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. 2020 Jul;34(7):356-358.
doi: 10.1097/BOT.0000000000001730.

Variables Associated With Lag Screw Sliding After Single-Screw Cephalomedullary Nail Fixation of Intertrochanteric Fractures

Joshua A Parry  1 , Travis Sapp  2 , Joshua R Langford  3 , Kenneth J Koval  4 , George J Haidukewych  3
Affiliations

Variables Associated With Lag Screw Sliding After Single-Screw Cephalomedullary Nail Fixation of Intertrochanteric Fractures

Joshua A Parry et al. J Orthop Trauma. 2020 Jul.

Abstract

Objectives: To evaluate variables associated with lag screw sliding after single-screw cephalomedullary nail (CMN) fixation of intertrochanteric femur fractures.

Design: Retrospective cohort study.

Setting: Level-one trauma center.

Patients/participants: One hundred fifty-eight intertrochanteric fractures in patients older than 65 years with an average follow-up of 22 months.

Intervention: Single-screw CMN fixation.

Main outcome measurements: Lag screw sliding and revision surgeries.

Results: The average amount of lag screw sliding was 5 ± 5 mm (range, 0-21 mm). Lag screw sliding was greater with unstable fracture patterns (mean difference 2 mm, 95% confidence interval 0.4-3.5 mm, P = 0.01) and calcar gapping >4 mm (mean difference 3.7 mm, 95% confidence interval 2-5 mm, P < 0.01). No association was found between lag screw sliding and age, female gender, implants, long versus short nails, distal interlock screw use, postoperative neck-shaft angle, or tip-apex distance (P > 0.05). Revision surgeries were performed in 6 (4%) patients. Indications included symptomatic lag screw removal (n = 2), avascular necrosis (n = 1), cutout (n = 1), loss of reduction (n = 1), and perimplant fracture (n = 1).

Conclusions: Unstable fracture patterns are unavoidable; however, careful attention to calcar reduction and selection of dual-screw CMN implants may minimize lag screw sliding and its detrimental effects on outcomes.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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References

    1. Serrano R, Blair JA, Watson DT, et al. Cephalomedullary nail fixation of intertrochanteric femur fractures. J Orthop Trauma. 2017;31:577–582.
    1. Parry J, Barrett I, Schoch B, et al. Does the angle of the nail matter for pertrochanteric fracture reduction? Matching nail angle and native neck-shaft-angle. J Orthop Trauma. 2018;32:174–177.
    1. Ciufo DJ, Zaruta DA, Lipof JS, et al. Risk factors associated with cephalomedullary nail cutout in the treatment of trochanteric hip fractures. J Orthop Trauma. 2017;31:583–588.
    1. Yoshimine F, Latta LL, Milne EL. Sliding characteristics of compression hip screws in the intertrochanteric fracture: a clinical study. J Orthop Trauma. 1993;7:348–353.
    1. Rha JD, Kim YH, Yoon SI, et al. Factors affecting sliding of the lag screw in intertrochanteric fractures. Int Orthop. 1993;17:320–324.