Role of dynamic hip screw with locking side plate in intertrochanteric fractures in elderly patients
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20205563Keywords:
Dynamic hip screw, Trochanteric fracture, Intertrochanteric, LockingAbstract
Background: Dynamic hip screw (DHS) is a vital mainstay implant in managing intertrochanteric fractures. While most of the modifications of implant have been done in screw design, this study evaluates the role of employing locking side plate with DHS to increase the screw hold and avoid plate pull out in trochanteric fractures of elderly patients.
Methods: A prospective study was conducted from August 2012 to August 2014 on 30 patients having trochanteric fractures. The fixation, fracture consequences, functional outcome and complications were assessed clinically and radiologically in immediate post-operative period and on follow-ups at six weeks, three months, six months and one year. Young patients (<55 years), fractures with subtrochanteric extension and pathological fractures were excluded from study. Fractures in elderly patients from AO 31A1.1 to AO 31A3.1 were included in study. Evaluation of the clinical outcome was done by modified Harris hip score at the last follow-up.
Results: Average age of the patients in study was 64 years; males had better outcome scores, which was statistically significant. The mean trauma-surgery interval was four days. Trauma surgery interval and functional outcome by Harris hip score was statistically significant and was inversely proportional. Union was achieved in all patients with delayed union noted in four cases; the average time to union was 12.2 weeks with no major complications and good functional outcome by Harris hip score.
Conclusions: This study suggests that locking side plate with DHS would make a stronger bone implant construct and a valuable modification to prevent sliding, screw cut-out and side plate pull-out with low infection rates.
References
Rao JP, Banzon MT, Weiss AB, Rayhack J. Treatment of unstable intertrochanteric fractures with anatomic reduction and compression hip screw fixation. Clin Orthop Relat Res. 1983;(175):65-71.
Davis TR, Sher JL, Horsman A. Intertrochenteric femoral fractures; Mechanical failure after internal fixation. J Bone Joint Surg Br. 1990;72B:26-31.
Adams CL, Robinson CM, Court-Brown CM, McQueen MM. Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur. J Orthop Trauma. 2001;15:394-400.
Sperner G, Wanit Schek P, Benedettok K, Glotzer W. Technical errors and early complications of osteosynthesis of pertrochantric fractures using dynamic hip screw. Unfallchirurg. 1989;92:571-6.
Dean GL, David SG, Jason HN. Osteoporotic pertrochanteric hip fractures: management and current controversies. J Bone Joint Surg [Am]. 2004;86:398-409.
Jewell DPA, Gheduzzi S, Mitchell MS, Miles AW. Locking plate increases the strength of dynamic hip screw. Injury. 2008;39(2):209-12.
Laohapoonrungsee A, Arpornchayanon O, Phornputkul C. Two-hole side-plate DHS in the treatment of intertrochanteric fracture: Results and complications. Injury. 2005;36(11):1355-60.
Gutwald R, Alpert B, Schmelzeisen R. Principle and stability of locking plates. Keio J Med. 2003;52(1):21-4.
Sahlstrand T. The Richards Compression Screw and Sliding Hip Screw System in the Treatment of Intertrochanteric Fractures. Acta Orthop Scand. 1974;45:213-9.
Kulkarni GS. Treatment of Trochanteric Fractures of the Hip by Modified Richard’s Compressing and Collapsing Screw. Indian J Orthopaedics. 1984;18(1):30-4.
