Top

International Orthopaedics

Published in:

01-12-2011 | Original Paper

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

Authors: Richard Stern, Anne Lübbeke, Domizio Suva, Hermes Miozzari, Pierre Hoffmeyer

Published in: International Orthopaedics | Issue 12/2011

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.

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 92:792–798PubMedCrossRef

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 79:969–971PubMedCrossRef

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 72:26–31PubMed

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 34:719–722PubMedCrossRef

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

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 34:1273–1276PubMedCrossRef

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

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

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

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 34:273–276CrossRef

11.

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

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 77:1058–1064PubMed

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 254:242–246PubMed

14.

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

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 126:706–712PubMedCrossRef

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 41:1399–1408PubMed

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–S87PubMedCrossRef

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 133:1–10PubMed

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 18:361–368PubMedCrossRef

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 37:984–989PubMedCrossRef

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) 24:59–64CrossRef

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–S133PubMedCrossRef

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 90:700–707PubMedCrossRef

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 92:1105–1114PubMedCrossRef

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

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 16:386–393PubMedCrossRef

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 23:31–38PubMedCrossRef

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 65:852–857PubMedCrossRef

30.

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

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 14:20–25PubMedCrossRef

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 14:26–30PubMedCrossRef

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 32:488PubMedCrossRef

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 39:932–939PubMedCrossRef

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 41:1292–1296PubMedCrossRef

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 33:81–85PubMedCrossRef

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 41:1234–1238PubMedCrossRef

Title: Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures
Authors: Richard Stern
Anne Lübbeke
Domizio Suva
Hermes Miozzari
Pierre Hoffmeyer
Publication date: 01-12-2011
Publisher: Springer-Verlag
Published in: International Orthopaedics / Issue 12/2011
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-011-1232-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2011

Comment on Sen et al.: Posterior wall reconstruction using iliac crest strut graft in severely comminuted posterior acetabular wall fracture

Magnetic resonance imaging assessment of tibial tuberosity–trochlear groove distance: normal values for males and females

Comparison of five patellar height measurement methods in 90° knee flexion

Conservative versus surgical management of Pipkin type I fractures associated with posterior dislocation of the hip: a randomised controlled trial

Reply to the letter to the editor: Has the role of exchange nailing in femoral nonunion diminished?

Outcome after pelvic sarcoma resection and reconstruction with a modular hemipelvic prostheses