Dynamic hip screw fixation for femoral intertrochanteric fracture: failure reason

doi:10.3969/j.issn.2095-4344.2015.13.024

Abstract

Abstract:

BACKGROUND: Intertrochanteric fracture showed shattered state of different degrees in the clinic. The medial cortex is often a lack of continuity. Indentation and lesser trochanter displacement often cause destruction of biomechanics of femoral calcar to different degrees. Under this condition, it is very important to perform detailed classification of fractures and to strictly master indication of dynamic hip screw.
OBJECTIVE: To further analyze the reasons for failure of internal fixation with dynamic hip screw for intertrochanteric fracture.
METHODS: Data of 82 patients with intertrochanteric fracture repaired by internal fixation with dynamic hip screw, who were treated at the Department of Orthopedics, Kangtai Branch of the Second Hospital of Lanzhou University from March 2004 to December 2013, were retrospectively analyzed. The reason for failure of internal fixation and prevention method were explored.
RESULTS AND CONCLUSION: All patients were followed up for 4-48 months. Time of fracture healing was 12-38 weeks. Fixation failure was found in 12 cases, with an incidence of 15%. Of 12 failure cases, 7 cases
affected hip screw cutting out femoral head neck (including 1 case combined with avascular necrosis of the femoral head), 1 case suffered from compression screw slipping out of the tube, 3 cases experienced screw pulling out and breaking, plate loosening, and 1 case affected steel plate breakage. There were 1 case of Evans II type (8%), 3 cases of type III (25%), 5 cases of type IV (42%), and 3 cases of type V (25%). Lesser trochanter was not completely reset in 5 cases (42%). There were tip-apex distance > 25 mm in 7 cases (58%) and early weight loading (3 weeks after fixation) in 1 case (8%). These data confirmed that the selection of indications, the degree of stability after reduction, accuracy of implant position and postoperative unreasonable exercise will cause fixation failure of dynamic hip screw. Preoperative careful and comprehensive analysis, intraoperative precise operation and postoperative reasonable functional exercise are the keys to ensure success of fixation.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: Femur, Fractures, Bone, Fracture Fixation, Internal, Internal Fixators, Screw

CLC Number:

R318

Wei Jiu-ding, Fu Ting-jun, Cheng Zhong-yang, Jin Wen-xue, Da Zhao-ming, Xia Ya-yi. Dynamic hip screw fixation for femoral intertrochanteric fracture: failure reason[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(13): 2096-2012.

Figures/Tables 2

2.1 参与者数量分析纳入动力髋螺钉置入内固定修复老年股骨转子间骨折患者91例，剔除2例失访和7例死亡患者，共82例获得随访，其中12例固定失效。 2.2 随访结果所有患者随访4-48个月，骨折愈合时间12-38周。末次随访时髋关节按Harris评定标准评价：优27例，良 35例，可8例，差12例，优良率为76%。不同骨折分型患者内固定相关指标、骨折愈合时间及髋关节功能评分见表1。 2.3 影像学结果根据骨折固定失效的相关标准，对影像学资料和临床体征进行分析。结果显示，本组82例患者中，12例固定失效(表2)，发生率为15%，所有内固定失效患者均不同程度出现患侧髋关节疼痛、跛行、肢体短缩及关节活动受限等症状。在所有固定失效病例中，髋螺钉切割致穿出股骨头颈7例，其中合并股骨头坏死1例；加压钉滑出套筒1例，螺钉拔出、断裂、钢板松动3例，钢板断裂1例。Evans Ⅱ型1例(8%)，Ⅲ型3例(25%)，Ⅳ型5例(42%)，Ⅴ型3例(25%)。小转子未完全复位5例，占42%，尖顶距> 25 mm 7例，占58%，早期负重(内固定后3周)1例，占8%。 2.4 典型病例男性患者，56岁，股骨转子间骨折Evans Ⅴ型，患者车祸伤后多脏器损伤，在受伤当地医院拍片(图2A)，为减少搬动加重伤情，入院时再未拍片。1周后病情趋平稳，在全麻下行切开复位动力髋螺钉置入内固定，术中除小转子移位(向内上)未能完全复位固定外，余部术中见复位固定皆佳，被动活动患髋亦见牢靠稳固，术毕C臂透视后亦见位置及固定情况良好，患者因头部仍有较重症状，为安全起见未去放射科拍片。3周后全身状况明显好转，复查X射线正位片示侧板及断端远侧股骨内移，主钉尾部退出约1 cm(图2B)；患者及家属不同意再次处理，4个月后渐半负重行走，内固定后7个月患髋X射线片示骨折远端进一步内移，尾钉退出约2.5 cm，固定完全失效(图2C)。"

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