Pertrochanteric fractures are a highly relevant topic not only because of the high frequency or age of the population concerned, but also because of comorbidity (osteoporosis, malnutrition, decreased physical activity, decreased visual acuity, neurological deficits, asthenia, disorders of the equilibrium and impaired reflexes) and the mortality associated with this type of fractures. The cut-out of the cervical screw is a mechanical complication common to different means of osteosynthesis of pertrochanteric fractures, this complication significantly increases the morbidity. From January 2013 to May 2019, out of a total of 340 patients having had surgery for pertrochanteric fracture, 12 cases of cervical screw cut-out were recorded within the Brugmann University Hospital. The average follow-up after surgery was 18 months. This study analyses different parameters and their link with cervical screw cut-outs, and compares the results with the ones published in the scientific literature.
Study Type
OBSERVATIONAL
Enrollment
12
Data extraction from medical files
CHU Brugmann
Brussels, Belgium
Ender Classification
Ender classification of the fracture. I: stable basal-cervical fracture. II: stable pertrochanteric fracture. III: unstable intertrochanteric fracture. IV: unstable subtrochanteric fracture. V: unstable trochantero-diaphyseal fracture
Time frame: 5 minutes
Bone quality
Presence of osteoporosis or pathologies inside the bone (yes/no)
Time frame: 5 minutes
Type of osteosynthesis
Material used. Choice between: short/long gamma nail, long/short PFNA nail, long/short Affixus nail
Time frame: 5 minutes
Correct positioning of the screw
Correct positioning of the screw on radiological images (yes/no)
Time frame: 5 minutes
Delay between fracture and screw cut-off
Delay between fracture and screw cut-off
Time frame: up to 18 months
Tip Apex Distance (TAD)
TAD is a measure of how close the tip of the lag screw lies to the femoral apex.
Time frame: 5 minutes
Parker ratio
This method involves recording the superior, inferior, anterior and posterior borders of the femoral head. The ratio is calculated in both the AP and lateral views to give a value within a range of 0 to 100 for each view. In the AP view, 0 is considered to be the most inferior screw placement and 100 is considered to be the most superior pin placement. In the lateral view, 0 is considered to be the most posterior screw placement and 100 is considered to be the most anterior pin placement.
Time frame: 5 minutes
Age
Age of the patient
Time frame: 5 minutes
Sex
Sex of the patient
Time frame: 5 minutes
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