[Screw fracture after sliding hip screw fixation of an intertrochanteric fracture].
Although no cases have been reported to date, fracture of a sliding hip screw on a screw-plate fixation is a real entity since material watch registries have revealed two non-published cases. We report an illustrative case. A 67-year-old man was hospitalized for a right intertrochanteric fracture. The patient was treated with a sliding hip screw plate fixation (short cannon, 105 mm screw). On the eighth postoperative day, fracture impaction was present with complete loss of impaction reserve associated with secondary discrete divergence in the cannon-screw alignment. Weight-bearing was postponed until the 45th postoperative day. At three months, bone healing had not been achieved. A clear image was also visible at the plate end of the cannon. The patient complained of persistent pain but there were no signs of infection. At the fifth month, the patient fell from the standing position and standard x-rays visualized the nonunion of the intertrochanteric fracture plus a infratrochanteric diaphyseal fracture line in addition to a fracture of the sliding hip screw. The plate screws were intact. The patient underwent revision osteosynthesis with a Medoff plate. Fracture of a sliding hip screw is a rare event. In the present case, the mechanism involved an insufficient impaction reserve and use of a short cannon. Treatment requires extraction of the distal fragment of the screw and a new cemented osteosynthesis.
Manicom
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Service de Chirurgie Orthopédique, Hôpital Henri-Mondor, 51 avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil. philippe.hernigou@hmn.aphp.fr
Karoubi
M
M
Mseddi
M
M
Demoura
A
A
Hernigou
P
P
D000368:Aged; D001863:Bone Screws; D004868:Equipment Failure; D005593:Fracture Fixation, Internal; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*