Fernandez, M. A., Aquilina, A., Achten, J., Parsons, Nicholas R., Costa, Matthew L. and Griffin, X. L. (2017) The tip-apex distance in the X-Bolt dynamic plating system. Bone and Joint Research, 6 (4). pp. 204-207. doi:10.1302/2046-3758.64.BJR-2015-0016.R2

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Abstract

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.

Item Type:	Journal Article
Subjects:	R Medicine > RD Surgery
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Statistics and Epidemiology Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Hip joint -- Fractures --Treatment., Bone screws (Orthopedics), Orthopedic implants, Orthopedic apparatus, Flexure., Internal fixation in fractures.
Journal or Publication Title:	Bone and Joint Research
Publisher:	British Editorial Society of Bone and Joint Surgery
ISSN:	2046-3758
Official Date:	12 April 2017
Dates:	Date Event 12 April 2017 Published
Volume:	6
Number:	4
Page Range:	pp. 204-207
DOI:	10.1302/2046-3758.64.BJR-2015-0016.R2
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
Funder:	X-bolt Direct Limited, University of Warwick, University Hospitals Coventry and Warwickshire NHS Trust

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