Clinical outcomes of dynamic hip screw fixation of intertrochanteric fractures: comparison with additional anti-rotation screw use

  • Chul-Ho Kim
  • Jae Suk Chang
  • Ji Wan KimEmail author
Original Article • HIP - TRAUMA



Hip screw cutout is among the most common causes of intertrochanteric fracture fixation failure using dynamic hip screws (DHS). This study aimed to evaluate the effect of using an additional anti-rotation screw on hip screw migration or cutout in intertrochanteric fracture fixation.

Materials and methods

We screened 488 patients with unilateral fragile intertrochanteric fractures treated with DHS between January 2001 and March 2016. The inclusion criteria were as follows: (1) age ≥ 50 years; (2) low-energy injury; (3) follow-up of at least 6 months; and (4) short barrel plate used in the operation. The exclusion criteria were as follows: (1) combination with other fracture; or (2) pathological fracture. Subsequently, 166 patients were enrolled; of them, 128 underwent surgery using DHS with an additional screw (Group 1) and 38 patients underwent surgery without an additional screw (Group 2). We compared the postoperative results and clinical outcomes while focusing on screw migration and cutout. Furthermore, we investigated the risk factors for lag screw migration.


Bone union was achieved in 160 patients (96.4%) without secondary intervention. Two patients (1.6%) in Group 1 and 1 (2.6%) in Group 2 developed screw cutout, while 18 (14.1%) in Group 1 and 12 (31.6%) in Group 2 developed screw migration. Thus, Group 2 demonstrated a higher screw migration rate. Multiple logistic regression analysis revealed that the additional anti-rotation screw was the most important factor in preventing screw migration (P = 0.019).


The additional anti-rotation screw reduced the lag screw migration rate following DHS surgery for intertrochanteric fractures.

Level of evidence

Level IV, retrospective series.


Intertrochanteric fracture Anti-rotation screw Dynamic hip screw Cutout Mechanical failure 


Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no competing interests


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryAsan Medical Center, Ulsan University, College of MedicineSongpa-Gu, SeoulRepublic of Korea

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