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Countersinking the Lag Screw or Blade During Cephalomedullary Nailing of Geriatric Intertrochanteric Femur Fractures: Less Collapse and Implant Prominence Without Increased Cutout Rates.

Publication ,  Journal Article
Henry Goodnough, L; Wadhwa, H; Tigchelaar, SS; Pfaff, K; Heffner, M; van Rysselberghe, N; DeBaun, MR; Gardner, MJ; Bishop, JA
Published in: J Am Acad Orthop Surg
January 1, 2022

INTRODUCTION: The lag screw or helical blade of a cephalomedullary nail facilitates controlled collapse of intertrochanteric proximal femur fractures. However, excessive collapse results in decreased hip offset and symptomatic lateral implants. Countersinking the screw or helical blade past the lateral cortex may minimize subsequent prominence, but some surgeons are concerned that this will prevent collapse and result in failure through cutout. We hypothesized that patients with countersunk lag screws or helical blades do not experience higher rates of screw or blade cutout and have less implant prominence after fracture healing. METHODS: A retrospective review of 175 consecutive patients treated with cephalomedullary nails for AO/OTA 31A1-3 proximal femur fractures and a minimum 3-month follow-up and 254 patients with a 6-week follow-up at a single US level I trauma center. Patients were stratified based on countersunk versus noncountersunk lag screw or helical blade in a cephalomedullary nail. The primary outcome was the cutout rate at minimum 3 months, and the secondary outcome was radiographic collapse at minimum 6 weeks. RESULTS: Cutout rates were no different in patients with countersunk and noncountersunk screws and blades, and countersinking was associated with less collapse and less implant prominence at 6 weeks. DISCUSSION: Surgeons can countersink the lag screw or blade when treating intertrochanteric proximal femur fractures with a cephalomedullary nail without increasing failure rates and with the potential benefits of less prominent lateral implants and decreased collapse.

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Published In

J Am Acad Orthop Surg

DOI

EISSN

1940-5480

Publication Date

January 1, 2022

Volume

30

Issue

1

Start / End Page

e83 / e90

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Orthopedics
  • Humans
  • Hip Fractures
  • Fracture Fixation, Intramedullary
  • Femur
  • Bone Screws
  • Bone Nails
  • Aged
 

Citation

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Henry Goodnough, L., Wadhwa, H., Tigchelaar, S. S., Pfaff, K., Heffner, M., van Rysselberghe, N., … Bishop, J. A. (2022). Countersinking the Lag Screw or Blade During Cephalomedullary Nailing of Geriatric Intertrochanteric Femur Fractures: Less Collapse and Implant Prominence Without Increased Cutout Rates. J Am Acad Orthop Surg, 30(1), e83–e90. https://doi.org/10.5435/JAAOS-D-20-01029
Henry Goodnough, L., Harsh Wadhwa, Seth S. Tigchelaar, Kayla Pfaff, Michael Heffner, Noelle van Rysselberghe, Malcolm R. DeBaun, Michael J. Gardner, and Julius A. Bishop. “Countersinking the Lag Screw or Blade During Cephalomedullary Nailing of Geriatric Intertrochanteric Femur Fractures: Less Collapse and Implant Prominence Without Increased Cutout Rates.J Am Acad Orthop Surg 30, no. 1 (January 1, 2022): e83–90. https://doi.org/10.5435/JAAOS-D-20-01029.
Henry Goodnough L, Wadhwa H, Tigchelaar SS, Pfaff K, Heffner M, van Rysselberghe N, et al. Countersinking the Lag Screw or Blade During Cephalomedullary Nailing of Geriatric Intertrochanteric Femur Fractures: Less Collapse and Implant Prominence Without Increased Cutout Rates. J Am Acad Orthop Surg. 2022 Jan 1;30(1):e83–90.
Henry Goodnough, L., et al. “Countersinking the Lag Screw or Blade During Cephalomedullary Nailing of Geriatric Intertrochanteric Femur Fractures: Less Collapse and Implant Prominence Without Increased Cutout Rates.J Am Acad Orthop Surg, vol. 30, no. 1, Jan. 2022, pp. e83–90. Pubmed, doi:10.5435/JAAOS-D-20-01029.
Henry Goodnough L, Wadhwa H, Tigchelaar SS, Pfaff K, Heffner M, van Rysselberghe N, DeBaun MR, Gardner MJ, Bishop JA. Countersinking the Lag Screw or Blade During Cephalomedullary Nailing of Geriatric Intertrochanteric Femur Fractures: Less Collapse and Implant Prominence Without Increased Cutout Rates. J Am Acad Orthop Surg. 2022 Jan 1;30(1):e83–e90.

Published In

J Am Acad Orthop Surg

DOI

EISSN

1940-5480

Publication Date

January 1, 2022

Volume

30

Issue

1

Start / End Page

e83 / e90

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Orthopedics
  • Humans
  • Hip Fractures
  • Fracture Fixation, Intramedullary
  • Femur
  • Bone Screws
  • Bone Nails
  • Aged