Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende

Die Highlights vom Kongress des American College of Cardiology 2024

Im April diskutierten die Herz-Kreislauf-Spezialisten aus der ganzen Welt auf dem  Kongress des American College of Cardiology (ACC) u.a. neue Therapieansätze bei akutem Myokardinfarkt, koronarer Herzerkrankung, kardiogenem Schock oder Aortenklappenstenose. In unserem Kongress-Dossier haben wir für Sie Berichte über die „Late-Breaking Trials“ und andere wichtige Studien zusammengestellt. 
Erweiterte Suche
Anmelden
nach oben
International Orthopaedics
Erschienen in: International Orthopaedics 12/2011

01.12.2011 | Original Paper

Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures

verfasst von: Richard Stern, Anne Lübbeke, Domizio Suva, Hermes Miozzari, Pierre Hoffmeyer

Erschienen in: International Orthopaedics | Ausgabe 12/2011

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The purpose of this study was to compare femoral head placement, rates of reoperation and cephalic implant cut-out of a screw versus a blade for patients over age 60 with low energy trochanteric fractures (AO/OTA 31-A1, A2, and A3) treated either with sliding hip screw or cephalomedullary nail.

Methods

After surgeon selection of either hip screw or nail, hip screw patients were randomised to either a DHS (dynamic hip system screw) or DHS blade (dynamic hip system blade), while nail patients were randomised to either a Gamma3 Trochanteric Nail or a PFNA (proximal femoral nail antirotation). This resulted in a screw group (DHS and Gamma nail), and a blade group (DHS blade and PFNA). Outcome measures included tip-apex distance and zone location of the cephalic implant, as well as reoperation and implant cut-out within the first postoperative year.

Results

A total of 335 patients were randomised, 172 to a screw and 163 to a blade. There was no significant difference concerning mean tip-apex distance, percentage of patients with a tip-apex distance >25 mm, and patients with a centre–centre position of the cephalic implant. There were 137 patients in the screw group and 132 in the blade group available for follow-up. They did not differ regarding rates of reoperation or cut-out (screw group = 2.9%; blade group = 1.5%).

Conclusions

Both a screw and a blade performed equally well in terms of implant placement in the femoral head and outcome.
Literatur
1.
Barton TM, Gleeson R, Topliss C, Greenwood R, Harries WJ, Chesser TJ (2010) A comparison of the long gamma nail with the sliding hip screw for the treatment of AO/OTA 31-A2 fractures of the proximal part of the femur: a prospective randomized trial. J Bone Joint Surg Am 92:792–798PubMedCrossRef
2.
Baumgaertner MR, Solberg BD (1997) Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip. J Bone Joint Surg Br 79:969–971PubMedCrossRef
3.
Davis TR, Sher JL, Horsman A, Simpson M, Porter BB, Checketts RG (1990) Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br 72:26–31PubMed
4.
Geller JA, Saifi C, Morrison TA, Macaulay W (2010) Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures. Int Orthop 34:719–722PubMedCrossRef
5.
Gundle R, Gargan MF, Simpson AH (1995) How to minimize failure of fixation of unstable intertrochanteric fractures. Injury 26:611–614PubMedCrossRef
6.
Hsueh KK, Fang CK, Chen CM, Su YP, Wu HF, Chiu FY (2010) Risk factors in cutout of sliding hip screw in intertrochanteric fractures: an evaluation of 937 patients. Int Orthop 34:1273–1276PubMedCrossRef
7.
Lobo-Escolar A, Joven E, Iglesias D, Herrera A (2010) Predictive factors for cutting-out in femoral intramedullary nailing. Injury 41:1312–1316PubMedCrossRef
8.
Kyle RF (1994) Fractures of the proximal part of the femur. J Bone Joint Surg Am 76:924–950
9.
Parker MJ (1992) Cutting-out of the dynamic hip screw related to its position. J Bone Joint Surg Br 74:625PubMed
10.
Walton M, Barnett A, Jackson M (2008) Tip-apex distance as a predictor of failure following cephalo-medullary fixation for unstable fractures of the proximal femur. Eur J Trauma Emerg S 34:273–276CrossRef
11.
Pervez H, Parker MJ, Vowler S (2004) Prediction of fixation failure after sliding hip screw fixation. Injury 35:994–998PubMedCrossRef
12.
Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM (1995) The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 77:1058–1064PubMed
13.
Bannister GC, Gibson AG, Ackroyd CE, Newman JH (1990) The fixation and prognosis of trochanteric fractures. A randomized prospective controlled trial. Clin Orthop Relat Res 254:242–246PubMed
14.
Chirodian N, Arch B, Parker MJ (2005) Sliding hip screw fixation of trochanteric hip fractures: outcome of 1024 procedures. Injury 36:793–800PubMedCrossRef
15.
Lenich A, Mayr E, Ruter A, Mockl C, Fuchtmeier B (2006) First results with the trochanter fixation nail (TFN): a report on 120 cases. Arch Orthop Trauma Surg 126:706–712PubMedCrossRef
16.
Cleveland M, Bosworth DM, Thompson FR, Wilson HJ Jr, Ishizuka T (1959) A ten-year analysis of intertrochanteric fractures of the femur. J Bone Joint Surg Am 41:1399–1408PubMed
17.
Sahni V, Sureen S, Shetty V (2001) Who is responsible for failure of a dynamic hip screw by cutout, the patient or the surgeon? In: Proceedings of the 68th annual meeting of the American Academy of Orthopaedic Surgeons, vol 2, p 385
18.
Stern R (2007) Are there advances in the treatment of extracapsular hip fractures in the elderly? Injury 38(Suppl 3):S77–S87PubMedCrossRef
19.
Al-Munajjed AA, Hammer J, Mayr E, Nerlich M, Lenich A (2008) Biomechanical characterisation of osteosyntheses for proximal femur fractures: helical blade versus screw. Stud Health Technol Inform 133:1–10PubMed
20.
Sommers MB, Roth C, Hall H, Kam BC, Ehmke LW, Krieg JC et al (2004) A laboratory model to evaluate cutout resistance of implants for pertrochanteric fracture fixation. J Orthop Trauma 18:361–368PubMedCrossRef
21.
Strauss E, Frank J, Lee J, Kummer FJ, Tejwani N (2006) Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation. Injury 37:984–989PubMedCrossRef
22.
Windolf M, Braunstein V, Dutoit C, Schwieger K (2009) Is a helical shaped implant a superior alternative to the dynamic hip screw for unstable femoral neck fractures? A biomechanical investigation. Clin Biomech (Bristol, Avon) 24:59–64CrossRef
23.
Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA et al (2007) Fracture and dislocation classification compendium—2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 21:S1–S133PubMedCrossRef
24.
Anglen JO, Weinstein JN (2008) Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg Am 90:700–707PubMedCrossRef
25.
Forte ML, Virnig BA, Eberly LE, Swiontkowski MF, Feldman R, Bhandari M et al (2010) Provider factors associated with intramedullary nail use for intertrochanteric hip fractures. J Bone Joint Surg Am 92:1105–1114PubMedCrossRef
26.
Parker MJ, Handoll HH (2008) Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev 3:CD000093
27.
Saudan M, Lubbeke A, Sadowski C, Riand N, Stern R, Hoffmeyer P (2002) Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma 16:386–393PubMedCrossRef
28.
Kuzyk PR, Lobo J, Whelan D, Zdero R, McKee MD, Schemitsch EH (2009) Biomechanical evaluation of extramedullary versus intramedullary fixation for reverse obliquity intertrochanteric fractures. J Orthop Trauma 23:31–38PubMedCrossRef
29.
Park SY, Yang KH, Yoo JH, Yoon HK, Park HW (2008) The treatment of reverse obliquity intertrochanteric fractures with the intramedullary hip nail. J Trauma 65:852–857PubMedCrossRef
30.
Johnson LJ, Cope MR, Shahrokhi S, Tamblyn P (2008) Measuring tip-apex distance using a picture archiving and communication system (PACS). Injury 39:786–790PubMedCrossRef
31.
Zuckerman JD, Koval KJ, Aharonoff GB, Hiebert R, Skovron ML (2000) A functional recovery score for elderly hip fracture patients: I. Development. J Orthop Trauma 14:20–25PubMedCrossRef
32.
Zuckerman JD, Koval KJ, Aharonoff GB, Skovron ML (2000) A functional recovery score for elderly hip fracture patients: II. Validity and reliability. J Orthop Trauma 14:26–30PubMedCrossRef
33.
Lindsey RW, Ahmed S, Overturf S, Tan A, Gugala Z (2009) Accuracy of lag screw placement for the dynamic hip screw and the cephalomedullary nail. Orthopedics 32:488PubMedCrossRef
34.
Simmermacher RK, Ljungqvist J, Bail H, Hockertz T, Vochteloo AJ, Ochs U et al (2008) The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study. Injury 39:932–939PubMedCrossRef
35.
Lenich A, Vester H, Nerlich M, Mayr E, Stockle U, Fuchtmeier B (2010) Clinical comparison of the second and third generation of intramedullary devices for trochanteric fractures of the hip-blade vs screw. Injury 41:1292–1296PubMedCrossRef
36.
Park JH, Lee YS, Park JW, Wang JH, Kim JG (2010) A comparative study of screw and helical proximal femoral nails for the treatment of intertrochanteric fractures. Orthopedics 33:81–85PubMedCrossRef
37.
Yaozeng X, Dechun G, Huilin Y, Guangming Z, Xianbin W (2010) Comparative study of trochanteric fracture treated with the proximal femoral nail anti-rotation and the third generation of gamma nail. Injury 41:1234–1238PubMedCrossRef
Metadaten
Titel
Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures
verfasst von
Richard Stern
Anne Lübbeke
Domizio Suva
Hermes Miozzari
Pierre Hoffmeyer
Publikationsdatum
01.12.2011
Verlag
Springer-Verlag
Erschienen in
International Orthopaedics / Ausgabe 12/2011
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-011-1232-8

Weitere Artikel der Ausgabe 12/2011

International Orthopaedics 12/2011 Zur Ausgabe

Letter to the Editor

Conservative versus surgical management of Pipkin type I fractures associated with posterior dislocation of the hip: a randomised controlled trial

Original Paper

Personalised modified osteotomy using computer-aided design–rapid prototyping to correct thoracic deformities

Original Paper

Evaluation of adequacy of short-course chemotherapy for extraspinal osteoarticular tuberculosis using 99mTc ciprofloxacin scan

Original Paper

Mineralisation and mechanical strength of the glenoid cavity subchondral bone plate

Original Paper

The relation of tumour necrosis and survival in patients with osteosarcoma

Original Paper

Total hip replacement with an uncemented Wagner cone stem for patients with congenital hip dysplasia

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

TEP mit Roboterhilfe führt nicht zu größerer Zufriedenheit

15.05.2024 Knie-TEP Nachrichten

Der Einsatz von Operationsrobotern für den Einbau von Totalendoprothesen des Kniegelenks hat die Präzision der Eingriffe erhöht. Für die postoperative Zufriedenheit der Patienten scheint das aber unerheblich zu sein, wie eine Studie zeigt.

Lever-Sign-Test hilft beim Verdacht auf Kreuzbandriss

15.05.2024 Vordere Kreuzbandruptur Nachrichten

Mit dem Hebelzeichen-Test lässt sich offenbar recht zuverlässig feststellen, ob ein vorderes Kreuzband gerissen ist. In einer Metaanalyse war die Vorhersagekraft vor allem bei positivem Testergebnis hoch.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Aquatherapie bei Fibromyalgie wirksamer als Trockenübungen

03.05.2024 Fibromyalgiesyndrom Nachrichten

Bewegungs-, Dehnungs- und Entspannungsübungen im Wasser lindern die Beschwerden von Patientinnen mit Fibromyalgie besser als das Üben auf trockenem Land. Das geht aus einer spanisch-brasilianischen Vergleichsstudie hervor.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise