The Effect of Subchondral Claw-Deploying Lag Screw on Lateral Sliding Distance and Cut-Out in Treating Intertrochanteric Fractures

Yıl 2024, Cilt: 34 Sayı: 1, 32 - 37, 29.02.2024

Levent Horoz , Mehmet Cakmak

https://doi.org/10.54005/geneltip.1331906

Öz

Introduction: The incidence of intertrochanteric fractures has increased in recent years due to the growing elderly population at risk of hip fractures, primarily attributed to osteoporosis. Among hip fractures, the prevalence of intertrochanteric fractures is progressively rising.
Aim: To evaluate clinical and radiological results of the lag screw that deploys the claw in the subchondral area of the femoral head in the treatment of advanced age unstable intertrochanteric fractures.
Methods: We retrospectively reviewed patients with intertrochanteric fractures treated with proximal femoral nails between 2019 and 2021. A total of 107 patients were examined under two groups according to the choice of the nail (Interclaw lag screw(n=52), Proximal femoral nail anti-rotation (n=55) used in the treatment. The radiological parameters in the post-operative 1st-day radiographs of the patients were evaluated. The changes in the first month, three, six months, and one-year control radiographs of the patients were evaluated. Changes in tip apex distance and lateral sliding of the lag screw were compared between the two groups.
Result: There was no statistically significant difference between the two groups regarding operation time, post-operative femoral neck/shaft angle, post-operative Calcar gap (mm), and tip-apex distance (TAD) (mm). In the last clinical follow-up, the two groups had a statistically significant difference in the femoral neck/shaft angle and TAD change. There was a significant difference in sliding distance between the two groups at the last follow-up.
Conclusion: Using a subchondral claw-deploying lag screw is a reliable implant choice in the surgical treatment of geriatric intertrochanteric fractures. The claw mechanism increases fixation strength and restricts the movements of the lag screw in the femoral head.

Anahtar Kelimeler

İntertrochanteric fracture, Proximal femoral nailing, Lag screw sliding, lag screw

İntertrokanterik Kırıkların Tedavisinde Subkondral Pençe Yerleştirme Gecikmeli Vidanın Yanal Kayma Mesafesine ve Kesmeye Etkisi

Öz

Giriş: İntertrokanterik kırıkların insidansı, özellikle osteoporoza atfedilen kalça kırığı riski taşıyan yaşlı nüfusun artması nedeniyle son yıllarda artmıştır. Kalça kırıkları arasında intertrokanterik kırıkların prevalansı giderek artmaktadır.
Amaç: İleri yaş instabil intertrokanterik kırıkların tedavisinde, femur başında subkondral pence açan lag vidanın klinik ve radyolojik sonuçlarını değerlendirmek.
Metod: 2019-2021 yılları arasında proximal femur çivisi ile tedavi edilen intertrokanterik kırıklı hastaları retrospektif olarak inceledik. Toplam 107 hasta çivi seçimine göre iki grup altında incelendi (Interclaw lag screw(n=52), Proksimal femoral çivi anti-rotasyon (n=55) Hastaların post-operatif 1. gün radyografileri değerlendirildi. Hastaların 1, 3, 6 ay ve 1. yıl kontrol grafilerindeki değişiklikler değerlendirildi. Lag vidasının uç apeks mesafesindeki değişiklikler ve lag vidasının yanal kayması iki grup arasında karşılaştırıldı.
Bulgular: Ameliyat süresi, ameliyat sonrası femur boyun/şaft açısı, ameliyat sonrası Kalkar açıklığı (mm) ve vida uç-tepe mesafesi (VUTM) (mm) açısından iki grup arasında istatistiksel olarak anlamlı fark yoktu. Son klinik takipte femur boyun/şaft açısı ve VUTM değişikliği açısından iki grup arasında istatistiksel olarak anlamlı bir fark bulundu. Son takipte iki grup arasında yanal kayma mesafesinde anlamlı bir fark gözlemlendi.
Sonuç: İleri yaş intertrokanterik kırıklı hastaların cerrahi tedavisinde subkondral pençe açılan lag vidası kullanımı güvenilirdir. Pençe mekanizması, lag vidasının tespit gücünü arttırmakta femur başı içindeki hareketlerini kısıtlamaktadır.

Anahtar Kelimeler

İntertrokanterik kırık, Proksimal femur çivileme, lag vidası kayması, çektirme vidası

Destekleyen Kurum

yok

Kaynakça

• Kim B-S, Lim J-Y, Ha Y-C. Recent Epidemiology of Hip Fractures in South Korea. Hip pelvis. 2020 Sep;32(3):119–24.
• Adeyemi A, Delhougne G. Incidence and Economic Burden of Intertrochanteric Fracture: A Medicare Claims Database Analysis. JB JS open access. 2019 Mar;4(1):e0045.
• Zhang H, Zhu X, Pei G, Zeng X, Zhang N, Xu P, et al. A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in elderly patients with osteoporosis: a minimum follow-up of 3 years. J Orthop Surg Res. 2017 Oct;12(1):147.
• Turesson E, Ivarsson K, Thorngren K-G, Hommel A. Hip fractures - Treatment and functional outcome. The development over 25 years. Injury. 2018 Dec;49(12):2209–15.
• Gong XF, Li XP, Zhang LX, Center JR, Bliuc D, Shi Y, et al. Current status and distribution of hip fractures among older adults in China. Osteoporos Int a J Establ as result Coop between Eur Found Osteoporos Natl Osteoporos Found USA. 2021 Sep;32(9):1785–93.
• Cho Y, Lee I, Ha SH, Park JH, Park JH. Comparison of hip subregion bone mineral density to the type of proximal femur fracture. Arch Osteoporos. 2020 Aug;15(1):122.
• Niu E, Yang A, Harris AHS, Bishop J. Which Fixation Device is Preferred for Surgical Treatment of Intertrochanteric Hip Fractures in the United States? A Survey of Orthopaedic Surgeons. Clin Orthop Relat Res. 2015 Nov;473(11):3647–55.
• Zhang W-Q, Sun J, Liu C-Y, Zhao H-Y, Sun Y-F. Comparing the Intramedullary Nail and Extramedullary Fixation in Treatment of Unstable Intertrochanteric Fractures. Sci Rep [Internet]. 2018;8(1):2321. Available from: https://doi.org/10.1038/s41598-018-20717-2
• Shon O-J, Choi CH, Park CH. Factors Associated with Mechanical Complications in Intertrochanteric Fracture Treated with Proximal Femoral Nail Antirotation. Hip pelvis. 2021 Sep;33(3):154–61.
• Yu W, Zhang X, Zhu X, Hu J, Liu Y. A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation-Asia in the treatment of unstable intertrochanteric femur fractures in the elderly. J Orthop Surg Res. 2016 Jan;11:10.
• Ye K-F, Xing Y, Sun C, Cui Z-Y, Zhou F, Ji H-Q, et al. Loss of the posteromedial support: a risk factor for implant failure after fixation of AO 31-A2 intertrochanteric fractures. Chin Med J (Engl). 2020 Jan;133(1):41–8.
• Fan J, Xu X, Zhou F, Zhang Z, Tian Y, Ji H, et al. Risk factors for implant failure of intertrochanteric fractures with lateral femoral wall fracture after intramedullary nail fixation. Injury. 2021 Nov;52(11):3397–403.
• Schmitz PP, Hannink G, Reijmer J, Somford MP, Van Susante JLC. Increased failure rates after the introduction of the TFNA proximal femoral nail for trochanteric fractures: implant related or learning curve effect? Acta Orthop. 2022 Jan;93:234–40.
• Mao W, Ni H, Li L, He Y, Chen X, Tang H, et al. Comparison of Baumgaertner and Chang reduction quality criteria for the assessment of trochanteric fractures. Bone Joint Res. 2019 Oct;8(10):502–8.
• Momii K, Fujiwara T, Mae T, Tokunaga M, Iwasaki T, Shiomoto K, et al. Risk factors for excessive postoperative sliding of femoral trochanteric fracture in elderly patients: A retrospective multicenter study. Injury. 2021 Nov;52(11):3369–76.
• Han S-B, Jung J-K, Jang C-Y, Kwak D-K, Kim J-W, Yoo J-H. Gamma3 nail with U-Blade (RC) lag screw is effective with better surgical outcomes in trochanteric hip fractures. Sci Rep. 2020 Apr;10(1):6021.
• Keppler AM, Pfeufer D, Kau F, Linhart C, Zeckey C, Neuerburg C, et al. Cement augmentation of the Proximal Femur Nail Antirotation (PFNA) is associated with enhanced weight-bearing in older adults. Injury. 2021 Oct;52(10):3042–6.
• Yapici F, Ucpunar H, Camurcu Y, Emirhan N, Tanoglu O, Tardus I. Clinical and radiological outcomes of patients treated with the talon distalfix proximal femoral nail for intertrochanteric femur fractures. Injury. 2020 Apr;51(4):1045–50.
• Zehir S, Şahin E, Zehir R. Comparison of clinical outcomes with three different intramedullary nailing devices in the treatment of unstable trochanteric fractures. Ulus travma ve acil cerrahi Derg = Turkish J trauma Emerg Surg TJTES. 2015 Dec;21(6):469–76.
• Sonawane D. Classifications of Intertrochanteric fractures and their Clinical Importance. Trauma Int. 2015 Jul 1;1:7–11.
• Ciufo DJ, Zaruta DA, Lipof JS, Judd KT, Gorczyca JT, Ketz JP. Risk Factors Associated With Cephalomedullary Nail Cutout in the Treatment of Trochanteric Hip Fractures. J Orthop Trauma. 2017 Nov;31(11):583–8.
• Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop Relat Res. 1998 Mar;(348):87–94.
• Hoffmann MF, Khoriaty JD, Sietsema DL, Jones CB. Outcome of intramedullary nailing treatment for intertrochanteric femoral fractures. J Orthop Surg Res [Internet]. 2019;14(1):360. Available from: https://doi.org/10.1186/s13018-019-1431-3
• Xie H, Xie L, Wang J, Chen C, Zhang C, Zheng W. Intramedullary versus extramedullary fixation for the treatment of subtrochanteric fracture: A systematic review and meta-analysis. Int J Surg. 2019 Mar;63:43–57.
• Grønhaug KML, Dybvik E, Matre K, Östman B, Gjertsen J-E. Intramedullary nail versus sliding hip screw for stable and unstable trochanteric and subtrochanteric fractures : 17,341 patients from the Norwegian Hip Fracture Register. Bone Joint J. 2022 Feb;104-B(2):274–82.
• Li S, Chang S-M, Jin Y-M, Zhang Y-Q, Niu W-X, Du S-C, et al. A mathematical simulation of the tip-apex distance and the calcar-referenced tip-apex distance for intertrochanteric fractures reduced with lag screws. Injury. 2016 Jun;47(6):1302–8.
• T J, Kwek EBK. Are Intertrochanteric Fractures Evolving? Trends in the Elderly Population over a 10-Year Period. Clin Orthop Surg. 2022 Mar;14(1):13–20.
• Yoon Y-C, Oh C-W, Sim J-A, Oh J-K. Intraoperative assessment of reduction quality during nail fixation of intertrochanteric fractures. Injury. 2020 Feb;51(2):400–6.
• 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 Jul;34(7):356–8.
• Carpintero P, Caeiro JR, Carpintero R, Morales A, Silva S, Mesa M. Complications of hip fractures: A review. World J Orthop. 2014 Sep;5(4):402–11.
• Serrano R, Blair J, Watson D, Infante A, Shah A, Mir H, et al. Cephalomedullary nail fixation Of intertrochanteric fractures: Are two proximal screws better than one? J Orthop Trauma. 2017 Aug 1;31:1.
• Lim EJ, Sakong S, Son WS, Cho J-W, Oh J-K, Kim C-H. Comparison of sliding distance of lag screw and nonunion rate according to anteromedial cortical support in intertrochanteric fracture fixation: A systematic review and meta-analysis. Injury. 2021 Oct;52(10):2787–94.
• Gavaskar AS, Tummala NC, Srinivasan P, Gopalan H, Karthik B, S S. Helical Blade or the Integrated Lag Screws: A Matched Pair Analysis of 100 Patients With Unstable Trochanteric Fractures. J Orthop Trauma. 2018 Jun;32(6):274–7.
• Ruangsillapanan MD, Rattanakitkoson MD, Ittimongkonkul MD. Comparison of Dynamic Versus Static Lag Screw Modes for Short Cephalomedullary Nails in the Treatment of Unstable Intertrochanteric Fractures: A Randomized Controlled Trial. J Southeast Asian Orthop. 2022 Jul 28;46:10–6.
• Yang Y-H, Wang Y-R, Jiang S-D, Jiang L-S. Proximal femoral nail antirotation and third-generation Gamma nail: which is a better device for the treatment of intertrochanteric fractures? Singapore Med J. 2013 Aug;54(8):446–50.
• Drouinaud A, Alain A, Caudron S, Cunique T, Auditeau E, Marcheix P-S. Trochanteric fractures treated by internal fixation using short intramedullary nails: Does the visual intraoperative estimation of the Tip-Apex Distance (TAD) concur with its digital postoperative measurement? Orthop Traumatol Surg Res. 2021 Oct;107(6):103001.
• Geller JA, Saifi C, Morrison TA, Macaulay W. Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures. Int Orthop. 2010 Jun;34(5):719–22.
• Yoo J, Kim S, Choi J, Hwang J. Gamma 3 U-Blade lag screws in patients with trochanteric femur fractures: are rotation control lag screws better than others? J Orthop Surg Res. 2019 Dec;14(1):440.
• Zhang S, Zhang K, Jia Y, Yu B, Feng W. InterTan nail versus Proximal Femoral Nail Antirotation-Asia in the treatment of unstable trochanteric fractures. Orthopedics. 2013 Mar;36(3):e288-94.
• Rompen IF, Knobe M, Link B-C, Beeres FJP, Baumgaertner R, Diwersi N, et al. Cement augmentation for trochanteric femur fractures: A meta-analysis of randomized clinical trials and observational studies. PLoS One. 2021;16(6):e0251894.
• Gunay C, Atalar H, Altay M, Yavuz OY, Yildirim AO, Oken OF. Does the wedge wing in the neck screw prevent cut-out failure in Ota/AO 31-A2 trochanteric fractures in elderly patients? Acta Orthop Belg. 2014 Mar;80(1):26–33.
• Temiz A, Durak A, Atici T. Unstable intertrochanteric femur fractures in geriatric patients treated with the DLT trochanteric nail. Injury. 2015 Jul;46 Suppl 2:S41-6.
• Lee C-H, Su K-C, Chen K-H, Pan C-C, Wu Y-C. Impact of tip-apex distance and femoral head lag screw position on treatment outcomes of unstable intertrochanteric fractures using cephalomedullary nails. J Int Med Res. 2018 Jun;46(6):2128–40.
• Quental C, Vasconcelos S, Folgado J, Guerra-Pinto F. Influence of the PFNA screw position on the risk of cut-out in an unstable intertrochanteric fracture: a computational analysis. Med Eng Phys. 2021 Nov;97:70–6.
• Özgür Verim and Mehmet Nuri Konya. “Biomechanical Comparison of Different PFN Models on Intertrochanteric Femur FractureFixation”. EC Orthopaedics 13.9 (2022): 28-36. 10.31080/ecor.2022.13.00968