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130- versus 135-degree sliding hip screws and failure in pertrochanteric hip fractures
Ross Radic1, Piers J Yates, Tao Shan Lim
1Orthopaedics, Royal Perth Hospital, Perth, Western Australia, Australia.
Background:
The fixed-angle sliding hip screw has become a popular method of fixation for pertrochanteric hip fractures. The tip-to-apex distance (TAD) concept was introduced by Baumgaertner et al. in 1995 and has subsequently become a decisive predictor of the successfulness of fixation. The 135-degree plate has become the most popular plate used for fracture fixation, although this has not been compared with lower angled plates (130 degree) in relation to TAD.
Method:
We analysed 567 consecutive cases of dynamic hip screw (DePuy-Synthes) fixation to compare TAD in various angled plates and rate of failure.
Results:
The 130-degree plate has significantly lower mean TAD 19.3 mm versus 20.8 mm (P = 0.016). There were nine failures because of superior screw cut-out in the 135-degree plates and 0 failures in the 130-degree plates.
Conclusion:
We believe the improved trajectory for lag screw placement using 130-degree angled plates leads to a lower TAD and improved fixation in pertrochanteric fractures.
