scholarly journals Dynamic hip screw fixation: Is the tip-apex distance the most important predictor for lag screw cutout?

2014 ◽  
Vol 12 ◽  
pp. S60
Author(s):  
Ioannis Sarantitis ◽  
Giles Foley ◽  
Henry Wynn-Jones
Keyword(s):  
Screw Fixation ◽  
Dynamic Hip Screw ◽  
Important Predictor ◽  
Lag Screw ◽  
Hip Screw ◽  
Tip Apex Distance

scholarly journals Intertrochanteric fracture fixation with Dynamic Hip Screw: Is tip-apex distance measurement useful for predicting fixation failure?

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Goh KL ◽  
Zamzuri Z ◽  
Mohd Ariff S ◽  
Mohamed Azril MA
Keyword(s):  
Intertrochanteric Fracture ◽  
Demographic Data ◽  
Dynamic Hip Screw ◽  
Optimal Placement ◽  
Fixation Failure ◽  
Lag Screw ◽  
Hip Screw ◽  
Tip Apex Distance ◽  
One Year

Introduction: Application of dynamic hip screw (DHS) implant for the treatment of unstable intertrochanteric fractures continues to raise concern related to risk of lag screw cut-out with or without subsequent damage to the acetabulum. Measurement of tip-apex distances (TAD) has been recommended to guide the optimal placement of lag screw and to predict subsequent risk of screw cut-out. In this study, the value of TAD was evaluated to verify its usefulness. Methods: This is a retrospective study of 33 consecutive patients with intertrochanteric fracture treated with DHS. Demographic data of the patients were traced from their case notes. Post-operative radiographs were reviewed by focusing on measurement of TAD on anteroposterior and lateral radiographs. Radiographs at one year follow-up were reviewed to depict any fixation-related failure or complication. Results: Fifty two percent of patients did not achieved the recommended TAD of ≤ 25mm. The mean post-operative TAD was 25.9mm and elderly patients were likely to achieve TAD of ≤ 25mm. The overall complication rate of 6% was attributed to screw cut-out in two cases. The unstable left-sided fracture was identified to be a potential risk for screw cut-out or migration. Conclusion: TAD is a valuable measurement to guide optimal placement of lag screw during DHS fixation of intertrochanteric fracture.

scholarly journals To analyze and use the parameters in post-operative unstable intertrochanteric fractures treated using dynamic hip screw fixation as guidelines for re-operation

2016 ◽  
Vol 2 (4) ◽  
pp. 273
Author(s):  
K. Thirusenthil Aathipan ◽  
T. R. Ashok ◽  
Ganesan G. Ram
Keyword(s):  
Prospective Study ◽  
Screw Fixation ◽  
Dynamic Hip Screw ◽  
Intertrochanteric Fractures ◽  
Anatomical Reduction ◽  
Pull Out ◽  
Hip Screw ◽  
Tip Apex Distance ◽  
Definite Indicator ◽  
A Prospective Study

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">The treatment of unstable intertrochanteric fractures is challenging due to the difficulty in obtaining anatomical reduction. The purpose of this study was to analyse and use the parameters (lateral femoral wall integrity and tip-apex distance) in post-operative unstable intertrochanteric fractures treated using dynamic hip screw (DHS) fixation as guidelines for re-operation.</span></p><p class="abstract"><strong>Methods:</strong> This was a prospective study and included 40 patients with unstable intertrochanteric fractures treated using DHS fixation from December 2014 to September 2016. The AO/OTA classification was used to classify each of the patients and their lateral femoral wall integrity and tip-apex distance was assessed in the post-operative radiographs.<strong></strong></p><p class="abstract"><strong>Results:</strong> In this study, 3 patients out of 40 (7.5%) had screw pull out within 5 months of surgery. 2 pull outs occurred when the screw was in the antero-superior zone and 1 when it was in the centre to centre zone. Thus, the rate of screw pull out was higher in the antero-superior zone. The 3 patients with screw pull out had a mean tip-apex distance (TAD) of 36.01 mm as compared to 32.96 mm of those who did not have screw pull out. We further found that pre-operatively 6 patients out of 40 (15%) had lost lateral femoral wall integrity whereas post-operatively 26 patients out of 40 (65%) had lost it. In summary, there is a 5 times higher risk of losing lateral femoral wall integrity if DHS is the implant of choice<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> On conclusion, unacceptable TAD limit with loss of lateral femoral wall integrity was found to be a definite indicator of DHS implant pull out. And also found that by using the DHS as an implant of choice, there is a 5 times higher risk of losing lateral femoral wall integrity intra-operatively and that its use for the treatment of unstable intertrochanteric fractures must be guarded<span lang="EN-IN">.</span></p>

scholarly journals INTERTROCHANTERIC FRACTURES;

2017 ◽  
Vol 24 (11) ◽  
pp. 1740-1744
Author(s):  
Faaiz Ali Shah ◽  
Waqar Alam ◽  
Mian Amjad Ali
Keyword(s):  
Case Series ◽  
Dynamic Hip Screw ◽  
Mechanical Complication ◽  
Intertrochanteric Fractures ◽  
Contributing Factors ◽  
Exclusion Criteria ◽  
Lag Screw ◽  
Hip Screw ◽  
Tip Apex Distance ◽  
Superior Portion

Objectives: To determine the frequency of lag screw cut out in intertrochantericfractures fixed with dynamic hip screw and to identify the possible contributing factors for screwcut out. Study Design: Descriptive case series. Place and Duration of the Study: Orthopaedic& Traumatology Unit”A” Lady. Reading Hospital Peshawar from January 2014 to January 2017.Material and Methods: Patients of either gender or age with intertrochanteric fractures fulfillingthe inclusion and exclusion criteria were fixed with dynamic hip screw (DHS). Post operativelyfracture reduction, position of screw in head of femur and tip apex distance were calculatedon anterio posterior and lateral radiographs. All the patients were reviewed fortnightly for twomonth and then monthly for six months for lag screw cut out on radiographs. Results: Total 110patients mean age 72(range 22 to 98 years) years were fixed with dynamic hip screw. Lag screwcut out was noted in 12(10.9%) patients with 4(33.3%) male and 8(66.6%) female patients.The mean age was 62 years. Right side was involved in two (16.6%) patients while left in ten(83.3%) patients. Radiographically fracture reduction was poor in most (50%, n=6)) patients.The mean tip apex distance (TAD) was 32mm (range 24 to 40 mm). Majority (75%, n=9) ofcut out screw were in superior portion of the head of femur. Four (33.3%) patients had screwcut out at 8th week postoperatively while eight (66.6%) patients had screw cut out at 12th week.Conclusion: Lag screw cut out wasthe most common mechanical complication after fixation ofintertrochanteric fractures and all of the cut out patients were elderly with inadequately reducedfracture, superiorly placed lag screw and longer tip apex distance.

DESIGN OPTIMIZATION FOR DYNAMIC HIP SCREW FIXATION IN PROXIMAL FEMUR INTERTROCHANTER FRACTURE

2007 ◽  
Vol 40 ◽  
pp. S572-S573
Author(s):  
Shih Liang Shih ◽  
Jui-Sheng Sun ◽  
Yang-Hwei Tsuang ◽  
Chen-Sheng Chen ◽  
Cheng-Kung Cheng
Keyword(s):  
Design Optimization ◽  
Proximal Femur ◽  
Screw Fixation ◽  
Dynamic Hip Screw ◽  
Hip Screw
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