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Discussion of Sliding Hip Screw Devices

- See:
    - Screw-Plate Angle
    - High Angle Plates
    - Low Plate Angle
    - Nail Placement in Femoral Head and Neck
    - Screw Length
    - Sliding Screw Fixation in Subtroch Frx

- Discussion:
    - sliding screw fixation allows for improved fracture fixation w/ potential for continuous impaction at frx site while lessening chance of nail penetration thru or cutting out of the femoral head;
         - important that the barrel must cross the fracture site and that sufficient slide must remain in the nail after insertion;
    - permit deeper insertion of screw w/o fear of later penetration of joint;
    - permit controlled collapse of frx site w/o penetration of femoral head;
    - improves wt bearing capacity of implant by reduction of moment arm;
    - telescoping nails maximize bony contact & hence frx stability, thereby decrease implant failure;

- Indications:
    - sliding hip screw is implant of choice for the treatment of both stable and unstable intertrochanteric hip frx;
    - may also be used for low femoral neck frx (basilar neck):
         Compression screw fixation for displaced subcapital fracture of the femur. Success or failure?
         Biomechanical analysis of the sliding characteristics of compression hip screws.
         Treatment of femoral neck fractures with the sliding compression screw.

- Contraindications:
    - high subtroch & unstable intertroch frx, however, may not be compressed because of their location in relation to plate, causing displacement to occur;

- Complications:
    - sliding screw fixation of intertroch frxs is assoc w/ incidence of loss of fixation in < 10% of cases, and most often occurs w/ Unstable frx;
    - most fixation failures can be attributed to technical problems of fracture reduction and screw placement.
         - often due to poor reduction, poor implant placement, & inadequate nail depth;
    - use of screw fixation can result in rotation of femoral head on its axis, leading to further compromise of the vessels on ligament teres