Aims. The conversion of previous hip fracture surgery to total hip arthroplasty (CTHA) can be surgically challenging with unpredictable outcomes; reported complication rates vary significantly. This study aimed to establish the medium-term survival and outcomes of CTHA performed following a previous hip fracture surgery. Methods. All CTHAs performed at our tertiary orthopaedic institution between January 2008 and January 2020 following previous ipsilateral hip fracture surgery were included. Patients were followed up clinically using Oxford Hip Scores (OHS), and radiologically until death or revision surgery. Postoperative complications, radiological implant failure, and indications for revision surgery were reviewed. Results. A total of 166 patients (167 hips) were included in the study, with a mean age of 71 years (42 to 99). Of these, 113 patients (67.7%) were female. CTHA followed cannulated screw fixation in 75 cases, hemiarthroplasty in 18, dynamic hip screw fixation in 47, and cephalomedullary nail in 27 cases. Patients were followed up for a mean of four years (0.1 to 9.3). During the follow-up period, 32 patients (19.2%) died. Overall, 14 patients (8.4%) suffered a complication of surgery, with intraoperative fractures (4.2%) and dislocations (3.6%) predominating. The survival probability was 96% at 9.53 years in the cemented group and 88% at 9.42 years in the uncemented group (p = 0.317). The median OHS improved from 13 (IQR 7.75 to 21.25) preoperatively to 39 (IQR 31 to 45) postoperatively in the uncemented group, and from 14 (IQR 10.5 to 22) to 38 (IQR 27 to 45) in the cemented group. Conclusion. This study highlights that CTHA from hip fracture surgery is associated with higher complication rates than conventional THA, but good medium-term results can be achieved. Their classification within the NJR requires review, acknowledging the increased potential for complications. Cite this article: Bone Jt Open 2025;6(2):195–205

Femoral head collapse due to avascular necrosis (AVN) is a relatively rare occurrence following intertrochanteric fractures; however, with over thirty-thousand intertrochanteric fractures per year in England and Wales alone, and an incidence of up to 1.16%, it is still significant. Often patients are treated with a hip fixation device, such as a sliding hip screw or X-Bolt. This study aimed to investigate the influence of three factors on the likelihood of head collapse: (1) implant type; (2) the size of the femoral head; and (3) the size of the AVN lesion. Finite element (FE) models of an intact femur, and femurs implanted with two common hip fixation designs, the Compression Hip Screw (Smith & Nephew) and the X-Bolt (X-Bolt Orthopaedics), were developed. Experimental validation of the FE models on 4. th. generation Sawbones composite femurs (n=5) found the peak failure loads predicted by the implanted model was accurate to within 14%. Following validation on Sawbones, the material modulus (E) was updated to represent cancellous (E=500MPa) and cortical (E=1GPa) bone, and the influence of implant design, head size, and AVN was examined. Four head sizes were compared: mean male (48.4 mm) and female (42.2 mm) head sizes ± two standard deviations. A conical representation of an AVN lesion with a lower modulus (1MPa) was created, and four different radii were studied. The risk of head collapse was assessed from (1) the critical buckling pressure and (2) the peak failure stress. The likelihood of head collapse was reduced by implantation of either fixation device. Smaller head sizes and greater AVN lesion size increased the risk of femoral head collapse. These results indicate the treatment of intertrochanteric fractures with a hip fixation device does not increase the risk of head collapse; however, patient factors such as small head size and AVN severity significantly increase the risk

Objectives. Fractures of the proximal femur are a common clinical problem, and a number of orthopaedic devices are available for the treatment of such fractures. The objective of this study was to assess the rotational stability, a common failure predictor, of three different rotational control design philosophies: a screw, a helical blade and a deployable crucifix. Methods. Devices were compared in terms of the mechanical work (W) required to rotate the implant by 6° in a bone substitute material. The substitute material used was Sawbones polyurethane foam of three different densities (0.08 g/cm. 3. , 0.16 g/cm. 3. and 0.24 g/cm. 3. ). Each torsion test comprised a steady ramp of 1°/minute up to an angular displacement of 10°. Results. The deployable crucifix design (X-Bolt), was more torsionally stable, compared to both the dynamic hip screw (DHS, p = 0.008) and helical blade (DHS Blade, p= 0.008) designs in bone substitute material representative of osteoporotic bone (0.16 g/cm. 3. polyurethane foam). In 0.08 g/cm. 3. density substrate, the crucifix design (X-Bolt) had a higher resistance to torsion than the screw (DHS, p = 0.008). There were no significant differences (p = 0.101) between the implants in 0.24 g/cm. 3. density bone substitute. Conclusions. Our findings indicate that the clinical standard proximal fracture fixator design, the screw (DHS), was the least effective at resisting torsional load, and a novel crucifix design (X-Bolt), was the most effective design in resisting torsional load in bone substitute material with density representative of osteoporotic bone. At other densities the torsional stability was also higher for the X-Bolt, although not consistently significant by statistical analysis. Cite this article: J. D. Gosiewski, T. P. Holsgrove, H. S. Gill. The efficacy of rotational control designs in promoting torsional stability of hip fracture fixation. Bone Joint Res 2017;6:270–276. DOI: 10.1302/2046-3758.65.BJR-2017-0287.R1

There is continued debate as to whether cemented or cementless implants should be utilized in particular cases based upon chronological age. This debate has been rekindled in the UK and other countries by directives mandating certain forms of acetabular and femoral component fixation based exclusively on the chronological age of the patient. This editorial focuses on the literature-based arguments to support the use of cementless total hip arthroplasty (THA), while addressing potential concerns surrounding safety and cost-effectiveness.

Cite this article: Bone Joint Res. 2019;8(12):604–607.

A fluoroscopic based computer enhancement system was designed for accurate insertion of guide wires for hip fracture fixation while decreasing fluoroscopy time. A saw bone model was created. The femur was imaged with fluoroscopy and a three-dimensional computer model was created. The femur, fluoroscopy drum, and drill were tracked with an optical tracking device. Guide wire position was planned on the computer model. Using a tracked drill the guide wire was inserted. The number of fluoroscopic images was decreased by 85% and the number of passes required to place the guide wire in acceptable position was decreased by 60% using computer enhanced technique. A fluoroscopic based computer enhancement system was designed for accurate insertion of guide wires for hip fracture fixation while decreasing fluoroscopy time. The number of fluoroscopic images and passes required to place the guide wire in acceptable position were decreased using computer enhanced technique. Final guide wire position was not different between the two groups. Orthopedic surgeons are exposed to radiation from fluoroscopy on a daily basis. This system allowed us to insert guide wires using substantially less fluoroscopy, without compromising accuracy. An average of 13.5 images were taken for each standard technique trial compared to two images for each computer enhanced trial, representing a reduction in fluoroscopy of 85%. One pass was used for each computer enhanced trial. An average of 2.4 trials was used for standard technique. Average final error was 3.6mm using standard technique and 3.8mm using computer technique. A saw bone model with a soft tissue sleeve was created. A DRB (dynamic referencing body) was fixed to the femur. The DRB, fluoroscopy drum, and drill were tracked with an optical tracking device. The system created a 3D model from two orthogonal fluoroscopic images. Guide wire position was then planned on the computer model. Using a tracked drill the guide wire was inserted. Computer enhanced trials were compared to standard techniques in regards to number of fluoroscopic images taken, number of trials to obtain acceptable guide wire position, and accuracy of guide wire placement. Guide wire position was measured on AP and lateral x-rays. Funding: This project was funded in part through a grant from the Canadian Foundation for Innovation

Intra-operative Tip-Apex Distance (TAD) estimation optimises dynamic hip screw (DHS) placement during hip fracture fixation, reducing risk of cut-out. Thread-width of a standard DHS screw measures approximately 12.5 millimetres. We assessed the effect of introducing screw thread-width as an intra-operative distance reference to surgeons. The null hypothesis was that there were no differences between hip fracture fixation before and after this intervention. Primary outcome measure was TAD. Secondary outcome measures included position of the screw in the femoral head, quality of reduction, cut-out and surgeon accuracy of estimating TAD. 150 intra-operative DHS radiographs were assessed before and after introducing screw thread-width distance reference to surgeons. Mean TAD reduced from 19.37mm in the control group to 16.49mm in the prospective group (p=<0.001). The number of DHS with a TAD > 25mm reduced from 14% to 6%. Screw position on lateral radiographs was significantly improved (p=0.004). There were no significant differences in screw position on antero-posterior radiographs, quality of reduction, or rate of cut-out. Significant improvement in accuracy (p=0.05) and precision (p=0.005) of TAD estimation was demonstrated. Awareness and use of screw-thread width improves estimation and positioning of a DHS screw in the femoral head during fixation of hip fractures

The ultimate goal of surgery for acetabular fractures is hip joint preservation for the rest of the patient’s life. However, besides Letournel’s series, long term survi-vorship in this predominantly young patient group has never been published in a very large series. The aim of this study was to determine the cumulative 20-year sur-vivorship of the hip after fixation of acetabular fractures and to identify factors predicting the need for total hip arthroplasty. A Kaplan-Meier survivorship analysis of 1218 consecutive surgically treated acetabular fractures was carried out. 816 fractures were available for analysis with a mean follow up of 10.3 years (range 2–29 years). All the surgeries were performed by a single surgeon in accordance to an established treatment protocol based on Letournel’s principles. Inclusion criteria were a minimum follow-up of two years or failure at any time. Failure was defined as conversion to total hip arthroplasty of hip arthrodesis. A Cox-regression analysis identified significant risk factors predicting the need for total hip arthroplasty. Analyzed parameters comprised data on patient history, preoperative clinical examination, associated injuries, fracture pattern, radiographic and intra-operative features, and the accuracy of reduction. The cumulative 20-years survivorship was 79% (95% CI, 76–81%). Statistically significant factors influencing the need for artificial hip replacement/arthrodesis were: age over 40 years (Hazard ratio [HR] 2.4), femoral head damage (HR 2.6), acetabular impaction (HR 1.5), postoperative incongruence of the acetabular roof (2.9), involvement of the posterior wall (HR 1.6), anterior dislocation (5.9), initial displacement > 20mm (HR 1.6), and a malreduction with residual displacement > 1mm (HR 3.0). There was a significantly different survivorship of the individual fracture types. The worst survivorship occurred in anterior wall fractures (34% at 20 years) and the best survivorship in both column fractures (87% at 20 years). The accuracy of reduction improved significantly over time. In summary, the hip joint can be successfully preserved and prosthetic replacement avoided in 79% of displaced acetabular fractures at 20 years. Many of the factors influencing the long term prognosis are already determined at the time of injury. The factors that can be influenced by the surgeon are anatomic reduction, achievement of congruency of the acetabular roof and correction of marginal impaction. The presented unique results even exceed Letournel’s series in size and follow up. Therefore, they provide benchmark data for any type of comparative evaluation studies dealing with surgical treatment of acetabular fractures in future

The placement of the guide wire in the dynamic hip screw operation can be a challenging task to the trauma surgeon. Complications can arise related to incorrect guide wire entry point, making wrong tracks, or even accepting an unsatisfactory lag screw placement. Insisting to optimise the guide wire position can lead to increase in operation and radiation exposure times. A new non-invasive technique is described to assist precision placement of the guide wire in the dynamic hip screw fixation of the neck of femur fractures using no more than a size A4 plain folded paper and a non-permanent marker pen. The new non-invasive “no high tech” method can help the trauma surgeons to shorten the operation time and reduce the radiation exposure time needed to place the guide wire in the dynamic hip screw fixation of the neck of femur fractures

Introduction

Failure of intertrochanteric fracture fixation often occurs in patients, who have poor bone quality, severe osteoporosis, or unstable fracture patterns. Hip arthroplasty is a good replacement procedure even though it involves technical issues such as implant removal, bone loss, poor bone quality, trochanteric nonunion and difficulty of surgical exposure. The purpose of this study is to evaluate the outcomes of total hip arthroplasty (THA) as the replacement for failed fixation of intertrochanteric fractures of the femur.

Aim: To compare the acute haemoglobin level drop following hip fracture fixation with IMHS and CHS at James Cook University Hospital and assess whether the surgeon’s seniority has any effect on the amount of blood loss in these two procedures. Methods: Trauma data base was searched for all IMHS procedures performed from January 2002 till March 2007 both included and CHS procedures performed from January 2007 till March 2008 both included. There were 159 CHS procedures and 146 IMHS procedures. 137 CHS and 123 IMHS procedures fulfilled the blood testing and transfusion criteria. Haemoglobin levels were used as an indication for blood loss attributable to surgery. The difference between the last level of haemoglobin checked preoperatively and the first post operative level performed between 12–48 hours postoperatively is calculated. Cases where blood transfusion was carried out preoperatively without further preoperative haemoglobin check were excluded, so were cases receiving intra or post operative blood transfusion prior to the defined postoperative haemoglobin check was carried out. Results: SPSS 13.0 statistical package was used to analyse the results. Levene’s test proved equality of variances of blood loss within the two groups of patients undergoing one of the two procedures, P=0.5. Hence, Independent Samples T test was applicable and showed that patients undergoing an IMHS procedure dropped their haemoglobin levels by 2.96 g/dl. While, those undergoing a CHS procedure dropped their haemoglobin levels by 2.32 g/dl. The 0.64 g/dl difference in haemoglobin drop was statistically significant at 5% significance level with 95% CI (0.27 to 1.01), P=0.001. The surgeons’ grades were classified into three groups as: Consultants, Registrars and Senior House Officers. Levene’s test again proved the variances of haemoglobin drop within each group to be homogeneous. Hence a One-Way ANOVA test was carried out showing that the differences in haemoglobin drop were not statistically significant when comparing the three groups of surgeons to each other. This was true for both IMHS and CHS procedures. Conclusion: Patients undergoing a CHS procedure drop their haemoglobin levels by 0.64 g/dl less than those undergoing an IMHS procedure. The surgeon’s seniority does not make difference to the amount of haemoglobin level drop following either of the two procedures. We recommend the use of CHS for stable fractures and reserve the IMHS for the unstable ones due to the increased blood loss with IMHS procedures

Introduction: Dynamic Hip Screw (DHS) fixation is one of the most common orthopaedic surgical procedures. Tip Apex Distance (TAD) is a well recognised method of evaluating the screw position of the DHS. We studied the adequacy of fixation of DHS by assessing TAD and type of reduction.

Materials and Methods: We selected a random cohort of 102 patients who had DHS fixation and had the requisite clinico-radiologic data. TAD is defined as sum of the distance, in millimeteres, from the tip of the lag screw to the apex of femoral head, as measured on AP radiograph and Lateral radiograph, after correction has been made for radiological magnification. Tip apex distance of 25 mm or less is considered as good, 26–30mm as acceptable, 31–35mm as poor and more than 35mm as unacceptable.

Quality of reduction was assessed as per Sernbo. Good, if alignment was normal on AP and maximum 20 degrees angulation on lateral radiograph and less than 4mm of displacment of any fragment. To be labelled acceptable, a reduction had to meed the criteria of a good reduction with respect to either alignement or displacement, but not both. A poor reduction met neither.

Results: Mean TAD in our series was 24mm. (9.84 – 37.6). Our of this 58.82% were 25mm or less indicating good, 25.49% of them were 26–30mm indicating acceptable, 8.82% were 30–35mm indicating poor and 6.8% were more than 35mm indicating unacceptable. 39.21% patients had good reduction. 43.13% had acceptable reduction and 17.64% had poor reduction.

Conclusion: This study shows that only 58.82% of all patients having DHS fixation had good placement of the fixation device and only 39.21% had a good reduction. We conclude that complacency must not set in on DHS fixation and that we must endeavour for good reduction and placement in as many cases as possible.

Introduction

The use of the dynamic hip screw is common practice for the fixation of intertrochanteric fractures of the femur. The success of this procedure requires accurate guide wire placement. This can prove difficult at times and can result in repeated attempts leading to longer operating time, multiple tracks and more importantly greater radiation exposure to both patient and operating staff. We hypothesised that rather than using the standard anterior-posterior projected image (Figure 1) of a proximal femur, rotating the intensifier image (Figure 2) so that the guide wire appears to pass vertically makes it easier to visualise the projected direction of the guide wire.

Introduction

Internal fixation of pertrochanteric fractures is evolving as newer implants are being developed. Proximal Femoral Nail Antirotation (PFNA) is a recently introduced implant from AO/ASIF designed to compact the cancellous bone and may be particularly useful in unstable and osteoporotic hip fractures. This study is a single and independent centre experience of this implant used in management of acute hip fractures.

Aims. Total hip arthroplasty (THA) is considered the preferred treatment for displaced proximal femoral neck fractures. However, in many countries this option is economically unviable. To improve outcomes in financially disadvantaged populations, we studied the technique of concomitant valgus hip osteotomy and operative fixation (VOOF). This prospective serial study compares two treatment groups: VOOF versus operative fixation alone with cannulated compression screws (CCSs). Methods. In the first series, 98 hip fixation procedures were performed using CCS. After fluoroscopic reduction of the fracture, three CCSs were placed. In the second series, 105 VOOF procedures were performed using a closing wedge intertrochanteric osteotomy with a compression lag screw and lateral femoral plate. The alignment goal was to create a modified Pauwel’s fracture angle of 30°. After fluoroscopic reduction of fracture, lag screw was placed to achieve the calculated correction angle, followed by inter-trochanteric osteotomy and placement of barrel plate. Patients were followed for a minimum of two years. Results. Mean follow-up was 4.6 years (4.1 to 5.0) in the CCS group and 5.5 years (5.25 to 5.75) in the VOOF group. The mean Harris Hip Score at two-year follow-up was 83.85 in the CCS group versus 88.00 in the VOOF group (p < 0.001). At the latest follow-up, all-cause failure rate was 29.1% in the CCS group and 11.7% in the VOOF group (p = 0.003). The total cost of the VOOF technique was 7.2% of a THA, and total cost of the CCS technique was 6.3% of a THA. Conclusion. The VOOF technique decreased all-cause failure rate compared to CCS. The total cost of VOOF was 13.5% greater than CCS, but 92.8% less than a THA. Increased cost of VOOF was considered acceptable to all patients in this series. VOOF technique provides a reasonable alternative to THA in patients who cannot afford a THA procedure. Cite this article: Bone Jt Open 2023;4(5):329–337

Majority of osteoporosis related fractures are treated surgically using metallic fixation devices. Anchorage of fixation devices is sometimes challenging due to poor osteoporotic bone quality that can lead to failure of the fracture fixation. Using a rat osteoporosis model, we employed neutron tomography and histology to study the biological effects of implant augmentation using an isothermally setting calcium sulphate/hydroxyapatite (CaS/HA) biomaterial with synthetic HA particles as recruiting moiety for systemically administered bisphosphonates. Using an osteoporotic sawbones model, we then provide a standardized method for the delivery of the CaS/HA biomaterial at the bone-implant interface for improved mechanical anchorage of a lag-screw commonly used for hip fracture fixation. As a proof-of-concept, the method was then verified in donated femoral heads and in patients with osteoporosis undergoing hip fracture fixation. We show that placing HA particles around a stainless-steel screw in-vivo, systemically administered bisphosphonates could be targeted towards the implant, yielding significantly higher peri-implant bone formation compared to un-augmented controls. In the sawbones model, CaS/HA based lag-screw augmentation led to significant increase (up to 4 times) in peak extraction force with CaS/HA performing at par with PMMA. Micro-CT imaging of the CaS/HA augmented lag-screws in cadaver femoral heads verified that the entire length of the lag-screw threads and the surrounding bone was covered with the CaS/HA material. X-ray images from fracture fixation surgery indicated that the CaS/HA material could be applied at the lag-screw-bone interface without exerting any additional pressure or risk of venous vascular leakage.: We present a new method for augmentation of lag-screws in fragile bone. It is envisaged that this methodcould potentially reduce the risk of fracture fixation failure especially when HA seeking “bone active” drugs are used systemically

The incidence of hip fractures in the elderly is increasing. Minimally displaced and un-displaced hip fractures can be treated with either internal fixation or hemiarthroplasty. The aim was identifying the revision rate of internal fixation and hemiarthroplasty in patients 60 years or older with Garden I or II hip fractures and to identify risk factors associated with each method. A retrospective analysis was conducted from 2 Major Trauma Centres and 9 Trauma Units between 01/01/2015 and 31/12/2020. Patients managed conservatively, treated with a total hip replacement and missing data were excluded from the study. 1273 patients were included of which 26.2% (n=334) had cannulated hip fixation (CHF), 19.4% (n=247) had a dynamic hip screw (DHS) and 54.7% (n=692) had a hemiarthroplasty. 66 patients in total (5.2%) required revision surgery. The revision rates for CHF, DHS and hemiarthroplasty were 14.4%, 4%, 1.2% (p<0.001) respectively. Failed fixation was the most common reason for revision with the incidence increasing by 7-fold in the CHF group [45.8% (n=23) vs. 33.3% (n=3) in DHS; p<0.01]. The risk factors identified for CHF revision were age >80 (p<0.05), female gender (p<0.05) and smoking (p<0.05). The average length of hospital stay was decreased when using CHF compared to DHS and hemiarthroplasty (12.6 days vs 14.9 days vs 18.1 days respectively, p<0.001) and the 1 year mortality rate for CHF, DHS and hemiarthroplasty was 2.5%, 2% and 9% respectively. Fixation methods for Garden I and II hip fractures in elderly patients are associated with a higher revision rate than hemiarthroplasty. CHF has the highest revision rate at 14.4% followed by DHS and hemiarthroplasty. Female patients, patients over the age of 80 and patients with poor bone quality are considered high risk for fixation failure with CHF. When considering a fixation method in such patients, DHS is more robust than a screw construct, followed by hemiarthroplasty

Aims. To evaluate if, for orthopaedic trainees, additional cadaveric simulation training or standard training alone yields superior radiological and clinical outcomes in patients undergoing dynamic hip screw (DHS) fixation or hemiarthroplasty for hip fracture. Methods. This was a preliminary, pragmatic, multicentre, parallel group randomized controlled trial in nine secondary and tertiary NHS hospitals in England. Researchers were blinded to group allocation. Overall, 40 trainees in the West Midlands were eligible: 33 agreed to take part and were randomized, five withdrew after randomization, 13 were allocated cadaveric training, and 15 were allocated standard training. The intervention was an additional two-day cadaveric simulation course. The control group received standard on-the-job training. Primary outcome was implant position on the postoperative radiograph: tip-apex distance (mm) (DHS) and leg length discrepancy (mm) (hemiarthroplasty). Secondary clinical outcomes were procedure time, length of hospital stay, acute postoperative complication rate, and 12-month mortality. Procedure-specific secondary outcomes were intraoperative radiation dose (for DHS) and postoperative blood transfusion requirement (hemiarthroplasty). Results. Eight female (29%) and 20 male trainees (71%), mean age 29.4 years, performed 317 DHS operations and 243 hemiarthroplasties during ten months of follow-up. Primary analysis was a random effect model with surgeon-level fixed effects of patient condition, patient age, and surgeon experience, with a random intercept for surgeon. Under the intention-to-treat principle, for hemiarthroplasty there was better implant position in favour of cadaveric training, measured by leg length discrepancy ≤ 10 mm (odds ratio (OR) 4.08 (95% confidence interval (CI) 1.17 to 14.22); p = 0.027). There were significantly fewer postoperative blood transfusions required in patients undergoing hemiarthroplasty by cadaveric-trained compared to standard-trained surgeons (OR 6.00 (95% CI 1.83 to 19.69); p = 0.003). For DHS, there was no significant between-group difference in implant position as measured by tip-apex distance ≤ 25 mm (OR 6.47 (95% CI 0.97 to 43.05); p = 0.053). No between-group differences were observed for any secondary clinical outcomes. Conclusion. Trainees randomized to additional cadaveric training performed hip fracture fixation with better implant positioning and fewer postoperative blood transfusions in hemiarthroplasty. This effect, which was previously unknown, may be a consequence of the intervention. Further study is required. Cite this article: Bone Jt Open 2023;4(8):602–611

Solid organ transplant (SOT) recipients present an increased medical risk; however, few studies analyze the outcomes of these patients undergoing hip fracture surgery. This study aimes to determine the incidence of hip fracture in SOT patients and to compare the outcomes of SOT patients with matched non-SOT controls after hip fracture fixation. A retrospective review identified 20 SOT patients with hip fracture at a single center from 2016 to 2021 and were matched (1:1) with a cohort of 20 patients with hip fracture without SOT. Patient outcomes, mortality/survival and clinical outcomes were compared between two groups. The incidence of hip fracture in SOT patients was 20/1787, 1.1%. There were significant differences in mortality rate (73.3% SOT group vs. 26.7% non-SOT group; p<0.05). There were no differences in survival time (p=0.746). There were no differences in time to surgery (5.0 days SOT group vs. 3.1 days non-SOT group; p=0.109), however, there were significant differences in the hospital length of stay (14 days SOT group vs. 8.6 days non-SOT group; p=0.018). There were no differences regarding the complication rate between the two groups (9/20, 45% vs. 6/20, 30% in the SOT and non-SOT groups, respectively). SOT patients with associated hip fracture required longer hospital length of stay than non-SOT patients. SOT patients did not show greater clinical complications; however, they presented higher mortality rate compared to non-SOT patients

Lag screw cut-out is a serious complication of dynamic hip screw fixation in trochanteric hip fractures. Lag screw position is recognised as a crucial factor influencing the occurrence of lag screw cut-out. We propose a modification of the Tip Apex Distance (TAD) and hypothesize that it could enhance the reliability of predicting lag screw cut-out in these injuries. A retrospective study of hip fracture cases was conducted from January 2018 to July 2022. A total of 109 patients were eligible for the final analysis. The modified TAD was measured in millimetres, based on the sum of the traditional TAD in the lateral view and the net value of two distances in the anteroposterior (AP) view. The first distance is from the lag screw tip to the opposite point on the femoral head along the lag screw axis, while the second distance is from that point to the femoral head apex. The first distance is a positive value, whereas the second distance is positive if the lag screw is superior and negative if it is inferior. Receiver operating characteristic (ROC) curve analysis was used to assess the reliability of various parameters for evaluating the lag screw position within the femoral head. Factors such as reduction quality, fracture pattern according to the AO/OTA classification, TAD, Calcar-Referenced TAD, Axis Blade Angle, Parker’s ratio in the AP view, Cleveland Zone 1, and modified TAD were statistically associated with lag screw cut-out. Among the tested parameters, the novel parameter exhibited 90.1% sensitivity and 90.9% specificity for predicting lag screw cut-out at a cut-off value of 25 mm, with a p-value < 0.001. The modified TAD demonstrated the highest reliability in predicting lag screw cut-out. A value of 25 mm may potentially reduce the risk of lag screw cut-out in trochanteric hip fractures

Appropriate surgical management of hip fractures has major clinical and economic consequences. Recently IMN use has increased compared to SHS constructs, despite no clear evidence demonstrating superiority of outcome. We therefore set out to provide further evidence about the clinical and economic implications of implant choice when considering hip fracture fixation strategies. A retrospective cohort study using Scottish hip fracture audit (SHFA) data was performed for the period 2016–2022. Patients ≥50 with a hip fracture and treated with IMN or SHS constructs at Scottish Hospitals were included. Comparative analyses, including adjustment for confounders, were performed utilising Multivariable logistic regression for dichotomous outcomes and Mann-Whitney-U tests for non-parametric data. A sub-group analysis was also performed focusing on AO-A1/A2 configurations which utilised additional regional data. Cost differences in Length of Stay (LOS) were calculated using defined costs from the NHS Scotland Costs book. In all analyses p<0.05 denoted significance. 13638 records were included (72% female). 9867 received a SHS (72%). No significant differences were identified in 30 or 60-day survival (Odds Ratio [OR] 1.05, 95%CI 0.90–1.23; p=0.532), (OR 1.10, 95%CI 0.97–1.24; p=0.138) between SHS and IMN's. There was however a significantly lower early mobilisation rate with IMN vs SHS (OR 0.64, 95%CI 0.59–0.70; p<0.001), and lower likelihood of discharge to domicile by day-30 post-admission (OR 0.77, 95%CI 0.71–0.84; p<0.001). Acute and overall, LOS were significantly lower for SHS vs IMN (11 vs 12 days and 20 vs 24 days respectively; p<0.001). Findings were similar across a sub-group analysis of 559 AO A1/A2 fracture configurations. Differences in LOS potentially increases costs by £1230 per-patient, irrespective of the higher costs of IMN's v SHS. Appropriate SHS use is associated with early mobilisation, reduced LOS and likely with reduced cost of treatment. Further research exploring potential reasons for the identified differences in early mobilisation are warranted