This document discusses the X-BOLT expanding bolt system for treating proximal femur fractures as an alternative to dynamic hip screws (DHS). It notes that 20% of 70,000 annual hip fractures in the UK are treated with hip nails, while 40% are treated with hemiarthroplasty/total hip replacement and 40% with DHS. However, DHS have an average 4% "cut-out" failure rate that can result in £40 million in additional costs annually in the UK. The X-BOLT system is designed to prevent cut-outs through its perpendicular expansion that does not disrupt bone, larger frontal load area, and maintenance of the optimal "tip-apex" distance

1. X-BOLT®
Expanding Bolt Osteosynthesis
for the Proximal Femur

2. 70,000 hips fractures p.a. in UK
40% treated with hemi/THR
40% treated with DHS
20% treated with hip nail
£10,000
Average in-patient cost per patient episode

3. The problem of ‘Cut-Out’

4. 2008 Cochrane Review: DHS ‘cut-out’ rates
Sample
4% Average
Size
‘Cut-Out’ Rate
250
200
150
100
50
0
0% 2% 4% 6% 8% 10% 12% 14%
DHS ‘cut-out’ rate

5. DHS ‘cut-out’ rates by year of publication
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
1990-1994 1995-1999 2000-2004 2005-2006

6. Economic Impact of ‘Cut-Out’
4% ‘Cut-Out’ rate
1600 Patients affected per year in UK
£40M Additional care costs

8. Get your (femoral) head fixed right
• 60% larger frontal load area
• Strong, secure fixation
• Rotationally stable
• One shot (centre-centre) fixation
• Dynamic sliding compression
• Reversible & removable

9. Perpendicular Expansion = No Disruption

10. Perpendicular Expansion = No Disruption

11. Perpendicular Expansion = No Disruption

12. Compacts bone = better stability

13. ‘Tip-Apex’ distance
Tip-Apex Distance (combined >25mm) is a major factor in predicting cut-out
Baumgaertner et al. JBJS Am 1995; 77:1058-64

14. ‘Tip-Apex’ fixation maintained

15. ‘Tip-Apex’ fixation maintained

16. ‘Tip-Apex’ fixation maintained

17. Best bone quality & trabecular lines

18. Snug fit in drill-hole

19. Not so snug

20. Biomechanical testing vs. DHS Screw

21. Push-out test for DHS lag screw
in synthetic bone
500
450
400
350
300
Load (N)
250
200
150
100
50
0
0 1 2 3 4 5 6 7 8 9 10
Displacement (mm)

22. Push-out test for X-BOLT
in synthetic bone
500
450
400
350
300
Load (N)
250
200
150
100
50
0
0 1 2 3 4 5 6 7 8 9 10
Displacement (mm)

23. X-BOLT®
Dynamic Hip Plating
Surgical Technique

38. X-BOLT®
Expanding Bolt Osteosynthesis
for the Proximal Femur
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