Title: A Prospective Study of Outcome of Intertrochanteric Fractures Treated with Dynamic Hip Screw
Authors: Dr Mohamed Afsal CH, Dr Ajay Kumar Mahto
DOI: https://dx.doi.org/10.18535/jmscr/v10i12.08
Abstract
Introduction
The demographics of world populations are set to change, with more elderly living in developing countries. The highest hip fracture rates are seen in North Europe and the US and lowest in Latin America and Africa. Asian countries show intermediate hip fracture rates. With rising life expectancy throughout the globe, the number of elderly individuals is increasing in every geographical region, and it is estimated that the incidence of hip fracture will rise from 1.66 million in 1990 to 6.26 million by 2050.1
But as three-quarters of the world’s population live in Asia, it is projected that Asian countries will contribute more to the pool of hip fractures in coming years. The highest incidence of hip fractures from Asia has been reported from Singapore. It is estimated that by 2050 more than 50% of all osteoporotic trochanteric fractures will occur in Asia. This variation in the distribution of hip fracture over different regions of the world demonstrate that genetic and environmental factors play a role in the etiology of hip fracture.1
In geriatric population, fall is the leading cause of nonfatal injuries and hospital admissions. Proximal femur fractures are divided into three categories: femoral neck and inter-trochanteric fractures account for 90%, sub-trochanteric fractures occurring in 5-10%.2
Intertrochanteric fractures unite readily due to broad fracture surfaces, adequate blood supply and they rarely lead to non-unions. If proper precautions are not taken fractures unite in malposition resulting in shortening, limp and restricted movements. Treatment must also consider effective internal fixation to help early mobilisation and to reduce morbidity.3A combination of surgical fixation, early postoperative physiotherapy and ambulation is usually the best approach. The overall goal in the treatment of hip fractures is to return the patient to pre-morbid level of function. Among the various internal fixation devices used for trochanteric fractures the dynamic hip screw with sliding plate is one of the implant which permits the proximal fragments to collapse or settle, seeking its own position of stability.
In our study period of two years 45 cases according to the inclusion criteria were radio logically classified and treated surgically as early as possible. These fractures were treated with dynamic hip screws and plate system. A study was undertaken to study the effectiveness of the DHS and Tip Apex distance, stability, reduction and the functional outcome with Harris Hip score.4
