title: Surgical treatment of intertrochanteric hip fractures with associated femoral neck fractures using a sliding hip screw.
abstract: OBJECTIVE
  The purpose of this study was to report the results of surgical treatment of a subset of intertrochanteric fractures with posteromedial comminution and extension of the fracture line into the femoral neck using a sliding hip screw.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Level I county trauma center.
  
  
  METHODS
  Twenty-nine fractures (8%) with this pattern were identified from 381 intertrochanteric hip fractures treated at a single institution over a 10-year period. Nine patients were excluded (2 died, 7 had incomplete radiographic follow-up), leaving 20 patients for assessment.
  
  
  METHODS
  All fractures were treated with a sliding hip screw.
  
  
  METHODS
  Radiographs at a mean follow-up of 17 months were recorded as demonstrating: 1) fixation failure; 2) fracture union; or 3) fracture nonunion. The tip-apex distance, amount of lag screw collapse, screw position in the femoral head, and adequacy of reduction were determined.
  
  
  RESULTS
  Treatment failed according to these radiographic measures in 5 of 20 (25%) fractures. Failures included fracture nonunion (1 case), lag screw cutout (2 cases), and combined nonunion/lag screw cutout (2 cases). All 5 failures had complete collapse of the lag screw, whereas 4 of the 15 successfully treated fractures had complete collapse. The amount of collapse was significantly greater for the treatment failures (mean, 38 mm) than in the successfully treated hips (mean, 20 mm). There was no significant association between treatment success or failure and tip-apex distance, lag screw position, and adequacy of reduction.
  
  
  CONCLUSIONS
  We conclude that intertrochanteric hip fractures with associated femoral neck fractures should not be managed with a standard sliding hip screw.
authors.affiliation: Department of Orthopaedic Surgery, Hennepin County Medical Center, Minneapolis, MN 55415, USA. richard.kyle@co.hennepin.mn.us
authors.forename: Richard F
authors.initials: RF
authors.lastname: Kyle
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Ellis
authors.forename: David C
authors.initials: DC
authors.lastname: Templeman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006620:Hip Fractures / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome