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The tip-apex distance in the X-Bolt dynamic plating system

OBJECTIVES: The Sliding Hip Screw (SHS) is commonly used to treat trochanteric hip fractures. Fixation failure is a devastating complication requiring complex revision surgery. One mode of fixation failure is lag screw cut-out which is greatest in unstable fracture patterns and when the tip-apex dis...

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Autores principales: Fernandez, M. A., Aquilina, A., Achten, J., Parsons, N., Costa, M. L., Griffin, X. L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2017
Materias:
Hip
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415904/
https://www.ncbi.nlm.nih.gov/pubmed/28404548
http://dx.doi.org/10.1302/2046-3758.64.BJR-2015-0016.R2
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author Fernandez, M. A.
Aquilina, A.
Achten, J.
Parsons, N.
Costa, M. L.
Griffin, X. L.
author_facet Fernandez, M. A.
Aquilina, A.
Achten, J.
Parsons, N.
Costa, M. L.
Griffin, X. L.
author_sort Fernandez, M. A.
collection PubMed
description OBJECTIVES: The Sliding Hip Screw (SHS) is commonly used to treat trochanteric hip fractures. Fixation failure is a devastating complication requiring complex revision surgery. One mode of fixation failure is lag screw cut-out which is greatest in unstable fracture patterns and when the tip-apex distance of the lag screw is > 25 mm. The X-Bolt Dynamic Hip Plating System (X-Bolt Orthopaedics, Dublin, Ireland) is a new device which aims to reduce this risk of cut-out. However, some surgeons have reported difficulty minimising the tip-apex distance with subsequent concerns that this may lead to an increased risk of cut-out. PATIENTS AND METHODS: We measured the tip-apex distance from the intra-operative radiographs of 93 unstable trochanteric hip fractures enrolled in a randomised controlled trial (Warwick Hip Trauma Evaluation, WHiTE One trial). Participants were treated with either the sliding hip screw or the X-Bolt dynamic hip plating system. We also recorded the incidence of cut-out in both groups, at a median follow-up time of 17 months. RESULTS: There was a significantly increased tip-apex distance with the use of the X-Bolt (mean difference 3.7mm (95% confidence interval 1.58 to 5.73); SHS mean 17.1 mm, X-Bolt mean 20.8; p = 0.001. However, this was not associated with an increased incidence of cut-out at a median follow-up time of 17 months, with three cut-outs (6%) in the SHS group and 0 (0%) in the X-Bolt group. CONCLUSION: The X-Bolt is a safe implant with no increased risk for cut-out. Concerns about minimising the tip-apex distance may be justified but do not appear to be clinically important. Cite this article: M. A. Fernandez, A. Aquilina, J. Achten, N. Parsons, M. L. Costa, X. L. Griffin. The tip-apex distance in the X-Bolt dynamic plating system. Bone Joint Res 2017;6:–207. DOI: 10.1302/2046-3758.64.BJR-2015-0016.R2.
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spelling pubmed-54159042017-05-17 The tip-apex distance in the X-Bolt dynamic plating system Fernandez, M. A. Aquilina, A. Achten, J. Parsons, N. Costa, M. L. Griffin, X. L. Bone Joint Res Hip OBJECTIVES: The Sliding Hip Screw (SHS) is commonly used to treat trochanteric hip fractures. Fixation failure is a devastating complication requiring complex revision surgery. One mode of fixation failure is lag screw cut-out which is greatest in unstable fracture patterns and when the tip-apex distance of the lag screw is > 25 mm. The X-Bolt Dynamic Hip Plating System (X-Bolt Orthopaedics, Dublin, Ireland) is a new device which aims to reduce this risk of cut-out. However, some surgeons have reported difficulty minimising the tip-apex distance with subsequent concerns that this may lead to an increased risk of cut-out. PATIENTS AND METHODS: We measured the tip-apex distance from the intra-operative radiographs of 93 unstable trochanteric hip fractures enrolled in a randomised controlled trial (Warwick Hip Trauma Evaluation, WHiTE One trial). Participants were treated with either the sliding hip screw or the X-Bolt dynamic hip plating system. We also recorded the incidence of cut-out in both groups, at a median follow-up time of 17 months. RESULTS: There was a significantly increased tip-apex distance with the use of the X-Bolt (mean difference 3.7mm (95% confidence interval 1.58 to 5.73); SHS mean 17.1 mm, X-Bolt mean 20.8; p = 0.001. However, this was not associated with an increased incidence of cut-out at a median follow-up time of 17 months, with three cut-outs (6%) in the SHS group and 0 (0%) in the X-Bolt group. CONCLUSION: The X-Bolt is a safe implant with no increased risk for cut-out. Concerns about minimising the tip-apex distance may be justified but do not appear to be clinically important. Cite this article: M. A. Fernandez, A. Aquilina, J. Achten, N. Parsons, M. L. Costa, X. L. Griffin. The tip-apex distance in the X-Bolt dynamic plating system. Bone Joint Res 2017;6:–207. DOI: 10.1302/2046-3758.64.BJR-2015-0016.R2. 2017-05-04 /pmc/articles/PMC5415904/ /pubmed/28404548 http://dx.doi.org/10.1302/2046-3758.64.BJR-2015-0016.R2 Text en © 2017 Fernandez et al. This is an open-access article distributed under the terms of the Creative Commons Attributions licence (CC-BY-NC), which permits unrestricted use, distribution, and reproduction in any medium, but not for commercial gain, provided the original author and source are credited.
spellingShingle Hip
Fernandez, M. A.
Aquilina, A.
Achten, J.
Parsons, N.
Costa, M. L.
Griffin, X. L.
The tip-apex distance in the X-Bolt dynamic plating system
title The tip-apex distance in the X-Bolt dynamic plating system
title_full The tip-apex distance in the X-Bolt dynamic plating system
title_fullStr The tip-apex distance in the X-Bolt dynamic plating system
title_full_unstemmed The tip-apex distance in the X-Bolt dynamic plating system
title_short The tip-apex distance in the X-Bolt dynamic plating system
title_sort tip-apex distance in the x-bolt dynamic plating system
topic Hip
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415904/
https://www.ncbi.nlm.nih.gov/pubmed/28404548
http://dx.doi.org/10.1302/2046-3758.64.BJR-2015-0016.R2
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