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Predictors of iatrogenic lateral wall fractures while treating intertrochanteric fracture femur with the dynamic hip screw system in Indian patients

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Abstract

Background

The integrity of the lateral wall has been reported to be an important factor determining fracture stability in an intertrochanteric fracture. Iatrogenic the lateral wall fracture (ILWF) has been reported while reaming for the lag screw and the barrel of the dynamic hip screw (DHS). This study aimed to identify the predictors of iatrogenic lateral wall fractures (ILWF) while using the DHS, which will help to improve the pre-operative planning and avoid their incidence.

Materials and methods

A total of 120 adult patients with intertrochanteric fracture femur treated with the DHS were included in this prospective series. Pre-operatively, the parameters noted were the demographic data, quality of bone using Singh’s index, fracture classification using AO/OTA and modified Evan’s system. The incidence of ILWF was recorded immediately after the fixation with the DHS. The two groups, i.e. one with ILWF and other without ILWF, were compared.

Results

The mean age of 46 females and 74 men in the study was 61 years. Among 120 patients, 87 (72.5 %) patients had a posterior sag that had to be corrected while passing the guide wire and while reaming the neck of femur. The incidence of ILWF was 23.33 %. The incidence of osteoporosis in patients with unstable fracture was 66.67 %. 1.7 % patients with a stable AO/OTA A1 fracture had ILWF, as compared to 50 % of patients with type A2.2 and type A2.3 who sustained an ILWF (p < 0.0001). None of the patients with a 2-part fracture on modified Evan’s classification had ILWF, while 53.84 % with a 4-part fracture had ILWF (p < 0.01).

Conclusion

There is a high risk of ILWF using the DHS in unstable intertrochanteric fractures (AO type A2.2 and A2.3 or 4-part fracture patterns).

Level of evidence

IV (case series).

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Conflict of interest

None.

Informed consent

All patients gave an informed consent prior to being included into the study. The study was authorised by the local ethical committee and was performed in accordance with the Ethical standards of the 1964 Declaration of Helsinki as revised in 2000.

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Authors and Affiliations

  1. Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India

    Deepak Joshi, Anoop C. Dhamangaonkar & Arvind B. Goregaonkar

  2. Warringal Medical Centre, Melbourne, VIC, Australia

    Sunil Ramawat

  3. 2/28, Madhavi Soc., Mogal Lane, Matunga (W), Mumbai, 400016, India

    Anoop C. Dhamangaonkar

Authors
  1. Deepak Joshi
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  2. Anoop C. Dhamangaonkar
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  3. Sunil Ramawat
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  4. Arvind B. Goregaonkar
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Corresponding author

Correspondence to Anoop C. Dhamangaonkar.

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Joshi, D., Dhamangaonkar, A.C., Ramawat, S. et al. Predictors of iatrogenic lateral wall fractures while treating intertrochanteric fracture femur with the dynamic hip screw system in Indian patients. Eur J Orthop Surg Traumatol 25, 677–682 (2015). https://doi.org/10.1007/s00590-014-1566-1

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  • DOI: https://doi.org/10.1007/s00590-014-1566-1

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