Hip Pelvis.  2018 Dec;30(4):269-275. 10.5371/hp.2018.30.4.269.

Cement Augmentation of Dynamic Hip Screw to Prevent Screw Cut Out in Osteoporotic Patients with Intertrochanteric Fractures: A Case Series

• Rai AK
• Goel R
• Bhatia C
• Singh S
• Thalanki S
• Gondane A

• KMID: 2427931
• DOI: http://doi.org/10.5371/hp.2018.30.4.269

Abstract

PURPOSE
The purpose of this study is to describe a method of inserting cement in the femoral head before fixation with dynamic hip screw to prevent screw cut out due to osteoporosis and to evaluate its clinical outcome in these patients.
MATERIALS AND METHODS
In this prospective study, 30 patients aged 60 years and older with intertrochanteric fracture were included. Bone mineral density was measured. After reaming of the femoral head and neck with a triple reamer and polymethyl methacrylate, bone cement was introduced into the femoral head using a customized nozzle and a barrel fitted on a cement gun. A Richard screw was inserted and the plate was fixed over the femoral shaft. Patients were mobilized and clinical outcomes were rated using the Salvati and Wilson's scoring system.
RESULTS
More patients included in this study were between 66 and 70 years old than any other age group. The most common fracture according to the Orthopaedic Trauma Association classification was type 31A2.2 (46.7%). The T-score was found to be −2.506±0.22 (mean±standard deviation); all patients were within the range of −2.0 to −2.8. The duration of radiological union was 13.67±1.77 weeks. Salvati and Wilson's scoring at 12 months of follow up was 30.96±4.97. The majority of patients were able to perform their normal routine activities; none experienced implant failure or screw cut out.
CONCLUSION
Bone cement augmentation may effectively prevent osteoporosis-related hardware complications like screw cut out in elderly patients experiencing intertrochanteric fractures.

Keyword

Aged; Osteoporosis; Hip fractures; Polymethyl methaacrylate

MeSH Terms

Aged
Bone Density
Classification
Follow-Up Studies
Head
Hip Fractures*
Hip*
Humans
Methods
Neck
Osteoporosis
Polymethyl Methacrylate
Prospective Studies
Polymethyl Methacrylate

Figure

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  Fig. 1 Implant failure due to screw cut out in both extramedullary (A) and intramedullary (B) devices.

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  Fig. 2 Cementing apparatus comprised of barrel, nozzle and the cement gun.

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  Fig. 3 Cement being inserted with a customized nozzle and cementing gun.

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  Fig. 4 Insertion of lag screw following augmentation of the femoral head with cement.

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  Fig. 5 A radiography of a patient at one-year follow up.

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  Fig. 6 Complications that can occur as a result of using excess cement.

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