A Retrospective Comparison of Cephalomedullary Nail Fixation of Intertrochanteric Femur Fractures Treated With Locked Versus Backed-off Set Screws.
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| Titel: | A Retrospective Comparison of Cephalomedullary Nail Fixation of Intertrochanteric Femur Fractures Treated With Locked Versus Backed-off Set Screws. |
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| Autoren: | Ward BA; From the Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO (Ward), and the Department of Orthopaedics, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (Parry)., Parry JA |
| Quelle: | The Journal of the American Academy of Orthopaedic Surgeons [J Am Acad Orthop Surg] 2025 Dec 01; Vol. 33 (23), pp. 1331-1338. Date of Electronic Publication: 2025 Mar 12. |
| Publikationsart: | Journal Article; Comparative Study |
| Sprache: | English |
| Info zur Zeitschrift: | Publisher: Wolters Kluwer Country of Publication: United States NLM ID: 9417468 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1940-5480 (Electronic) Linking ISSN: 1067151X NLM ISO Abbreviation: J Am Acad Orthop Surg Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2016- : Philadelphia : Wolters Kluwer Original Publication: Rosemont, IL : American Academy of Orthopaedic Surgeons, c1993- |
| MeSH-Schlagworte: | Bone Screws* , Fracture Fixation, Intramedullary*/methods , Fracture Fixation, Intramedullary*/instrumentation , Hip Fractures*/surgery , Bone Nails*, Humans ; Retrospective Studies ; Male ; Aged ; Female ; Middle Aged ; Treatment Outcome |
| Abstract: | Introduction: Excessive lag screw sliding after cephalomedullary nail fixation of intertrochanteric fractures can be problematic. Set screws are typically inserted to engage the lag screw and backed off to allow for sliding. The purpose of this study was to determine whether statically locking set screws affected lag screw sliding or cutout. Methods: A retrospective review was done at a single level 1 trauma center. Patients treated with locked versus backed-off set screws were compared in terms of lag screw sliding, loss of reduction, and lag screw cutout. Results: There were 186 patients included. The median age was 67.0 years (IQR 57.0 to 79.0 years) and 56.4% (n = 105) were male. Locked versus backed-off set screws were used in 23.7% (n = 44) and 76.3% (n = 142). The locked set screw group, compared with the backed-off set screw group, had a longer follow-up (4.0 vs. 3.0 months, P = 0.02), had a greater median tip-apex distance (21.3 vs. 19.0, P = 0.04), and did not differ in age, sex, acute varus displacement (vertical displacement of greater trochanter above the femoral head on injury radiographs), postoperative neck-shaft angle, or calcar gapping. The locked set screw group, compared with the backed-off set screw group, had less lag screw sliding (2.3 vs. 3.6 mm, P = 0.02) and no difference in lag screw sliding ≥10 mm (6.7% vs. 7.8%, P = 1.0), loss of reduction ≥10 mm (6.8% vs. 9.2%, P = 0.7), or cutout (0.0% vs. 1.4%, P = 1.0). Patients who had ≥10 mm of lag screw sliding were older (76.5 vs. 66.0, P = 0.04), more likely to have acute varus displacement (50.0% vs. 23.2%, P = 0.04), and had more varus postoperative neck-shaft angles (129° vs. 132°, P = 0.03). Conclusion: Locked set screws, compared with backed-off set screws, resulted in a median of 1.3 mm less of lag screw sliding and did not affect the rate of lag screw sliding ≥10 mm, loss of reduction, or cutout. Level of Evidence: Level III, retrospective comparison. (Copyright © 2025 by the American Academy of Orthopaedic Surgeons.) |
| References: | Switzer JA, O'Connor MI: AAOS management of hip fractures in older adults evidence-based clinical practice guideline. J Am Acad Orthop Surg 2022;30:e1297-e1301. Parker MJ, Cawley S: Sliding hip screw versus the Targon PFT nail for trochanteric hip fractures. Bone Joint J 2017;99B:1210-1215. Alessio-Mazzola M, Traverso G, Coccarello F, Sanguineti F, Formica M: Dynamic hip screw versus intramedullary nailing for the treatment of A1 intertrochanteric fractures: A retrospective, comparative study and cost analysis. Joint Dis Relat Surg 2022;33:314-322. Shin WC, Lee SM, Moon NH, Jang JH, Choi MJ: Comparison of cephalomedullary nails with sliding hip screws in surgical treatment of intertrochanteric fractures: A cumulative meta-analysis of randomized controlled trials. Clin Orthop Surg 2023;15:192-202. 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;77:1058-1064. Chinoy MA, Parker MJ: Fixed nail plates versus sliding hip systems for the treatment of trochanteric femoral fractures: A meta analysis of 14 studies. Injury 1999;30:157-163. Hwang J, Hadeed M, Sapp T, et al.: Varus displacement of intertrochanteric femur fractures on injury radiographs is associated with screw cutout. Eur J Orthop Surg Traumatol 2021;31:683-687. Ciufo DJ, Ketz JP: Proximal femoral shortening and varus collapse after fixation of “stable” pertrochanteric femur fractures. J Orthop Trauma 2021;35:87-91. Sanders D, Bryant D, Tieszer C, et al.: A multicenter randomized control trial comparing a novel intramedullary device (InterTAN) versus conventional treatment (sliding hip screw) of geriatric hip fractures. J Orthop Trauma 2017;31:1-8. Gausden EB, Sin D, Levack AE, et al.: Gait analysis after intertrochanteric hip fracture: Does shortening result in gait impairment? J Orthop Trauma 2018;32:554-558. Parry JA, Sapp T, Langford JR, Koval KJ, Haidukewych GJ: Variables associated with lag screw sliding after single-screw cephalomedullary nail fixation of intertrochanteric fractures. J Orthop Trauma 2020;34:356-358. Güven Ş, Naldöven ÖF, Alkan H, Erdoğan Y, Çepni Ş, Veizi E: Laterally protruded cephalomedullary nail lag screws are a source of consistent thigh pain after pertrochanteric fracture. J Orthop Trauma 2024;38:320-326. Henry Goodnough L, Wadhwa H, Tigchelaar SS, et al.: Countersinking the lag screw or blade during cephalomedullary nailing of geriatric intertrochanteric femur fractures: Less collapse and implant prominence without increased cutout rates. J Am Acad Orthop Surg 2022;30:e83-e90. Serrano R, Blair JA, Watson DT, et al.: Cephalomedullary nail fixation of intertrochanteric femur fractures: Are two proximal screws better than one? J Orthop Trauma 2017;31:577-582. Maseda M, Egol KA: Lag screw exchange for impinging lateral hardware following intramedullary nailing of intertrochanteric hip fractures—A case series demonstrating efficacy. Iowa Orthop J 2024;44:167-171. Strage KE, Parry JA, Mauffrey C: Standardizing statistics and data reporting in orthopaedic research. Eur J Orthop Surg Traumatol 2021;31:1-6. Fisher ND, Parola R, Anil U, et al.: A good tip-apex distance does not make up for a poor reduction in intertrochanteric hip fractures treated with an cephalomedullary nail: The utility of the neck-shaft angle in preventing fixation failure. J Am Acad Orthop Surg 2024;32:83-91. Kane P, Vopat B, Heard W, et al.: Is tip apex distance as important as we think? A biomechanical study examining optimal lag screw placement. Clin Orthop Relat Res 2014;472:2492-2498. Lopes-Coutinho L, Dias-Carvalho A, Esteves N, Sousa R: Traditional distance “tip-apex” vs. new calcar referenced “tip-apex” - which one is the best peritrochanteric osteosynthesis failure predictor? Injury 2020;51:674-677. Yoshimine F, Latta LL, Milne EL: Sliding characteristics of compression hip screws in the intertrochanteric fracture: A clinical study. J Orthop Trauma 1993;7:348-353. Gardner MJ, Briggs SM, Kopjar B, Helfet DL, Lorich DG: Radiographic outcomes of intertrochanteric hip fractures treated with the trochanteric fixation nail. Injury 2007;38:1189-1196. |
| Entry Date(s): | Date Created: 20250312 Date Completed: 20251201 Latest Revision: 20251201 |
| Update Code: | 20251201 |
| DOI: | 10.5435/JAAOS-D-24-01196 |
| PMID: | 40073148 |
| Datenbank: | MEDLINE |
Nájsť tento článok vo Web of Science | Abstract: | Introduction: Excessive lag screw sliding after cephalomedullary nail fixation of intertrochanteric fractures can be problematic. Set screws are typically inserted to engage the lag screw and backed off to allow for sliding. The purpose of this study was to determine whether statically locking set screws affected lag screw sliding or cutout.<br />Methods: A retrospective review was done at a single level 1 trauma center. Patients treated with locked versus backed-off set screws were compared in terms of lag screw sliding, loss of reduction, and lag screw cutout.<br />Results: There were 186 patients included. The median age was 67.0 years (IQR 57.0 to 79.0 years) and 56.4% (n = 105) were male. Locked versus backed-off set screws were used in 23.7% (n = 44) and 76.3% (n = 142). The locked set screw group, compared with the backed-off set screw group, had a longer follow-up (4.0 vs. 3.0 months, P = 0.02), had a greater median tip-apex distance (21.3 vs. 19.0, P = 0.04), and did not differ in age, sex, acute varus displacement (vertical displacement of greater trochanter above the femoral head on injury radiographs), postoperative neck-shaft angle, or calcar gapping. The locked set screw group, compared with the backed-off set screw group, had less lag screw sliding (2.3 vs. 3.6 mm, P = 0.02) and no difference in lag screw sliding ≥10 mm (6.7% vs. 7.8%, P = 1.0), loss of reduction ≥10 mm (6.8% vs. 9.2%, P = 0.7), or cutout (0.0% vs. 1.4%, P = 1.0). Patients who had ≥10 mm of lag screw sliding were older (76.5 vs. 66.0, P = 0.04), more likely to have acute varus displacement (50.0% vs. 23.2%, P = 0.04), and had more varus postoperative neck-shaft angles (129° vs. 132°, P = 0.03).<br />Conclusion: Locked set screws, compared with backed-off set screws, resulted in a median of 1.3 mm less of lag screw sliding and did not affect the rate of lag screw sliding ≥10 mm, loss of reduction, or cutout.<br />Level of Evidence: Level III, retrospective comparison.<br /> (Copyright © 2025 by the American Academy of Orthopaedic Surgeons.) |
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| ISSN: | 1940-5480 |
| DOI: | 10.5435/JAAOS-D-24-01196 |