title: Treatment of early cut-out of a lag screw using a trochanter supporting plate: 11 consecutive patients with unstable intertrochanteric fractures.
abstract: BACKGROUND
  Superior cut-out of a lag screw remains a serious complication in the treatment of intertrochanteric fractures. It is related to the stability of fracture reduction. We describe the application of a trochanter supporting plate (TSP) to restore the fracture stability after early cut-out of a lag screw in unstable intertrochanteric fractures.
  
  
  METHODS
  A total of 11 consecutive patients with superior cut-out of the lag screw of a dynamic hip screw (DHS) or a gamma nail in an unstable intertrochanteric fracture occurring within 6 months after surgery were included in the present study. They underwent repeat surgery for placement of a DHS and a laterally mounted TSP of our design. All patients were monitored for at least 6 months (median 15 months; range 6-28 months).
  
  
  RESULTS
  There was no repeated cut-out of a lag screw, and 10 patients (91%) achieved bony union within 5 months. At the last follow-up, all patients could walk with or without aids.
  
  
  CONCLUSIONS
  It reveals that a TSP, as an adjuvant to a lag screw placed inferiorly, is an easy and safe solution for the treatment of early cut-out of a lag screw in unstable intertrochanteric fractures.
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan. leebone@cgmh.org.tw
authors.forename: Po-Cheng
authors.initials: PC
authors.lastname: Lee
authors.forename: Shang-Won
authors.initials: SW
authors.lastname: Yu
authors.forename: Pang-Hsin
authors.initials: PH
authors.lastname: Hsieh
authors.forename: Tai-Yuan
authors.initials: TY
authors.lastname: Chuang
authors.forename: Ching-Lung
authors.initials: CL
authors.lastname: Tai
authors.forename: Chun-Hsiung
authors.initials: CH
authors.lastname: Shih
mesh_terms: D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000295:instrumentation; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D013997:Time Factors; D016896:Treatment Outcome