Reply to the comments of Kancherla et al. to the article: Prospective randomised study comparing...
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LETTER TO THE EDITOR Reply to the comments of Kancherla et al. to the article: Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures Richard Stern & Anne Lübbeke & Domizio Suva & Hermes Miozzari & Pierre Hoffmeyer Received: 23 January 2012 / Accepted: 25 January 2012 / Published online: 21 February 2012 # Springer-Verlag 2012 We read your letter regarding our recently published article “Prospective randomised study comparing screw versus he- lical blade in the treatment of low-energy trochanteric frac- tures” [1]. You describe the proposed advantages of a helical blade, but these were actually related to previously pub- lished biomechanical (and not clinical) studies and clearly mentioned in our article. The vast majority of hip fracture studies rely upon the tip-apex distance and zones in the head to tell us how well the procedure was performed. We specifically did not describe “quality of reduction” as that is more of a subjective determi- nation. Almost all the literature states that if the placement of the cephalic implant results in a tip-apex distance of less than 25 mm, and is centre-centre in the femoral head, there will be no cut-out. These are precise measurements which we feel are more meaningful. While a clinical follow-up at one year to show functional outcome is always an attractive idea, we clearly explained our reasoning for this not being performed. The authors also talk about varus malunion and time to fracture healing. We postulated that if the cephalic implant did not cut out and there was no implant failure these fractures would have healed. In our opinion this is the most important issue in the elderly population when comparing two different ce- phalic implants. We agree with the authors that additional evaluation of malunion and time to healing could have been of interest, but would not add substantially to functional outcome. Reference 1. Stern R, Lübbeke A, Suva D, Miozzari H, Hoffmeyer P (2011) Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures. Int Orthop 35:1855–1861 R. Stern (*) : A. Lübbeke : D. Suva : H. Miozzari : P. Hoffmeyer Division of Orthopaedics and Trauma Surgery, University Hospitals of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland e-mail: [email protected] International Orthopaedics (SICOT) (2012) 36:1111 DOI 10.1007/s00264-012-1509-6
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Transcript of Reply to the comments of Kancherla et al. to the article: Prospective randomised study comparing...
LETTER TO THE EDITOR
Reply to the comments of Kancherla et al. to the article:Prospective randomised study comparing screw versus helicalblade in the treatment of low-energy trochanteric fractures
Richard Stern & Anne Lübbeke & Domizio Suva &
Hermes Miozzari & Pierre Hoffmeyer
Received: 23 January 2012 /Accepted: 25 January 2012 /Published online: 21 February 2012# Springer-Verlag 2012
We read your letter regarding our recently published article“Prospective randomised study comparing screw versus he-lical blade in the treatment of low-energy trochanteric frac-tures” [1]. You describe the proposed advantages of a helicalblade, but these were actually related to previously pub-lished biomechanical (and not clinical) studies and clearlymentioned in our article.
The vast majority of hip fracture studies rely upon thetip-apex distance and zones in the head to tell us how well theprocedure was performed. We specifically did not describe“quality of reduction” as that is more of a subjective determi-nation. Almost all the literature states that if the placement ofthe cephalic implant results in a tip-apex distance of less than25 mm, and is centre-centre in the femoral head, there will beno cut-out. These are precise measurements which we feel aremore meaningful.
While a clinical follow-up at one year to show functionaloutcome is always an attractive idea, we clearly explained
our reasoning for this not being performed. The authors alsotalk about varus malunion and time to fracture healing. Wepostulated that if the cephalic implant did not cut out andthere was no implant failure these fractures would havehealed. In our opinion this is the most important issue inthe elderly population when comparing two different ce-phalic implants. We agree with the authors that additionalevaluation of malunion and time to healing could have beenof interest, but would not add substantially to functionaloutcome.
Reference
1. Stern R, Lübbeke A, Suva D, Miozzari H, Hoffmeyer P (2011)Prospective randomised study comparing screw versus helical bladein the treatment of low-energy trochanteric fractures. Int Orthop35:1855–1861
R. Stern (*) :A. Lübbeke :D. Suva :H. Miozzari : P. HoffmeyerDivision of Orthopaedics and Trauma Surgery, UniversityHospitals of Geneva,4 rue Gabrielle-Perret-Gentil,1211 Geneva, Switzerlande-mail: [email protected]
International Orthopaedics (SICOT) (2012) 36:1111DOI 10.1007/s00264-012-1509-6
