Comparative analysis between dynamic hip screw with trochanteric stabilisation plate and dynamic hip screw alone in the management of unstable intertrochanteric femur fractures
Keywords:DHS, TSP, Intertrochanteric
Background: Intertrochanteric fractures of the femur are difficult to manage because of the complex patterns they present with. A dynamic hip screw (DHS) and a DHS supplemented with a trochanteric stabilisation plate (TSP) are among a variety of fixation methods used in the management of such injuries. We compared the efficacy of DHS with TSP to DHS alone in the treatment of unstable intertrochanteric femur fractures.
Methods: 30 patients of intertrochanteric femur fractures (mean age 72 years) were included in the study, 14 were treated using DHS with TSP while 16 were treated using DHS alone, they were followed up till 16 weeks and the progress was recorded according to the parameters in the Salvati and Wilson score.
Results: 14 patients were treated using DHS with TSP, 11 of them had excellent Salvati and Wilson scores, 3 patients recorded good scores, 11 patients were able to walk with no pain while 3 needed aids for walking due to pain, normal function was restored in 12 patients while very little restriction was seen in 2 patients
Of the16 patients treated using DHS alone, 10 had excellent scores, 6 recorded a good score, 10 patients walked with no pain while 6 needed aids for walking due to pain, normal function was re-stored in 11 patients, very little restriction was seen in 4 patients while 1 patient had restricted nor-mal activity.
Conclusions: DHS with TSP appears to provide better fixation and functional outcome in unstable inter trochanteric fractures over DHS alone.
Apple DF, Hayes WC. Prevention of Falls and Hip Fractures in the Elderly. Rosemont (IL): Am Acad Orthop Surg. 1993.
Koval KJ, Zuckerman JD. Hip fractures I. Overview and evaluation and treatment of femoral neck fractures. J Am Acad Orthop Surg. 1994;2(3):141-9.
Madsen JE. Treatment of displaced intracapsular hip fractures in older patients. Br Med J. 2010;340:2810.
Alobaid A, Harry EJ, Elder GM. Minimally invasive dynamic hip screw: Prospective randomixed trial of two techniques of insertion of a standard dynamic fixation device. J Orthop Trauma. 2004;18(4):207-12.
Aune AK, Ekeland A, Odengaard B, Grøgaard B, Alho A. Gamma nail vs compression screw for trochanteric femur fracture. Acta Orthop Scand. 1994;65:127-31.
Bolhofner B, Russo P, Carmen B. Results of intertrochanteric femur fractures treated with a 135 degree sliding screw with a two hole side plate. J Orthop Trauma. 1999;13:5-8.
Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Surg. 1993;75B:797-8.
Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg. 1949;31:191-203.
Kaufer H, Matthews LS, Sonstegard D. Stable fixation of inter trochanteric fractures. J Bone Surg Am. 1974;56:899-907.
Kyle RF, Gustilo RB, Permer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg Am. 1979;61:216-21.
Yian EH, Bancrji I, Matthews LS. Optimal side plate fixation for unstable intertrochanteric hip fractures. J Orthop Trauma. 1997;11(4):254-9.
Boyd HB, Griffin LL. Classification and treatment of trochanteric fractures. Arch Surg 1949;58:853-66.