Helical blade vs telescoping lag screw for intertrochanteric fracture fixation

The purpose of this study was to compare fixation stability and lag screw sliding characteristics between 2 different hip-nail lag screw designs, a telescoping screwbarrel and a solid helical blade. Simulated, unstable, 4-part intertrochanteric hip fractures were created in 6 pairs of cadaveric femurs. Each nail type was randomly assigned within each femur pair. Lag screw sliding and inferior and lateral head displacements were measured following an applied static load of 750 N. Measurements were obtained before, during, and after cyclical loading with 750 N for 105 cycles. Ultimate failure strength was determined. After considering inferior head displacements, no significant differences between the 2 screw designs were found. Mean head displacement for the helical screw was 2.18 mm, compared with 1.87 mm for the telescoping screw (P = .731). A significant difference in the amount of lateral movement of the lag screws was found, however. The helical lag screws had mean lateral sliding of 2.68 mm, compared with 0.25 mm for the telescoping screws (P = .007). Neither of the lag screw constructs failed by screw cutout from the head. Both screw designs provide similar fixation strength for stabilization of 4-part intertrochanteric fractures. Both the telescoping lag screw and the helical blade facilitate fracture collapse, but the telescoping lag screw also minimizes lateral projection of the screw from the nail. This advantage may help minimize postoperative lateral soft-tissue impingement.