A novel technique for the fixation of inter-trochantieric hip fractures: A telescoping lag screw

Abstract

One-hundred and three patients with intertrochanteric hip fractures as classified by the OTA 2007 system underwent fixation using the telescoping AOS Galileo lag screw system and ES Nail (a long IM nail). Thirty-one patients (76%) were female and ten (24%) were male, with an average age of 75.70 ± 11.3 years at date of surgery. At final follow-up 21 (53%) patients returned to their pre-fracture ambulatory status, 20 (47%) had a reduction in ambulatory status, and no patients were confined to a wheel chair. The telescoping capability of the AOS Galileo lag screw allowed for a decrease in total length by 3.96 ± 3.04 mm during fracture healing. The TAD distance at final follow-up was 14.09 ± 4.69 mm. Lateral protrusion of the lag screw into soft tissue did not occur. There was one reported incidence of femoral head cutout, which occurred after the lag screw had telescoped its entire distance and began functioning as a rigid non-compressible lag screw. All other fractures healed uneventfully and no device failure occurred. The AOS Galileo telescoping lag screw has shown promise concerning IT fracture fixation and will continue to undergo further investigation.

Keywords: AOS, advanced orthopaedic solutions; ES nail, extended short nail; GLS, Galileo lag screw; Hip fracture; IT fracture; Intertrochanteric fracture; Intramedullary nail; Lag screw; Trauma; Trochanteric nail.

Fig. 1

Lateral protrusion of a sliding lag screw requiring removal (not a patient in this series).

Fig. 2

The Advanced Orthopaedic Solutions telescoping Galileo Lag Screw in comparison with a solid lag screw. The head of the lag screw (pink) telescopes up to 10 mm into the shaft of the screw as the fracture heals. The base of the lag screw (gold) expands within the portal of the IM nail to create a fixed mechanism.

Fig. 3

Anteroposterior radiograph with superimposed arrows indicating measurements. The radiograph is calibrated to the lag screw diameter of 10.5mm (1). Lag screw length is the distance from the base to the tip (2). Anteroposterior measurement of tip-to-apex distance from the tip of the lag screw to the apex of the femoral head (3). Measurement of lateral screw prominence from the lateral base of the GLS to the cortex of the bone, perpendicular to the IM nail (4). Note the lateral view component of tip-to-apex distance measurement is not shown here.

Fig. 4

Anteroposterior radiographs of successful compression of the Advanced Orthopaedic Solutions telescoping Galileo Lag screw from initial placement (a) to 6 month follow-up (b).

Fig. 5

Radiograph of patient in the current series, the Galileo lag screw telescoped its entire distance before functioning as a solid lag screw, which led to cutout through the femoral head.