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Single Screw Type of Lag Screw Results Higher Reoperation Rate in the Osteosynthesis of Basicervical Hip Fracture

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Single Screw Type of Lag Screw Results Higher Reoperation Rate in the Osteosynthesis of Basicervical Hip Fracture Journal of Orthopaedic Science xxx (xxxx) xxx Contents lists available at ScienceDirect Journal of Orthopaedic Science journal homepage: http://www.elsevier.com/locate/jos Original Article Single screw type of lag screw results higher reoperation rate in the osteosynthesis of basicervical hip fracture * Jung-Taek Kim a, Yong-Chan Ha b, Chan-Ho Park c, Jun-Il Yoo d, Tae-Young Kim e, a Ajou University Hospital, Department of Orthopaedic Surgery, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, South Korea b Chung-Ang University, College of Medicine, Department of Orthopaedic Surgery, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea c Yeungnam University Medical Center, Department of Orthopedic Surgery, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415, South Korea d Gyeongsang National University Hospital, Department of Orthopaedic Surgery, 79, Gangnam-ro, Jinju, Gyeongsangnam-do, 52727, South Korea e Konkuk University Medical Center, Department of Orthopaedic Surgery, School of Medicine, Konkuk University, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea article info abstract Article history: Background: Basicervical hip fractures are relatively rare with greater biomechanical instability Received 8 January 2019 compared to the other types of hip fractures. Several studies have reported ambivalent surgical outcomes Received in revised form of basicervical hip fractures. The purpose of this multicenter study was to analyze surgical outcomes of 7 February 2019 basicervical hip fractures according to the fixation type of proximal femur and lag screw type. Accepted 12 February 2019 Methods: Among 3220 hip fractures, 145 were classified as basicervical hip fractures. Of those, 106 Available online xxx patients treated with osteosynthesis were included to analyze the surgical complications according to fixation type of proximal femur: sliding hip screw(SHS) and cephalomedullary nail (CMN) groups. Sur- gical complications including the excessive displacement of fracture and the occurrence of reoperation were evaluated at the final follow up. We further evaluated surgical complications according to lag screw type with subgroup analysis in CMN group: single screw type, blade type and two integrated screw type. Results: Ten patients (9.4%) sustained surgical complications (5 excessive displacements and 5 reoper- ations). For fixation type of proximal femur, SHS group showed higher tendency of excessive displace- ment despite no statistical difference between the two groups (p ¼ 0.060). For lag screw type with subgroup analysis in CMN group, single screw type showed statistically high rates of reoperation compared to the other types of lag screw (p ¼ 0.022). Conclusion: Basicervical hip fractures treated with osteosynthesis resulted to high rates of surgical complications in this study. However, they could be drastically reduced if CMN with blade type or two integrated screw type were used in the osteosynthesis of basicervical hip fractures. © 2019 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved. 1. Introduction it represents an intermediate form between intracapsular and extracapsular fractures [5,6]. Hip fractures are common in elderly patients. They are consis- Basicervical hip fractures are relatively rare compared to other tently increasing with longer life expectancy [1,2]. There are two types of hip fractures. It has been reported that 1.8%e7.7% of hip types of hip fractures [3]: 1) intracapsular type which is usually fractures are true basicervical fractures [5,7]. These basicervical treated with multiple pinning or arthroplasty; and 2) extracapsular fractures have greater biomechanical instability than other types of type which is usually treated with sliding hip screw or cepha- hip fractures [8]. lomedullary nail. However, basicervical fracture is located at the Several studies have reported ambivalent surgical outcomes of border of intracapsular and extracapsular fracture. It is defined as a basicervical fractures. Earlier study has reported that sliding hip proximal femoral fracture through the base of femoral neck at its screw (SHS) is obviously unstable in rotatory stresses due to conical junction with the intertrochanteric region [4]. Due to this location, shape and an additional cancellous screw is probably needed to solve this problem in basicervical hip fractures [9]. However, another study has reported that using additional screw with SHS * Corresponding author. Fax: þ82 2 2030 7029. does not affect fracture stability or clinical outcome [8]. A later E-mail address: [email protected] (T.-Y. Kim). study has reported that surgical treatment of basicervical hip https://doi.org/10.1016/j.jos.2019.02.010 0949-2658/© 2019 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved. Please cite this article as: Kim J-T et al., Single screw type of lag screw results higher reoperation rate in the osteosynthesis of basicervical hip fracture, Journal of Orthopaedic Science, https://doi.org/10.1016/j.jos.2019.02.010 Downloaded for Anonymous User (n/a) at Konkuk University from ClinicalKey.com by Elsevier on May 13, 2019. For personal use only. No other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved. 2 J.-T. Kim et al. / Journal of Orthopaedic Science xxx (xxxx) xxx fractures with cephalomeduallary nail (CMN) is very effective [10]. two integrated screw type. Surgical complications including the But, a recent study has shown that CMN may be inadequate for excessive displacement of the fracture by femoral medialization of fixation of basicervical fractures [11]. >30% [16] and the occurrence of reoperation were evaluated at the Previous studies on basicervical hip fractures are usually case final follow up. series which could not evaluate the critical factors to affect their surgical outcomes [12]. The objective of this multicenter study was 2.1. Statistical analysis to analyze the surgical outcome of basicervical hip fractures according to fixation type of proximal femur and subgroup analysis All continuous data are expressed as means and standard of CMN group according to lag screw type. deviations. For statistical analysis, Student's t-test and Analysis of variance (ANOVA) was used for continuous data while Pearson's 2. Materials and methods Chi-squared test and Fisher's exact test was used for categorical data. All statistical analyses were conducted using SPSS v15.0 (SPSS Between 2011 and 2014, 3220 patients aged 60 years or older Inc., Chicago, IL, USA). Statistical significance was considered at with hip fractures were treated at five tertiary hospitals. Each of p < 0.05. these hospitals treated more than 150 patients with hip fractures per year. Five orthopedic surgeons representing these hospitals are 3. Results specialized in treatment of hip fractures and related diseases. The research protocol was approved by our Institutional Review Board Of 3220 hip fractures, 145 (4.5%) were classified as basicervical and informed consent was waived for this study. hip fractures. Twenty-four patients with basicervical hip fractures Patients were included in our study if radiographs showed who underwent hip arthroplasty were excluded from this study. basicervical hip fracture of the proximal part of the femur defined Among the remaining 121 patients with basicervical hip fractures as a two-part fracture at the base of the femoral neck that was treated with osteosynethsis, 15 died or lost to follow up less than medial to the intertrochanteric line, exiting above the lesser one year after the surgery. The remaining 106 patients with trochanter but was more lateral than a classic transcervical fracture basicervical hip fractures were finally included in this study. Mean [11]. Fractures in which the lesser trochanter was a separate frag- follow up period were 2.2 (1.0e3.6) years. ment or the fracture line exited distal to the lesser trochanter or out Ten patients (9.4%) sustained the surgical complications at the the lateral cortex of the greater trochanter were excluded. All final follow up (Table 1). Five patients sustained excessive preoperative radiographs were re-evaluated to ensure that there displacement without reoperation. Five patients sustained reop- was no evidence to reclassify these fracture patterns as either eration due to cut-out of lag screw, osteonecrosis of femoral head or transcervical or intertrochanteric. Among these patients, those who postoperative femoral neck fractures. underwent hip arthroplasty for the treatment of basicervical hip First, we analyzed the surgical outcomes according to the fractures were excluded. This retrospective study was approved by fixation type of proximal femur: SHS or CMN group. Thirty nine our Institutional Review Board. Demographic data included age, patients were included in the SHS group and 67 patients were sex, body mass index (BMI), and American society of anesthesiol- included in the CMN group (Table 2). Their demographic or oper- ogists (ASA) score preoperatively. Operative data included type of ative data showed no statistically significant difference except anesthesia, operative time, estimated blood loss, tip-apex distance operative time (p ¼ 0.003). SHS group showed higher tendency of (TAD), lag screw position, and fracture reduction state during excessive displacement despite no statistical difference between operation. TAD was measured on postoperative radiograph as the two groups (p ¼ 0.060). There was also no statistically differ- defined by Baumgaertner et al. [13].
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