Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2017

Open Access 01-12-2017 | Research article

Comparison and analysis of reoperations in two different treatment protocols for trochanteric hip fractures – postoperative technical complications with dynamic hip screw, intramedullary nail and Medoff sliding plate

Authors: Johnny Paulsson, Josefine Corin Stig, Ola Olsson

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

Login to get access

Abstract

Background

In treatment of unstable trochanteric fractures dynamic hip screw and Medoff sliding plate devices are designed to allow secondary fracture impaction, whereas intramedullary nails aim to maintain fracture alignment. Different treatment protocols are used by two similar Swedish regional emergency care hospitals. Dynamic hip screw is used for fractures considered as stable within the respective treatment protocol, whereas one treatment protocol (Medoff sliding plate/dynamic hip screw) uses biaxial Medoff sliding plate for unstable pertrochanteric fractures and uniaxial Medoff sliding plate for subtrochanteric fractures, the second (intramedullary nail/dynamic hip screw) uses intramedullary nail for subtrochanteric fractures and for pertrochanteric fractures with intertrochanteric comminution or subtrochanteric extension. All orthopedic surgeries are registered in a regional database.

Methods

All consecutive trochanteric fracture operations during 2011–2012 (n = 856) and subsequent technical reoperations (n = 40) were derived from the database. Reoperations were analysed and classified into the categories adjustment (percutaneous removal of the locking screw of the Medoff sliding plate or the intramedullary nail, followed by fracture healing) or minor, intermediate (reosteosynthesis) or major (hip joint replacement, Girdlestone or persistent nonunion) technical complications.

Results

The relative risk of intermediate or major technical complications was 4.2 (1.2–14) times higher in unstable pertrochanteric fractures and 4.6 (1.1–19) times higher in subtrochanteric fractures with treatment protocol: intramedullary nail/dynamic hip screw, compared to treatment protocol: Medoff sliding plate/dynamic hip screw. Overall rates of intermediate and major technical complications in unstable pertrochanteric and subtrochanteric fractures were with biaxial Medoff sliding plate 0.68%, with uniaxial Medoff sliding plate 1.4%, with dynamic hip screw 3.4% and with intramedullary nail 7.2%.

Conclusions

The treatment protocol based on use of biaxial Medoff sliding plate for unstable pertrochanteric and uniaxial Medoff sliding plate for subtrochanteric fractures reduced the risk of severe technical complications compared to using the treatment protocol based on dynamic hip screw and intramedullary nail.

Literature
  1. Jensen JS, Sonne-Holm S, Tondevold E. Unstable trochanteric fractures. A comparative analysis of four methods of internal fixation. Acta Orthop Scand. 1980;51:949–62.View ArticlePubMed
  2. Matre K, Havelin LI, Gjertsen JE, Espehaug B, Fevang JM. Intramedullary nails result in more reoperations than sliding hip screws in two-part intertrochanteric fractures. Clin Orthop Relat Res. 2013;471:1379–86.View ArticlePubMed
  3. Kyle RF, Wright TM, Burstein AH. Biomechanical analysis of the sliding characteristics of compression hip screws. J Bone Joint Surg Am. 1980;62:1308–14.View ArticlePubMed
  4. Olsson O, Ceder L, Hauggaard A. Femoral shortening in intertrochanteric fractures. A comparison between the Medoff sliding plate and the compression hip screw. J Bone Joint Surg Br. 2001;83:572–8.View ArticlePubMed
  5. Medoff RJ, Maes K. A new device for the fixation of unstable pertrochanteric fractures of the hip. J Bone Joint Surg Am. 1991;73:1192–9.View ArticlePubMed
  6. Matre K, Havelin LI, Gjertsen JE, Vinje T, Espehaug B, Fevang JM. Sliding hip screw versus IM nail in reverse oblique trochanteric and subtrochanteric fractures. A study of 2716 patients in the Norwegian hip fracture register. Injury. 2013;44:735–42.View ArticlePubMed
  7. Miedel R, Tornkvist H, Ponzer S, Söderqvist A, Tidermark J. Musculoskeletal function and quality of life in elderly patients after a subtrochanteric femoral fracture treated with a cephalomedullary nail. J Ortho Trauma. 2011;25:208–13.View Article
  8. Olseen P, Jonsson B, Ceder L, Besjakov J, Olsson O, Sernbo I, et al. The Hansson twin hook is adequate for fixation of trochanteric fractures: 2 fixation failures in a series of 157 prospectively followed patients. Acta Orthop. 2008;79:602–8.View ArticlePubMed
  9. Jensen JS, Michaelsen M. Trochanteric femoral fractures treated with McLaughlin osteosynthesis. Acta Orthop Scand. 1975;46:795–803.View ArticlePubMed
  10. Seinsheimer F. Subtrochanteric fractures of the femur. J Bone Joint Surg Am. 1978;60:300–6.View ArticlePubMed
  11. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995;77:1058–64.View ArticlePubMed
  12. Olsson O, Ceder L, Lunsjo K, Hauggaard A. Biaxial dynamization in unstable intertrochanteric fractures. Good experience with a simplified Medoff sliding plate in 94 patients. Acta Orthop Scand. 1997;68:327–31.View ArticlePubMed
  13. Bojan AJ, Beimel C, Taglang G, Collin D, Ekholm C, Jonsson A. Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures. BMC Musculoskelet Disord. 2013;14:1.View ArticlePubMedPubMed Central
  14. Watson JT, Moed BR, Cramer KE, Karges DE. Comparison of the compression hip screw with the Medoff sliding plate for intertrochanteric fractures. Clin Orthop Relat Res. 1998:79–86.
  15. Wachtl SW, Gautier E, Jakob RP. Low reoperation rate with the Medoff sliding plate: 1 technical failure in 63 trochanteric hip fractures. Acta Orthop Scand. 2001;72:141–5.View ArticlePubMed
  16. McCormack R, Panagiotopolous K, Buckley R, Penner M, Perey B, Pate G, et al. A multicentre, prospective, randomised comparison of the sliding hip screw with the Medoff sliding screw and side plate for unstable intertrochanteric hip fractures. Injury. 2013;44:1904–9.View ArticlePubMed
  17. Parker MJ. Trochanteric hip fractures. Fixation failure commoner with femoral medialization, a comparison of 101 cases. Acta Orthop Scand. 1996;67:329–32.View ArticlePubMed
  18. Miedel R, Tornkvist H, Ponzer S, Tidermark J. Musculoskeletal function and quality of life after an unstable trochanteric fracture treated with the trochanteric gamma nail. Arch Orthop Trauma Surg. 2012;132:1495–503.View ArticlePubMed
  19. Kummer FJ, Olsson O, Pearlman CA, Ceder L, Larsson S, Koval KJ. Intramedullary versus extramedullary fixation of subtrochanteric fractures. A biomechanical study. Acta Orthop Scand. 1998;69:580–4.View ArticlePubMed
  20. Mahomed N, Harrington I, Kellam J, Maistrelli G, Hearn T, Vroemen J. Biomechanical analysis of the gamma nail and sliding hip screw. Clin Orthop Relat Res. 1994:280–8.
  21. Mahomed MN, Harrington IJ, Hearn TC. Biomechanical analysis of the Medoff sliding plate. J Trauma. 2000;48:93–100.View ArticlePubMed
  22. Kouvidis G, Sakellariou VI, Mavrogenis AF, Stavrakakis J, Kampas D, Galanakis J, et al. Dual lag screw cephalomedullary nail versus the classic sliding hip screw for the stabilization of intertrochanteric fractures. A prospective randomized study. Strateg Trauma Limb Reconstr. 2012;7:155–62.View Article
  23. Miedel R, Ponzer S, Tornkvist H, Söderqvist A, Tidermark J. The standard gamma nail or the Medoff sliding plate for unstable trochanteric and subtrochanteric fractures. A randomised, controlled trial. J Bone Joint Surg Br. 2005;87:68–75.PubMed
  24. Ceder L, Lunsjo K, Olsson O, Stigsson L, Hauggaard A. Different ways to treat subtrochanteric fractures with the Medoff sliding plate. Clin Orthop Relat Res. 1998:101–6.
  25. Olsson O. Alternative techniques in trochanteric hip fracture surgery. Clinical and biomechanical studies on the Medoff sliding plate and the twin hook. Acta Orthop Scand Suppl. 2000;295:1–31.View ArticlePubMed
  26. Lunsjo K, Ceder L, Thorngren KG, Skytting B, Tidermark J, Berntsson PO, et al. Extramedullary fixation of 569 unstable intertrochanteric fractures: a randomized multicenter trial of the Medoff sliding plate versus three other screw-plate systems. Acta Orthop Scand. 2001;72:133–40.View ArticlePubMed
  27. Ekstrom W, Karlsson-Thur C, Larsson S, Ragnarsson B, Alberts KA. Functional outcome in treatment of unstable trochanteric and subtrochanteric fractures with the proximal femoral nail and the Medoff sliding plate. J Ortho Trauma. 2007;21:18–25.View Article
  28. Swedish Hip Fracture Registry Annual Report 2011. Rikshöft Web Site Available at: http://​rikshoft.​se/​wp-content/​uploads/​2013/​07/​arsrapport2011.​pdf. Accessed June 2, 2016.
  29. Palm H, Jacobsen S, Sonne-Holm S, Gebuhr P. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg Am. 2007;89:470–5.View ArticlePubMed
Metadata
Title
Comparison and analysis of reoperations in two different treatment protocols for trochanteric hip fractures – postoperative technical complications with dynamic hip screw, intramedullary nail and Medoff sliding plate
Authors
Johnny Paulsson
Josefine Corin Stig
Ola Olsson
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-017-1723-x

Other articles of this Issue 1/2017

BMC Musculoskeletal Disorders 1/2017 Go to the issue

Research article

Influence of surgical approach on heterotopic ossification after total hip arthroplasty – is minimal invasive better? A case control study

Research article

Polymorphism and protein expression of MUTYH gene for risk of rheumatoid arthritis

Research article

Generalised joint hypermobility and shoulder joint hypermobility, – risk of upper body musculoskeletal symptoms and reduced quality of life in the general population

Research article

Goldman score, but not Detsky or Lee indices, predicts mortality 6 months after hip fracture

Study protocol

Prospective comparison of the anterior and lateral approach in hemiarthroplasty for hip fractures: a study protocol

Research article

Long-term outcome following additional rhBMP-7 application in revision surgery of aseptic humeral, femoral, and tibial shaft nonunion