Lag screw cutout in intertrochanteric fractures fixed with DHS.

  • Muhammad Nasir Ali Civil Hospital Bahawalpur/ Quaid-e-Azam Medical College, Bahawalpur.
  • Muhammad Khalid Chishti Nishtar Hospital Multan/ Nishtar Medical University, Multan.
  • Kashif Siddiq Civil Hospital Bahawalpur/ Quaid-e-Azam Medical College, Bahawalpur.
  • Muhammad Hamayun Hameed Bolan Medical Complex Hospital Quetta.
  • Muhammad Tayyab Waheed Shahida Islam Medical College Lodhran.
  • Asad Ullah Mehmood Govt Town Hospital Shah Rukne Alam S Block Multan.
Keywords: Cutting Out Lag Screw, DHS, Stable IT Fractures, Tip Apex Distance

Abstract

Objectives: To determine the failure of DHS (dynamic hip screw) in terms of lag screw cutout. Study Design: Hospital Based Cross Sectional study. Setting: BVH and Civil Hospital Bahawalpur. Period: From 2013 to 2018. Material & Methods: 273 patients of both genders with age more than 50 years having stable intertrochanteric fractures were included in this study. With the help of C arm, the best possible anatomical reduction and rigid internal fixation was done with 135 degree DHS. Lag screw position and TAD determined on first postoperative day on radiographs (Anteroposterior & Lateral). Failure of fixation was determined on the radiographs during follow up. Lag screw cut-out was the projection of the screw from the femoral head by more than 1mm. Results: The mean age of the patients was 68.6 years (50-88). There were 132 (51.1 %) males and 126 (48.8%) females. Overall lag screw cutout rate was 11.2%. 21(30.8%) had screw cutout while 47 (69.1%) healed successfully among 68 patients with TAD 25mm. On the other hand 8(4.2%) had screw cutout while 182 (95.7%) healed successfully among 190 patients with TAD < 25mm. Middle middle and inferior middle position had highest success rate (˃ 92%) while inferior posterior position had highest cutout rate (36.2%). Among different age categories high failure rate (17.8%) seen in patients more than 70 years. Conclusion: The incidence of lag screw cutout is 11.2 % and risk of cutout can be minimized by placing lag screw in middle middle or inferior middle position and keeping the TAD < 25mm. More attention during follow up should be paid to patients with age ˃ 70 years.

Author Biographies

Muhammad Nasir Ali, Civil Hospital Bahawalpur/ Quaid-e-Azam Medical College, Bahawalpur.

FCPS

Professor Orthopedic Surgery

Muhammad Khalid Chishti, Nishtar Hospital Multan/ Nishtar Medical University, Multan.

FCPS

Assistant Professor Orthopedic Surgery

Kashif Siddiq, Civil Hospital Bahawalpur/ Quaid-e-Azam Medical College, Bahawalpur.

FCPS

Senior Registrar Orthopedic Surgery

Muhammad Hamayun Hameed, Bolan Medical Complex Hospital Quetta.

FCPS

Senior Registrar

Muhammad Tayyab Waheed, Shahida Islam Medical College Lodhran.

FCPS

Assistant Professor Orthopedic Surgery

Asad Ullah Mehmood, Govt Town Hospital Shah Rukne Alam S Block Multan.

MBBS, FCPS

Medical Officer Orthopedic Surgery

Published
2020-09-10