Surgery: Current Research Aguado-Maestro et al., Surgery Curr Res 2013, 3:4 http://dx.doi.org/10.4172/2161-1076.1000146 Research Article Open Access Volume 3 • Issue 4 • 1000146 Surgery Curr Res ISSN: 2161-1076 SCR, an open access journal Hip Fractures with Rotational Instability: Concept and Surgical Technique Aguado-Maestro I*, Escudero-Marcos R, Nistal-Rodríguez J, Alonso-García N, Pérez-Bermejo D, Bañuelos-Díaz A, Cebrián-Rodríguez E, Ramos-Galea R, and García-Alonso M Hospital Universitario del Río Hortega, Valladolid, Spain *Corresponding author: Aguado-Maestro I, Hospital Universitario del Río Hortega, Valladolid, Spain, E-mail: nacho.ams@gmail.com Received August 03, 2013; Accepted August 28, 2013; Published September 07, 2013 Citation: Aguado-Maestro I, Escudero-Marcos R, Nistal-Rodríguez J, Alonso- García N, Pérez-Bermejo D, et al. (2013) Hip Fractures with Rotational Instability: Concept and Surgical Technique. Surgery Curr Res 3: 146. doi:10.4172/2161- 1076.1000146 Copyright: © 2013 Aguado-Maestro I, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Hip fracture; Rotational instability; Surgical technique Introduction he high occurrence of hip fractures among senior citizens cannot be overlooked, as they are the most frequent cause of admission to trauma units in cases involving elderly patients. Half of them are considered extra capsular, leading to high mortality rates. he endomedular nail is one of the most frequently used devices for the treatment of these fractures in our hospitals at the moment. his device allows a shorter moment arm due to the force being applied over a shorter distance. his reduces bending loads seen by the implant. Helical blade in Proximal Femoral Nail Antirotation provides in addition greater angular and rotational stability by compacting trabecular bone while being inserted. Other systems have been designed to prevent rotation of the cervical fragment, such us double-screw nails. However, helical blade itself showed a decrease in postoperative implant-associated complications, especially in osteoporotic bone and unstable fracture types [1]. It has been demonstrated that intramedullary nails are better than sliding hip screws in unstable fractures [2-4]. Such unstable patterns consist of reverse obliquity fractures, transtrochanteric fractures, fractures with a large posteromedial fragment implying loss of the medial buttress, and fractures with subrochanteric extension [4,5]. Osteoporosis was considered by Harrington to be a predictor for instability in 1975 [6]. Recent studies have dispelled this theory. he relationship between the Singh method for radiographic evaluation of osteoporosis and mechanical complications remains controversial [7,8]. Furthermore, there is a wide variability intra and interobserver in Singh’s classiication [9]. he most common classiication for these fractures is the provided by AO/OTA, which divides the patterns into 3 diferent groups; 1 (pertrocantheric simple), 2 (pertrocantheric multifragmentary), and 3 (intertrocantheric) [10]. his is, for the most part, an anatomical classiication. However, in previous works [11], we noticed a higher incidence of cut out in simple pattern (AO/OTA 31A1) basicervical fractures treated with endomedullary nail (Proximal Femoral Nail Abstract Introduction: New concepts regarding instability in extra capsular fractures have led to a better understanding of their biomechanical behavior. Location and direction of the fracture line determine rotational instability in typically deined “stable” fractures. We propose a modiication of the classical osteosynthesis with endomedular nail. Material and methods: Fourteen patients met the inclusion criteria (31A1 fractures with a fracture line angled more than 70 degrees) between October 2012 and February 2013. They were all treated with PFNA nail, standard technique modiied by adding a 7.3 mm cannulated screw with anti-rotation effect as described by the authors. X-Ray controls were performed after 24 hours, and after 1, 3 and 6 months, evaluating reduction, helical blade position (Cleveland-Bosworth) and tip-apex distance (Baumgaertner). Consolidation, loss of reduction and function were also reviewed. Results: Reduction quality was good or fair in 91%, founding the helical blade in center-center position in every case, with an average tip-apex distance of 12.24 mm. Conclusions: The theory of helical blade rotation through the femoral is becoming more and more relevant regarding cut out. Deining those fracture lines affected by rotational instability will lead to more easily determining the criteria for using a cannulated screw for additional stabilization. The technique is safe, simple and easily replicated. Satisfactory results were observed in all the cases, despite the small sample size. Antirotation), which involved the 4 cases we had. In these four cases, we appreciated a simple fracture line, angled in more than 70 degrees with an imaginary horizontal line. A basicervical fracture is one that extends through the base of the femoral neck, next to the intertrochanteric region [12]. It is postulated that rotation of the femoral head is a potential initiator for cutting out [13,14]. Previous works by Massoud considered the possibility of treating these fractures with a DHS using a derotation screw. he aim of this article is to present the surgical technique and results of basicervical fractures treated in our hospital with a Proximal Femoral Nail Antirotation with a derotation screw to enhance rotational stability. Material and Methods Fourteen consecutive patients met the inclusion criteria between October 2012 and February 2013. hese criteria consisted of basicervical fractures (AO/OTA 31A1) with a fracture line angled at more than 70 degrees against an imaginary horizontal line, low-energy trauma (self height fall) and osteoporosis. he exclusion criteria excluded patients aged 60 years old or less and high-energy traumas. here were 14 women, with an average age of 80.3 years old (64- 87). he evaluation of the results was done by an independent surgeon. All of them were treated with a PFNA nail with a modiied technique