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European Journal of Orthopaedic Surgery & Traumatology
Published in: European Journal of Orthopaedic Surgery & Traumatology 5/2019

01-07-2019 | Dynamic Hip Screw | Original Article • HIP - TRAUMA

Clinical outcomes of dynamic hip screw fixation of intertrochanteric fractures: comparison with additional anti-rotation screw use

Authors: Chul-Ho Kim, Jae Suk Chang, Ji Wan Kim

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 5/2019

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Abstract

Background

Hip screw cutout is among the most common causes of intertrochanteric fracture fixation failure using dynamic hip screws (DHS). This study aimed to evaluate the effect of using an additional anti-rotation screw on hip screw migration or cutout in intertrochanteric fracture fixation.

Materials and methods

We screened 488 patients with unilateral fragile intertrochanteric fractures treated with DHS between January 2001 and March 2016. The inclusion criteria were as follows: (1) age ≥ 50 years; (2) low-energy injury; (3) follow-up of at least 6 months; and (4) short barrel plate used in the operation. The exclusion criteria were as follows: (1) combination with other fracture; or (2) pathological fracture. Subsequently, 166 patients were enrolled; of them, 128 underwent surgery using DHS with an additional screw (Group 1) and 38 patients underwent surgery without an additional screw (Group 2). We compared the postoperative results and clinical outcomes while focusing on screw migration and cutout. Furthermore, we investigated the risk factors for lag screw migration.

Results

Bone union was achieved in 160 patients (96.4%) without secondary intervention. Two patients (1.6%) in Group 1 and 1 (2.6%) in Group 2 developed screw cutout, while 18 (14.1%) in Group 1 and 12 (31.6%) in Group 2 developed screw migration. Thus, Group 2 demonstrated a higher screw migration rate. Multiple logistic regression analysis revealed that the additional anti-rotation screw was the most important factor in preventing screw migration (P = 0.019).

Conclusion

The additional anti-rotation screw reduced the lag screw migration rate following DHS surgery for intertrochanteric fractures.

Level of evidence

Level IV, retrospective series.
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Metadata
Title
Clinical outcomes of dynamic hip screw fixation of intertrochanteric fractures: comparison with additional anti-rotation screw use
Authors
Chul-Ho Kim
Jae Suk Chang
Ji Wan Kim
Publication date
01-07-2019
Publisher
Springer Paris
Published in
European Journal of Orthopaedic Surgery & Traumatology / Issue 5/2019
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-019-02397-4

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