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The tip-apex distance in the X-Bolt dynamic plating system
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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 ISSN 2046-3758.
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WRAP-tip-apex-distance-X-Bolt-dynamic-plating-system-Parsons-2017.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons: Attribution-Noncommercial 4.0. Download (2010Kb) | Preview |
Official URL: http://dx.doi.org/10.1302/2046-3758.64.BJR-2015-00...
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 | ||||
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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 |
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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: |
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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 (Creative Commons) | ||||
Date of first compliant deposit: | 26 September 2017 | ||||
Date of first compliant Open Access: | 3 October 2017 | ||||
Funder: | X-bolt Direct Limited, University of Warwick, University Hospitals Coventry and Warwickshire NHS Trust |
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