gundle R, Gargan MF, Simpson AH (1995) How to minimize failure of fixation of unstable intertrochanteric fractures. Injury 26:611–614

    Article  PubMed  CAS  Google Scholar 

  6. Hsueh KK, Fang CK, Chen CM, Su YP, Wu HF, Chiu FY (2010) Risk factors in cutout of sliding hip screw in intertrochanteric fractures: an evaluation of 937 patients. Int Orthop 34:1273–1276

    Article  PubMed  Google Scholar 

  7. Lobo-Escolar A, Joven E, Iglesias D, Herrera A (2010) Predictive factors for cutting-out in femoral intramedullary nailing. Injury 41:1312–1316

    Article  PubMed  Google Scholar 

  8. Kyle RF (1994) Fractures of the proximal part of the femur. J Bone Joint Surg Am 76:924–950

    Google Scholar 

  9. Parker MJ (1992) Cutting-out of the dynamic hip screw related to its position. J Bone Joint Surg Br 74:625

    PubMed  CAS  Google Scholar 

  10. Walton M, Barnett A, Jackson M (2008) Tip-apex distance as a predictor of failure following cephalo-medullary fixation for unstable fractures of the proximal femur. Eur J Trauma Emerg S 34:273–276

    Article  Google Scholar 

  11. Pervez H, Parker MJ, Vowler S (2004) Prediction of fixation failure after sliding hip screw fixation. Injury 35:994–998

    Article  PubMed  Google Scholar 

  12. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM (1995) The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 77:1058–1064

    PubMed  CAS  Google Scholar 

  13. Bannister GC, Gibson AG, Ackroyd CE, Newman JH (1990) The fixation and prognosis of trochanteric fractures. A randomized prospective controlled trial. Clin Orthop Relat Res 254:242–246

    PubMed  Google Scholar 

  14. Chirodian N, Arch B, Parker MJ (2005) Sliding hip screw fixation of trochanteric hip fractures: outcome of 1024 procedures. Injury 36:793–800

    Article  PubMed  CAS  Google Scholar 

  15. Lenich A, Mayr E, Ruter A, Mockl C, Fuchtmeier B (2006) First results with the trochanter fixation nail (TFN): a report on 120 cases. Arch Orthop Trauma Surg 126:706–712

    Article  PubMed  CAS  Google Scholar 

  16. Cleveland M, Bosworth DM, Thompson FR, Wilson HJ Jr, Ishizuka T (1959) A ten-year analysis of intertrochanteric fractures of the femur. J Bone Joint Surg Am 41:1399–1408

    PubMed  Google Scholar 

  17. Sahni V, Sureen S, Shetty V (2001) Who is responsible for failure of a dynamic hip screw by cutout, the patient or the surgeon? In: Proceedings of the 68th annual meeting of the American Academy of Orthopaedic Surgeons, vol 2, p 385

  18. Stern R (2007) Are there advances in the treatment of extracapsular hip fractures in the elderly? Injury 38(Suppl 3):S77–S87

    Article  PubMed  Google Scholar 

  19. Al-Munajjed AA, Hammer J, Mayr E, Nerlich M, Lenich A (2008) Biomechanical characterisation of osteosyntheses for proximal femur fractures: helical blade versus screw. Stud Health Technol Inform 133:1–10

    PubMed  Google Scholar 

  20. Sommers MB, Roth C, Hall H, Kam BC, Ehmke LW, Krieg JC et al (2004) A laboratory model to evaluate cutout resistance of implants for pertrochanteric fracture fixation. J Orthop Trauma 18:361–368

    Article  PubMed  Google Scholar 

  21. Strauss E, Frank J, Lee J, Kummer FJ, Tejwani N (2006) Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation. Injury 37:984–989

    Article  PubMed  Google Scholar 

  22. Windolf M, Braunstein V, Dutoit C, Schwieger K (2009) Is a helical shaped implant a superior alternative to the dynamic hip screw for unstable femoral neck fractures? A biomechanical investigation. Clin Biomech (Bristol, Avon) 24:59–64

    Article  Google Scholar 

  23. Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA et al (2007) Fracture and dislocation classification compendium—2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 21:S1–S133

    Article  PubMed  CAS  Google Scholar 

  24. Anglen JO, Weinstein JN (2008) Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg Am 90:700–707

    Article  PubMed  Google Scholar 

  25. Forte ML, Virnig BA, Eberly LE, Swiontkowski MF, Feldman R, Bhandari M et al (2010) Provider factors associated with intramedullary nail use for intertrochanteric hip fractures. J Bone Joint Surg Am 92:1105–1114

    Article  PubMed  Google Scholar 

  26. Parker MJ, Handoll HH (2008) Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev 3:CD000093

    Google Scholar 

  27. Saudan M, Lubbeke A, Sadowski C, Riand N, Stern R, Hoffmeyer P (2002) Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma 16:386–393

    Article  PubMed  Google Scholar 

  28. Kuzyk PR, Lobo J, Whelan D, Zdero R, McKee MD, Schemitsch EH (2009) Biomechanical evaluation of extramedullary versus intramedullary fixation for reverse obliquity intertrochanteric fractures. J Orthop Trauma 23:31–38

    Article  PubMed  Google Scholar 

  29. Park SY, Yang KH, Yoo JH, Yoon HK, Park HW (2008) The treatment of reverse obliquity intertrochanteric fractures with the intramedullary hip nail. J Trauma 65:852–857

    Article  PubMed  Google Scholar 

  30. Johnson LJ, Cope MR, Shahrokhi S, Tamblyn P (2008) Measuring tip-apex distance using a picture archiving and communication system (PACS). Injury 39:786–790

    Article  PubMed  Google Scholar 

  31. Zuckerman JD, Koval KJ, Aharonoff GB, Hiebert R, Skovron ML (2000) A functional recovery score for elderly hip fracture patients: I. Development. J Orthop Trauma 14:20–25

    Article  PubMed  CAS  Google Scholar 

  32. Zuckerman JD, Koval KJ, Aharonoff GB, Skovron ML (2000) A functional recovery score for elderly hip fracture patients: II. Validity and reliability. J Orthop Trauma 14:26–30

    Article  PubMed  CAS  Google Scholar 

  33. Lindsey RW, Ahmed S, Overturf S, Tan A, Gugala Z (2009) Accuracy of lag screw placement for the dynamic hip screw and the cephalomedullary nail. Orthopedics 32:488

    Article  PubMed  Google Scholar 

  34. Simmermacher RK, Ljungqvist J, Bail H, Hockertz T, Vochteloo AJ, Ochs U et al (2008) The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study. Injury 39:932–939

    Article  PubMed  CAS  Google Scholar 

  35. Lenich A, Vester H, Nerlich M, Mayr E, Stockle U, Fuchtmeier B (2010) Clinical comparison of the second and third generation of intramedullary devices for trochanteric fractures of the hip-blade vs screw. Injury 41:1292–1296

    Article  PubMed  Google Scholar 

  36. Park JH, Lee YS, Park JW, Wang JH, Kim JG (2010) A comparative study of screw and helical proximal femoral nails for the treatment of intertrochanteric fractures. Orthopedics 33:81–85

    Article  PubMed  Google Scholar 

  37. Yaozeng X, Dechun G, Huilin Y, Guangming Z, Xianbin W (2010) Comparative study of trochanteric fracture treated with the proximal femoral nail anti-rotation and the third generation of gamma nail. Injury 41:1234–1238

    Article  PubMed  Google Scholar 

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Funding

No funding was received for this work.

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Authors and Affiliations

  1. Division of Orthopaedics and Trauma Surgery, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland

    Richard Stern, Anne Lübbeke, Domizio Suva, Hermes Miozzari & Pierre Hoffmeyer

Authors
  1. Richard Stern
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  2. Anne Lübbeke
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  3. Domizio Suva
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  4. Hermes Miozzari
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  5. Pierre Hoffmeyer
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Corresponding author

Correspondence to Richard Stern.

Additional information

This investigation was performed at the Division of Orthopaedics and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland. Approval for this study was obtained from our Hospital Ethics Committee.

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Stern, R., Lübbeke, A., Suva, D. et al. Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures. International Orthopaedics (SICOT) 35, 1855–1861 (2011). https://doi.org/10.1007/s00264-011-1232-8

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  • DOI: https://doi.org/10.1007/s00264-011-1232-8

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