Abstract
Background: Hip fracture contributes to both morbidity and mortality in the elderly.
The dynamic hip screw (DHS), commonly used in extramedullary fixation, has become a standard implant in treatment of these fractures. We conducted this study to investigate the efficacy of DHS fixation in treatment of intertrochanteric fractures.
Materials & Methods: The plan was to study 50 cases of inter-trochanteric femur fractures of all types in Boyd and Griffin classification treated with Dynamic Hip Screw and to assess the outcome and the post-operative complications of it. Brief history and clinical examination was done according to the proforma attached. Radiological examination was done. Postoperative assessment was done. All the results were analyzed by SPSS software.
Results: In the DHS group, skin puckering with superficial infection was seen in 1 (2%) patient. Cut-out was seen in 2 patients. Shortening was seen in 1 (2%) patients. Mean TAD in the present study was found to be 23.98. Mean HHS at preoperative, 1 month postoperative, 2 month postoperative, 3 month postoperative and 6 month postoperative was 49.78, 60.96, 68.44, 74.28 and 82.12 respectively. Significant results were obtained while comparing the mean HHS among the patients of the DHS group at different time intervals. Conclusion: DHS still remains the gold standard for the treatment of stable intertrochanteric fractures in suitable patients. Therefore, we conclude that dynamic hip screw is a reliable, versatile and effective device for the treatment of intertrochanteric fractures
Keywords: Dynamic hip screw, Hip fracture.
References
- Dhanwal DK, Dennison EM, Harvey NC, Cooper C. Epidemiology of hip fracture: Worldwide geographic variation. Indian Journal of Orthopaedics. 2011;45(1):15-22.
- Gulberg B, Johnell O, Kanis JA. World-wide projection for hip fractures. Osteoporos Int. 1997;7(5):407–13.
- Cooper A. A Treatise on Dislocations and Fractures of the Joints.London, England: Longman, Hurst, Rees, Orme and Brown; 1822.
- Mittal R, Banerjee S. Proximal femoral fractures: Principles of management and review of literature. J Clinic Orthopaed Traum. 2012;3(1):15-23.
- Evans EM. The treatment of intertrochanteric fractures of the femur. JBJS 1949;31-B:190-203.
- Langenbeck B. Description of transfixion of femoral head by a transtrochantericnail (transl) Verh Dtsch Ges Chir. 1878;1:92.
- Smith-Petersen M. Treatment of fractures of the neck of the femur by internal fixation. Surg Gynecol Obstet. 1937;64:287.
- Tencer AF, Johnson KD. Biomechanics in Orthopaedictrauma: bone fracture and fixation. London: Martin Dunitz,1994.
- Jonnes C, SM S, Najimudeen S. Type II Intertrochanteric Fractures: Proximal Femoral Nailing (PFN) Versus Dynamic Hip Screw (DHS). Archives of Bone and Joint Surgery. 2016;4(1):23-28.
- Jonnes C, SM S, Najimudeen S. Type II Intertrochanteric Fractures: Proximal Femoral Nailing (PFN) Versus Dynamic Hip Screw (DHS). Archives of Bone and Joint Surgery. 2016;4(1):23-28.
- Sharma A, Sethi A, Sharma S. Treatment of stable intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw: a comparative study. RevistaBrasileira de Ortopedia (English Edition). Available online 8 November 2017. In Press, Uncorrected Proof. Doi: https://doi.org/10.1016/j.rboe.2017.07.008
- Bhakat U, Bandyopadhayay R. Comparitive Study between Proximal Femoral Nailing and Dynamic Hip Screw in Intertrochanteric Fracture of Femur. Open Journal of Orthopedics, 2013, 3, 291-295.
- Kumar R, Singh RN, Singh BN. Comparative prospective study of proximal femoral nail and dynamic hip screw in treatment of intertrochanteric fracture femur. Journal of Clinical Orthopaedics and Trauma. 2012;3(1):28-36.
- Lee YS, Huang HL, Lo TY, Huang CR. Dynamic hip screw in the treatment of intertrochanteric fractures: a comparison of two fixation methods. IntOrthop. 2007 Oct; 31(5): 683–688.
- Mundla MKR, Shaik MR, Buchupalli SR, Chandranna B. A prospective comparative study between proximal femoral nail and dynamic hip screw treatment in trochanteric fractures of femur. Int J Res Orthop. 2018Jan;4(1):58-64.
- Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric fractures. Clin Orthop Relat Res. 1998;348:87-94.
- Chua YP, Kwan MK, Ng WM, Saw A. Use of the Tip-Apex Distance in predicting Dynamic Hip Screw Cut Out in Intertrochanteric Fracture of the Femur in Asian Population. Malaysian Orthopaedic Journal. 2011; 5(2): 24-27.
- Schipper IB, Steyerberg EW, Castelein RM, et al. Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail. J Bone Joint Surg Br. 2004;86:86–94.
- Hrubina M1, Skoták M, Běhounek J. Complications of dynamic hip screw treatment for proximal femoral fractures. Acta Chir Orthop Traumatol Cech. 2010 Oct;77(5):395-401.
Corresponding Author
Dr Partap Singh Verka
Professor and Head, Department of Orthopaedics, Govt. Medical College, Amritsar, India