Treating peri-trochanteric hip fractures with intramedullary nail, when a second anti-rotational screw is necessary?
Abstract Introduction Fragility fractures around the proximal end of the femur have increased in recent years due to an aging population, adding to the pressure on national health care systems and to hospital expenses. Peri-trochanteric fractures have historically been treated successfully with anat...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-023-06892-y |
| _version_ | 1797578609458675712 |
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| author | Panagiotis Tilaveridis Efthymios Iliopoulos Paraskevas Georgoulas Georgios Drosos Athanasios Ververidis Konstantinos Tilkeridis |
| author_facet | Panagiotis Tilaveridis Efthymios Iliopoulos Paraskevas Georgoulas Georgios Drosos Athanasios Ververidis Konstantinos Tilkeridis |
| author_sort | Panagiotis Tilaveridis |
| collection | DOAJ |
| description | Abstract Introduction Fragility fractures around the proximal end of the femur have increased in recent years due to an aging population, adding to the pressure on national health care systems and to hospital expenses. Peri-trochanteric fractures have historically been treated successfully with anatomic intramedullary nails, giving stable fixation in order to allow early for mobilisation of these frail patients. Some of these nails allow a second (anti-rotational) screw through the nail into the femoral head. We assessed the use of this additional screw in terms of quality of reduction, post-operative mobilization and complications. Materials & methods All patients who were treated in the same hospital for peri-trochanteric fracture between January 2017 and December 2019 were included in the study. The patients were randomly assigned into group A, where the treatment included intramedullary nailing using one femoral hip screw, and group B, where the treatment additionally included a second anti-rotational screw. The patients were followed up clinically and radiologically, for at least 3 months post-operatively. Demographic and operative data were collected alongside radiographic and clinical data. Results A total of 118 patients with an average age of 82.7 years were included in the study after exclusion criteria was applied. There were no statistically significant differences between the two groups regarding the ASA grade, Nottingham Hip fracture score, Koval score, Mental score, operation time, transfusion requirements, and operative radiation dose and time (p > 0.05). In group A, more complications were observed (p < 0.05). The radiographic measurements were statistically significantly different. CART analysis revealed that the use of a single screw in the femoral head for the subgroup of the unstable peri-trochanteric fractures (Jensen Type 4–5 – AO31A2.2 and above), has a tendency toward developing more post-operative complications, though this was not statistically significant. Conclusion The use of an additional anti-rotational screw for unstable peri-trochanteric fractures (Jensen Type 4–5 and AO 31A2.2 and above) could prevent complications such as varus collapse and cut-out. |
| first_indexed | 2024-03-10T22:25:14Z |
| format | Article |
| id | doaj.art-8c00c990da094d5994bbfe0302b0073c |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-03-10T22:25:14Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-8c00c990da094d5994bbfe0302b0073c2023-11-19T12:08:25ZengBMCBMC Musculoskeletal Disorders1471-24742023-10-012411810.1186/s12891-023-06892-yTreating peri-trochanteric hip fractures with intramedullary nail, when a second anti-rotational screw is necessary?Panagiotis Tilaveridis0Efthymios Iliopoulos1Paraskevas Georgoulas2Georgios Drosos3Athanasios Ververidis4Konstantinos Tilkeridis5Trauma & Orthopaedics Department, General Hospital of DramasTrauma & Orthopaedics Department, University Hospital of Alexandroupolis, Democritus University of ThraceTrauma & Orthopaedics Department, University Hospital of Alexandroupolis, Democritus University of ThraceTrauma & Orthopaedics Department, University Hospital of Alexandroupolis, Democritus University of ThraceTrauma & Orthopaedics Department, University Hospital of Alexandroupolis, Democritus University of ThraceTrauma & Orthopaedics Department, University Hospital of Alexandroupolis, Democritus University of ThraceAbstract Introduction Fragility fractures around the proximal end of the femur have increased in recent years due to an aging population, adding to the pressure on national health care systems and to hospital expenses. Peri-trochanteric fractures have historically been treated successfully with anatomic intramedullary nails, giving stable fixation in order to allow early for mobilisation of these frail patients. Some of these nails allow a second (anti-rotational) screw through the nail into the femoral head. We assessed the use of this additional screw in terms of quality of reduction, post-operative mobilization and complications. Materials & methods All patients who were treated in the same hospital for peri-trochanteric fracture between January 2017 and December 2019 were included in the study. The patients were randomly assigned into group A, where the treatment included intramedullary nailing using one femoral hip screw, and group B, where the treatment additionally included a second anti-rotational screw. The patients were followed up clinically and radiologically, for at least 3 months post-operatively. Demographic and operative data were collected alongside radiographic and clinical data. Results A total of 118 patients with an average age of 82.7 years were included in the study after exclusion criteria was applied. There were no statistically significant differences between the two groups regarding the ASA grade, Nottingham Hip fracture score, Koval score, Mental score, operation time, transfusion requirements, and operative radiation dose and time (p > 0.05). In group A, more complications were observed (p < 0.05). The radiographic measurements were statistically significantly different. CART analysis revealed that the use of a single screw in the femoral head for the subgroup of the unstable peri-trochanteric fractures (Jensen Type 4–5 – AO31A2.2 and above), has a tendency toward developing more post-operative complications, though this was not statistically significant. Conclusion The use of an additional anti-rotational screw for unstable peri-trochanteric fractures (Jensen Type 4–5 and AO 31A2.2 and above) could prevent complications such as varus collapse and cut-out.https://doi.org/10.1186/s12891-023-06892-yHip fracturesUnstable intertrochanteric fracturesAntirotation hip screwFracture complicationsFragility fractures |
| spellingShingle | Panagiotis Tilaveridis Efthymios Iliopoulos Paraskevas Georgoulas Georgios Drosos Athanasios Ververidis Konstantinos Tilkeridis Treating peri-trochanteric hip fractures with intramedullary nail, when a second anti-rotational screw is necessary? BMC Musculoskeletal Disorders Hip fractures Unstable intertrochanteric fractures Antirotation hip screw Fracture complications Fragility fractures |
| title | Treating peri-trochanteric hip fractures with intramedullary nail, when a second anti-rotational screw is necessary? |
| title_full | Treating peri-trochanteric hip fractures with intramedullary nail, when a second anti-rotational screw is necessary? |
| title_fullStr | Treating peri-trochanteric hip fractures with intramedullary nail, when a second anti-rotational screw is necessary? |
| title_full_unstemmed | Treating peri-trochanteric hip fractures with intramedullary nail, when a second anti-rotational screw is necessary? |
| title_short | Treating peri-trochanteric hip fractures with intramedullary nail, when a second anti-rotational screw is necessary? |
| title_sort | treating peri trochanteric hip fractures with intramedullary nail when a second anti rotational screw is necessary |
| topic | Hip fractures Unstable intertrochanteric fractures Antirotation hip screw Fracture complications Fragility fractures |
| url | https://doi.org/10.1186/s12891-023-06892-y |
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