{"title":"A Retrospective Comparison of Cephalomedullary Nail Fixation of Intertrochanteric Femur Fractures Treated With Locked Versus Backed-off Set Screws.","authors":"Byron A Ward, Joshua A Parry","doi":"10.5435/JAAOS-D-24-01196","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Excessive lag screw sliding after cephalomedullary nail fixation of intertrochanteric fractures can be problematic. Set screws are typically inserted to engage the lag screw and backed off to allow for sliding. The purpose of this study was to determine whether statically locking set screws affected lag screw sliding or cutout.</p><p><strong>Methods: </strong>A retrospective review was done at a single level 1 trauma center. Patients treated with locked versus backed-off set screws were compared in terms of lag screw sliding, loss of reduction, and lag screw cutout.</p><p><strong>Results: </strong>There were 186 patients included. The median age was 67.0 years (IQR 57.0 to 79.0 years) and 56.4% (n = 105) were male. Locked versus backed-off set screws were used in 23.7% (n = 44) and 76.3% (n = 142). The locked set screw group, compared with the backed-off set screw group, had a longer follow-up (4.0 vs. 3.0 months, P = 0.02), had a greater median tip-apex distance (21.3 vs. 19.0, P = 0.04), and did not differ in age, sex, acute varus displacement (vertical displacement of greater trochanter above the femoral head on injury radiographs), postoperative neck-shaft angle, or calcar gapping. The locked set screw group, compared with the backed-off set screw group, had less lag screw sliding (2.3 vs. 3.6 mm, P = 0.02) and no difference in lag screw sliding ≥10 mm (6.7% vs. 7.8%, P = 1.0), loss of reduction ≥10 mm (6.8% vs. 9.2%, P = 0.7), or cutout (0.0% vs. 1.4%, P = 1.0). Patients who had ≥10 mm of lag screw sliding were older (76.5 vs. 66.0, P = 0.04), more likely to have acute varus displacement (50.0% vs. 23.2%, P = 0.04), and had more varus postoperative neck-shaft angles (129° vs. 132°, P = 0.03).</p><p><strong>Conclusion: </strong>Locked set screws, compared with backed-off set screws, resulted in a median of 1.3 mm less of lag screw sliding and did not affect the rate of lag screw sliding ≥10 mm, loss of reduction, or cutout.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparison.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Academy of Orthopaedic Surgeons","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5435/JAAOS-D-24-01196","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Excessive lag screw sliding after cephalomedullary nail fixation of intertrochanteric fractures can be problematic. Set screws are typically inserted to engage the lag screw and backed off to allow for sliding. The purpose of this study was to determine whether statically locking set screws affected lag screw sliding or cutout.
Methods: A retrospective review was done at a single level 1 trauma center. Patients treated with locked versus backed-off set screws were compared in terms of lag screw sliding, loss of reduction, and lag screw cutout.
Results: There were 186 patients included. The median age was 67.0 years (IQR 57.0 to 79.0 years) and 56.4% (n = 105) were male. Locked versus backed-off set screws were used in 23.7% (n = 44) and 76.3% (n = 142). The locked set screw group, compared with the backed-off set screw group, had a longer follow-up (4.0 vs. 3.0 months, P = 0.02), had a greater median tip-apex distance (21.3 vs. 19.0, P = 0.04), and did not differ in age, sex, acute varus displacement (vertical displacement of greater trochanter above the femoral head on injury radiographs), postoperative neck-shaft angle, or calcar gapping. The locked set screw group, compared with the backed-off set screw group, had less lag screw sliding (2.3 vs. 3.6 mm, P = 0.02) and no difference in lag screw sliding ≥10 mm (6.7% vs. 7.8%, P = 1.0), loss of reduction ≥10 mm (6.8% vs. 9.2%, P = 0.7), or cutout (0.0% vs. 1.4%, P = 1.0). Patients who had ≥10 mm of lag screw sliding were older (76.5 vs. 66.0, P = 0.04), more likely to have acute varus displacement (50.0% vs. 23.2%, P = 0.04), and had more varus postoperative neck-shaft angles (129° vs. 132°, P = 0.03).
Conclusion: Locked set screws, compared with backed-off set screws, resulted in a median of 1.3 mm less of lag screw sliding and did not affect the rate of lag screw sliding ≥10 mm, loss of reduction, or cutout.
Level of evidence: Level III, retrospective comparison.
简介：头髓内钉固定股骨粗隆间骨折后，螺钉过度滑动是有问题的。固定螺钉通常插入以啮合拉力螺钉，并后退以允许滑动。本研究的目的是确定静锁紧定螺钉是否会影响螺钉滑动或开孔。方法：对某一级创伤中心进行回顾性分析。用锁定螺钉治疗的患者与后撤固定螺钉治疗的患者在拉力螺钉滑动、复位损失和拉力螺钉切断方面进行了比较。结果：共纳入186例患者。中位年龄67.0岁（IQR 57.0 ~ 79.0岁），男性56.4% （n = 105）。23.7% （n = 44）和76.3% （n = 142）的患者使用锁定螺钉。与后移固定螺钉组相比，锁定固定螺钉组随访时间较长（4.0个月vs. 3.0个月，P = 0.02），针尖距中位数较大（21.3 vs. 19.0, P = 0.04），且在年龄、性别、急性内翻移位（损伤片上股骨头上方大转子垂直移位）、术后颈轴角或跟骨间隙方面无差异。锁紧固定螺钉组与背脱固定螺钉组相比，螺钉滑动滞后较少（2.3 vs 3.6 mm, P = 0.02），螺钉滑动滞后≥10 mm （6.7% vs. 7.8%, P = 1.0）、复位损失≥10 mm （6.8% vs. 9.2%, P = 0.7）或切出（0.0% vs. 1.4%, P = 1.0）无差异。拉力螺钉滑动≥10 mm的患者年龄较大（76.5 vs. 66.0, P = 0.04），更容易发生急性内翻移位（50.0% vs. 23.2%, P = 0.04），术后颈轴角内翻较多（129°vs. 132°，P = 0.03）。结论：与后撤螺钉相比，锁定螺钉导致螺钉滑动中位数减少1.3 mm，并且不影响螺钉滑动率≥10 mm，复位损失或切出。证据等级：III级，回顾性比较。
期刊介绍：
The Journal of the American Academy of Orthopaedic Surgeons was established in the fall of 1993 by the Academy in response to its membership’s demand for a clinical review journal. Two issues were published the first year, followed by six issues yearly from 1994 through 2004. In September 2005, JAAOS began publishing monthly issues.
Each issue includes richly illustrated peer-reviewed articles focused on clinical diagnosis and management. Special features in each issue provide commentary on developments in pharmacotherapeutics, materials and techniques, and computer applications.
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