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Article: Sliding Hip Screw Versus Sliding Helical Blade For Intertrochanteric Fractures

TitleSliding Hip Screw Versus Sliding Helical Blade For Intertrochanteric Fractures
Authors
Issue Date2015
Citation
The Bone & Joint Journal, 2015, v. 97-B n. 3, p. 398-404 How to Cite?
AbstractThe spiral blade modification of the Dynamic Hip Screw (DHS) was designed for superior biomechanical fixation in the osteoporotic femoral head. Our objective was to compare clinical outcomes and in particular the incidence of loss of fixation. In a series of 197 consecutive patients over the age of 50 years treated with DHS-blades (blades) and 242 patients treated with conventional DHS (screw) for AO/OTA 31.A1 or A2 intertrochanteric fractures were identified from a prospectively compiled database in a level 1 trauma centre. Using propensity score matching, two groups comprising 177 matched patients were compiled and radiological and clinical outcomes compared. In each group there were 66 males and 111 females. Mean age was 83.6 (54 to 100) for the conventional DHS group and 83.8 (52 to 101) for the blade group. Loss of fixation occurred in two blades and 13 DHSs. None of the blades had observable migration while nine DHSs had gross migration within the femoral head before the fracture healed. There were two versus four implant cut-outs respectively and one side plate pull-out in the DHS group. There was no significant difference in mortality and eventual walking ability between the groups. Multiple logistic regression suggested that poor reduction (odds ratio (OR) 11.49, 95% confidence intervals (CI) 1.45 to 90.9, p = 0.021) and fixation by DHS (OR 15.85, 95%CI 2.50 to 100.3, p = 0.003) were independent predictors of loss of fixation. The spiral blade design may decrease the risk of implant migration in the femoral head but does not reduce the incidence of cut-out and reoperation. Reduction of the fracture is of paramount importance since poor reduction was an independent predictor for loss of fixation regardless of the implant being used.
Persistent Identifierhttp://hdl.handle.net/10722/209316

 

DC FieldValueLanguage
dc.contributor.authorFang, CXen_US
dc.contributor.authorLau, TWen_US
dc.contributor.authorWong, TMen_US
dc.contributor.authorLee, HLRen_US
dc.contributor.authorLeung, FKLen_US
dc.date.accessioned2015-04-17T05:06:41Z-
dc.date.available2015-04-17T05:06:41Z-
dc.date.issued2015en_US
dc.identifier.citationThe Bone & Joint Journal, 2015, v. 97-B n. 3, p. 398-404en_US
dc.identifier.urihttp://hdl.handle.net/10722/209316-
dc.description.abstractThe spiral blade modification of the Dynamic Hip Screw (DHS) was designed for superior biomechanical fixation in the osteoporotic femoral head. Our objective was to compare clinical outcomes and in particular the incidence of loss of fixation. In a series of 197 consecutive patients over the age of 50 years treated with DHS-blades (blades) and 242 patients treated with conventional DHS (screw) for AO/OTA 31.A1 or A2 intertrochanteric fractures were identified from a prospectively compiled database in a level 1 trauma centre. Using propensity score matching, two groups comprising 177 matched patients were compiled and radiological and clinical outcomes compared. In each group there were 66 males and 111 females. Mean age was 83.6 (54 to 100) for the conventional DHS group and 83.8 (52 to 101) for the blade group. Loss of fixation occurred in two blades and 13 DHSs. None of the blades had observable migration while nine DHSs had gross migration within the femoral head before the fracture healed. There were two versus four implant cut-outs respectively and one side plate pull-out in the DHS group. There was no significant difference in mortality and eventual walking ability between the groups. Multiple logistic regression suggested that poor reduction (odds ratio (OR) 11.49, 95% confidence intervals (CI) 1.45 to 90.9, p = 0.021) and fixation by DHS (OR 15.85, 95%CI 2.50 to 100.3, p = 0.003) were independent predictors of loss of fixation. The spiral blade design may decrease the risk of implant migration in the femoral head but does not reduce the incidence of cut-out and reoperation. Reduction of the fracture is of paramount importance since poor reduction was an independent predictor for loss of fixation regardless of the implant being used.en_US
dc.languageengen_US
dc.relation.ispartofThe Bone & Joint Journalen_US
dc.titleSliding Hip Screw Versus Sliding Helical Blade For Intertrochanteric Fracturesen_US
dc.typeArticleen_US
dc.identifier.emailFang, CX: cfang@hku.hken_US
dc.identifier.emailLau, TW: catcher@hkucc.hku.hken_US
dc.identifier.emailWong, TM: wongtm@hku.hken_US
dc.identifier.emailLee, HLR: rhllee@hku.hken_US
dc.identifier.emailLeung, FKL: klleunga@hkucc.hku.hken_US
dc.identifier.authorityFang, CX=rp02016en_US
dc.identifier.authorityWong, TM=rp01689en_US
dc.identifier.authorityLeung, FKL=rp00297en_US
dc.identifier.doi10.1302/0301-620X.97B3.34791en_US
dc.identifier.hkuros242878en_US

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