title: Measurement of Tip Apex Distance and Migration of Lag Screws and Novel Blade Screw Used for the Fixation of Intertrochanteric Fractures.
abstract: Fixation with a dynamic hip screw (DHS) is one of the most common methods for stabilizing intertrochanteric fractures, except for unstable and reverse oblique fracture types. However, failure is often observed in osteoporotic patients whereby the lag screw effectively 'cuts out' through the weak bone. Novel anti-migration blades have been developed to be used in combination with a lag screw ('Blade Screw') to improve the fixation strength in osteoporotic intertrochanteric fractures. An in-vitro biomechanical study and a retrospective clinical study were performed to evaluate lag screw migration when using the novel Blade Screw and a traditional threaded DHS. The biomechanical study showed both the Blade Screw and DHS displayed excessive migration (≥10 mm) before reaching 20,000 loading cycles in mild osteoporotic bone, but overall migration of the Blade Screw was significantly less (p ≤ 0.03). Among the patients implanted with a Blade Screw in the clinical study, there was no significant variation in screw migration at 3-months follow-up (P = 0.12). However, the patient's implanted with a DHS did display significantly greater migration (P<0.001) than those implanted with the Blade Screw. In conclusion, the Blade Screw stabilizes the bone fragments during dynamic loading so as to provide significantly greater resistance to screw migration in patients with mild osteoporosis.
authors.affiliation: Division of Joint Reconstruction, Department of Orthopaedics, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Jesse Chieh-Szu
authors.initials: JC
authors.lastname: Yang
authors.affiliation: Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan.|Department of Orthopaedics, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Hsin-Chang
authors.initials: HC
authors.lastname: Chen
authors.affiliation: Orthopaedic Device Research Center, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yu-Shu
authors.identifier: http://orcid.org/0000-0002-6288-1697
authors.initials: YS
authors.lastname: Lai
authors.affiliation: Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Cheng-Kung
authors.initials: CK
authors.lastname: Cheng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006620:Hip Fractures / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design