The Effect of Bone Quality on Treatment of Intertrochanteric Fractures with Helical Blade Versus Lag Screw Fixation in Cephalomedulary Nails

Abstract

Introduction. The specific aim of this retrospective study was to determine whether bone quality has any effect on the complication rates or overall survivorship between helical blades and lag screws in cephalomedullary nails used for intertrochanteric hip fractures.

Methods. Clinical charts and radiographic studies of patients between Jan 2012 through July 2019 were reviewed. Radiographic images (pre-, intra-, and post-operative) were reviewed to evaluate fracture fixation type, fracture reduction grade, and post-operative complications. DEXA scan results (T-score) and serum alkaline phosphatase (ALP) isoenzyme activity values were collected to evaluate patient bone quality.

Results. 303 (helical: 197, screw: 106) cases were included. Complications were found in 31 helical blade cases (16%) and 23 lag screw cases (22%). No statistically significant difference was detected when comparing complication rates to patient bone quality between these two groups. These two groups had similar one-year implant survivorship with respect to T-score, the low ALP level group, and normal ALP level group. The helical blade had higher implant survivorship compared to lag screw in five-year survival rate with respect to osteoporotic group, high ALP level group, and normal ALP level group. (Osteoporotic: 77% vs 69%, High ALP: 73% vs 67%, normal ALP: 70% vs 64%).

Conclusions. Similar complication rates were observed between helical blade and lag screw constructs in cephalomedullary femoral nails when accounting for patient bone quality. However, the bone quality had positive influence on the initial post-operative fracture reduction grade, and the five-year implant survivorship.