ABSTRACT

Aim : To assess the rate of implant failure in stable intertrochanteric fractures of femur in elderly patients treated with the dynamic hip screw with a tip apex distance.

Study design: Descriptive Place and duration of study: Department of Orthopaedic, Sahara Medical College, Narowal from 12th August 2019 to 11th February 2020.

Methodology: Sixty patients with implant failure. Patients of both genders, age more than 50 years, closed undisplaced intertrochanteric fractures (AO/OTA 31A1) identified on preoperative radiograph and history of fall were included. Those patients who have fracture shaft of femur, bone mineral density less than 2 standard deviation on DEXA scan, open intertrochanteric fractures, polytrauma and advanced osteoporosis as diagnosed by X-ray were excluded from the study. All patients were underwent dynamic hip screw fixation.

Results: Thirty six (60%) were males and 24 (40%) patients were females with mean age 59.9±12.7 years. Mean body mass index of the patients was 26.7±3.8 kg/m2. Thirty seven cases (61.7%) had right side fracture and rest 23 patients (38.3%) had left sided fractures. The tip apex distance <20mm was found among 35 patients (58.3%) in which frequency of implant failure was among 3 cases (8.6%). Among 15 patients (25%) had tip apex distance 20-30mm in which implant failure measured among 5 cases (33.3%) and 10 patients (16.7%) had tip apex distance >40mm in which implant failure observed among 1 patient (10%). Falling was the most common reason of injury in which 51 cases (85%) found, 6 injuries (10%) due to road traffic accident and 3 cases (5%) had other reason of injury.

Conclusion: The tip apex distance 20-40mm increased the rate of the implant failure of the dynamically fixed dynamic hip screw, with stable femoral intertrochanteric fracture.

Keywords: Tip apex distance, Implant failure, Intertrochanteric fracture, Dynamic hip screw.