Randomized control trial comparing the functional outcomes of dynamic hip screw and locking plate dynamic hip screw in intertrochanteric fractures of femur


  • Kiran Ramachandran Department of Orthopaedics, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala
  • Dileep Sasidharan Department of Orthopaedics, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala
  • Oommen Mathew Department of Orthopaedics, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala




DHS, Locking plate DHS, Intertrochanteric fractures, Osteoporosis


Background: The objective of the study was to compare the functional outcomes of intertrochanteric fractures of the femur treated with dynamic hip screw (DHS) and locking plate DHS in elderly.

Methods: 48 participants (23 in DHS and 25 in locking plate DHS) aged ≥ 50 years with intertrochanteric fracture of femur were enrolled in the present randomized open label parallel group trial conducted at Pushpagiri Institute of Medical Sciences and Research Centre during a period of 1 year. Open, pathological, other fractures in the same limb and participants with neurological involvement were excluded. Standard of care (pre and post-operative care) was given to all participants. Sociodemographic, radiological findings, fracture type and Singh’s index were recorded at baseline, 6 weeks, 3 and 6 months. Study commenced after approval from Institutional Ethics Committee and written informed consent was obtained from all study participants. Participants were randomized in 1:1 ratio using coin flip method. Quantitative variables were expressed means and medians and qualitative variables were expressed as proportions. Tests of significance were independent sample t test, Mann Whitney U test, Friedman test and Chi square test.

Results: Between DHS and locking plate DHS, no significant difference in baseline parameters, neck shaft angle, tip apex distance, shortening, Harris hip score, range of motion score and length of hospital stay were observed.

Conclusions: The functional outcomes and complications between DHS and locking plate DHS were not significantly different.


Stalenhoef P, Crebolder H, Knottnerus J, Horst F. Injuries. Incidence, risk factors and consequences of falls among elderly subjects living in the community. A criteria-based analysis. Eur J Public Health. 1997;7:328-34.

Lyons AR. Clinical outcomes and treatment of hip fractures. Am J Med. 1997;103(2):51-63.

McLoughlin SW, Wheeler DL, Rider J, Bolhofner B. Biomechanical evaluation of the dynamic hip screw with two- and four-hole side plates. J Orthop Trauma. 2000;14(5):318-23.

Bolhofner BR, Russo PR, Carmen B. Results of intertrochanteric femur fractures treated with a 135-degree sliding screw with a two-hole side plate. J Orthop Trauma. 1999;13(1):5-8.

Simpson AH, Varty K, Dodd CA. Sliding hip screws: modes of failure. Injury. 1989;20(4):227-31.

Tanner DA, Kloseck M, Crilly RG, Chesworth B, Gilliland J. Hip fracture types in men and women change differently with age. BMC Geriatr. 2010;10:12.

Rath S, Yadav L, Tewari A, Chantler T, Woodward M, Kotwal P, et al. Management of older adults with hip fractures in India: a mixed methods study of current practice, barriers and facilitators, with recommendations to improve care pathways. Arch Osteoporos. 2017;12(1).

Ahuja K, Sen S, Dhanwal D. Risk factors and epidemiological profile of hip fractures in Indian population: A case-control study. Osteoporos Sarcopenia. 2017;3(3):138-48.

Paul P, Issac RT. Delay in time from fracture to surgery: A potential risk factor for in-hospital mortality in elderly patients with hip fractures. J Orthop. 2018;15(2):375-8.

Boyd HB, Griffin LL. Classification and treatment of trochanteric fractures. Arch Surg. 1949;58(6):853-66.

Lee Y-S, Huang H-L, Lo T-Y, Huang C-R. Dynamic hip screw in the treatment of intertrochanteric fractures: a comparison of two fixation methods. Int Orthop. 2007;31(5):683-8.

Dolk T. Operation on hip fracture patient Analysis of the time factor. Injury. 1990;21:369-92.

Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg Am. 1979;61(2):216-21.

Davis TR, Sher JL, Horsman A, Simpson M, Porter BB, Checketts RG. Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br. 1990;72(1):26-31.

Jensen JS, Tøndevold E, Sonne-Holm S. Stable trochanteric fractures. A comparative analysis of four methods of internal fixation. Acta Orthop Scand. 1980;51(5):811-6.






Original Research Articles