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Related Experiment Videos

The tip-apex distance in the X-Bolt dynamic plating system.

M A Fernandez1, A Aquilina2, J Achten2

  • 1University of Oxford, NDORMS, John Radcliffe Hospital, Oxford OX3 9DU and Specialty Registrar, Trauma and Orthopaedic Surgery, University Hospital Coventry, Clifford Bridge Road, Coventry, CV2 2DX, UK miguel.fernandez@ndorms.ox.ac.uk.

Bone & Joint Research
|April 14, 2017
PubMed
Summary

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The X-Bolt dynamic hip plating system showed a greater tip-apex distance compared to the sliding hip screw. However, this did not lead to an increased risk of fixation failure or lag screw cut-out in unstable hip fractures.

Area of Science:

  • Orthopaedic surgery
  • Trauma surgery
  • Biomedical engineering

Background:

  • Trochanteric hip fractures are common, with fixation failure a significant complication.
  • Lag screw cut-out is a mode of failure, particularly in unstable fractures and with increased tip-apex distance (TAD).
  • The X-Bolt dynamic hip plating system aims to reduce cut-out risk, but concerns exist regarding its TAD.

Purpose of the Study:

  • To compare the tip-apex distance (TAD) between the X-Bolt system and the sliding hip screw (SHS).
  • To evaluate the incidence of lag screw cut-out with both devices in unstable trochanteric hip fractures.

Main Methods:

  • A randomized controlled trial (WHiTE One trial) involving 93 patients with unstable trochanteric hip fractures.
  • Measurement of TAD from intra-operative radiographs for both SHS and X-Bolt groups.
Keywords:
Hip fractureTip-apex distanceX-Bolt

Related Experiment Videos

  • Recording of cut-out incidence at a median follow-up of 17 months.

    • Main Results:

    • The X-Bolt group had a significantly increased mean TAD (20.8 mm) compared to the SHS group (17.1 mm) (mean difference 3.7 mm, p = 0.001).
    • Despite the increased TAD, no cut-outs were observed in the X-Bolt group (0%) compared to three (6%) in the SHS group.
    • The difference in cut-out incidence was not statistically significant at the 17-month follow-up.

    Conclusions:

    • The X-Bolt dynamic hip plating system is a safe implant for treating unstable trochanteric hip fractures.
    • Concerns regarding achieving a minimal tip-apex distance with the X-Bolt may be unwarranted, as it does not appear to increase the risk of cut-out.
    • The X-Bolt system demonstrates comparable or improved outcomes regarding fixation failure compared to the sliding hip screw.