The stability of fixation of proximal femoral fractures: a radiostereometric analysis.
The aim of this study was to quantify the stability of fracture-implant complex in fractures after fixation. A total of 15 patients with an undisplaced fracture of the femoral neck, treated with either a dynamic hip screw or three cannulated hip screws, and 16 patients with an AO31-A2 trochanteric fracture treated with a dynamic hip screw or a Gamma Nail, were included. Radiostereometric analysis was used at six weeks, four months and 12 months post-operatively to evaluate shortening and rotation. Migration could be assessed in ten patients with a fracture of the femoral neck and seven with a trochanteric fracture. By four months post-operatively, a mean shortening of 5.4 mm (-0.04 to 16.1) had occurred in the fracture of the femoral neck group and 5.0 mm (-0.13 to 12.9) in the trochanteric fracture group. A wide range of rotation occurred in both types of fracture. Right-sided trochanteric fractures seem more rotationally stable than left-sided fractures. This prospective study shows that migration at the fracture site occurs continuously during the first four post-operative months, after which stabilisation occurs. This information may allow the early recognition of patients at risk of failure of fixation.
Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The, Netherlands.
D
D
van Embden
University Hospital Maastricht, P. Debyelaan 25, 6229 HX, Maastricht, The, Netherlands.
G A N L
GA
Stollenwerck
Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The, Netherlands.
L A
LA
Koster
Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The, Netherlands.
B L
BL
Kaptein
Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The, Netherlands.
R G H H
RG
Nelissen
Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The, Netherlands.
I B
IB
Schipper
D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D001863:Bone Screws; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging*; D005593:Fracture Fixation, Internal / Q000379:methods*; D006620:Hip Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D059869:Radiostereometric Analysis; D017211:Treatment Failure
Gamma Nail; RSA; cannulated screw fixation; dynamic hip screw; fixation failure; fixation related complications; hip fracture treatment; proximal femoral fractures; radiostereometric analysis; rotational instability