Why the study?
Does double placement of a lag screw during hip compression screw treatment lead to poor outcomes in patients with intertrochanteric hip fractures?
Does double placement of a lag screw during hip compression screw treatment lead to poor outcomes in patients with intertrochanteric hip fractures?
Double placement of a lag screw in hip compression screw treatment for intertrochanteric fractures is dangerous and often leads to poor results.
Answers are grounded in this paper and cite their sources.
Double lag screw insertion was associated with extrusion and poor results; case series leaves open whether technique increases failure risk in intertrochanteric fractures.
Seventy-five patients were treated for intertrochanteric hip fractures with the hip compression screw. There were 4 cases in which the lag screw was inserted twice into the femoral head. Three of these patients had a poor result due to superolateral migration and extrusion of the lag screw. The fact that the lag screw is large in comparison to the femoral head makes double placement dangerous. Satisfactory guide wire placement is essential for a one time, precise insertion of the lag screw into the femoral head. The use of a threaded tip guide wire minimizes the chance of it falling out when withdrawing the reamer or tap. If the position of a lag screw is unacceptable, it seems better to insert a flanged nail rather than a second screw in a second track.
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Doherty et al. (1979) studied this question.
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