Breakage of sliding hip screw after fixation of pertrochanteric hip fracture: A rare complication
| Autor: | Hassan M. Wardani, Mohammad O Boushnak, Ali Hassan Chamseddine, Abbas A. Dib |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Orthodontics
musculoskeletal diseases Hip fracture Impaction business.industry Pertrochanteric hip fractures Nonunion Barrel (horology) Case Report Breakage of lag hip screw medicine.disease Compression (physics) musculoskeletal system equipment and supplies Intertrochanteric hip fractures Fixation (surgical) Trochanteric stabilizing plate surgical procedures operative Breakage medicine Fracture (geology) Surgery business Dynamic hip screw (DHS) failure |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| Popis: | Introduction The authors report a rare case of lag screw breakage in a patient treated using locking DHS with home-made trochanteric stabilizing plate (TSP) for pertrochanteric hip fracture. Case presentation A 67 year-old female was operated for pertrochanteric hip fracture with incompetent lateral wall using locking DHS with home-made TSP. At seven months postoperative, there was radiographic nonunion with breakage of the sliding lag screw. Patient was consequently scheduled for total hip replacement. Discussion Breakage of DHS lag screw has been attributed to multiple-cycle, low-stress fatigue failure associated with nonunion. Predisposing factors are: situation of the medial edge of the barrel at the level of the fracture site prohibiting fracture compression, and mechanical obstacle to the lag screw back sliding into the barrel. In our case, the use of handmade TSP interdicted lag screw back sliding and prevented fracture impaction which was already impaired by the location of the medial edge of the barrel at the fracture level. Additionally our fixation construct was very rigid because of the use of locking screws in the DHS side plate. Conclusion When DHS fixation is planned for unstable or potentially unstable trochanteric hip fracture the surgeon should be prepared by making available a TSP from the manufacturer in the operative room rather than improvising intra-operatively with handmade TSP; this augmentation device shouldn't interfere with lag screw back sliding. Furthermore the DHS barrel should ideally not impinge with the fracture site, and the use of locking screws in the DHS plate should be cautious. Highlights • Our case highlights the modes of failure of DHS and describes the mechanism and risk factors for breakage of the lag screw. • Prevention of back sliding of the lag screw by the home-made TSP was a major risk factor for screw breakage. • Other factors are represented by the situation of the medial edge of the DHS barrel at the fracture site preventing any possible fracture impaction, and the use of locking screws in the DHS side plate which increased the rigidity of the construct and contributed concentrating the stress at the junction lag screw-barrel. • Our case is rare and is sparsely described in the literature. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|