Dynamic hip screw in proximal femoral fractures followed by “single-stage” hip arthroplasty—retrospective analysis (original) (raw)
Related papers
Acta orthopaedica Belgica, 2008
Thirty-two patients (11 male, 21 female) with a mean age of 64 years were prospectively studied after undergoing total hip replacement after failed treatment of intertrochanteric fractures. One patient had bilateral surgery. The mean time from primary surgery to the salvage arthroplasty was 15 months (range, 4 to 32 months). The mean follow-up period was 57 months (range, 30 to 108 months). Intraoperative femoral fracture occurred in one patient and postoperative dislocation in another. Three patients had deep venous thrombosis, two had gastrointestinal bleeding and one had a non fatal pulmonary embolism. At the last follow-up, we were able to review 26 patients with 27 arthroplasties; the other 6 patients had died. The majority had good pain relief and marked functional improvement. Twenty-two patients had either no or mild pain and 24 patients were able to walk freely with or without support. Almost 78% of patients had either excellent or good clinical results based on Harris hip ...
2014
Background: Pertrochanteric fractures are the most commonly operated fracture type globally but have the highest fatality rate post-operatively. The conservative management of these fractures is associated with almost double the rate of fatality. The dynamic hip screw (DHS) plate system continues to be the preferred implant as “collapse to stability” remains a distinct advantage. This study was to analyze the implications of “surgeon unrelated” morbidities like age, gender, fracture type, degree of comminution, osteopenia and “surgeon related” morbidities like fracture reduction, screw placement and tip apex distance (TAD). Methods: 96 fractures in mean 68.43 years subject age were selected, the fractures classified. The uninjured hip used to grade pre-existing osteopenia by Singh's index and compare neck shaft angle restored after surgery. All fractures operated by a standard lateral proximal femoral approach and fixed with 135° DHS. Postoperative skiagrams done to assess union...
Implant failure in a proximal femoral fracture treated with dynamic hip screw fixation
Journal of Surgical Case Reports, 2015
Dynamic hip screw fixation is a common orthopaedic procedure and to date, still can cause difficulties to the senior trauma surgeon. We present a case where an extra-capsular fracture of the proximal femur was managed with a dynamic hip screw (DHS) fixation. She proceeded to the operating theatre, where the fracture was stabilized with a 75-mm DHS and short-barrelled plate. The implant position was checked with intraoperative screening and the position accepted. Following attempted mobilization at 11 days post-operatively, the patient developed a recurrence of her preoperative pain. X-ray showed that the implant screw had separated from the barrel. Later scrutiny of the intraoperative screening films revealed that the barrel and screw were not engaged at the time of surgery. Intraoperative screening films should be carefully checked to ensure congruity of implant components.
International Journal of Orthopaedics Sciences, 2018
Background: Trochanteric fractures are devastating injuries that most commonly affect the elderly and also in young, have a tremendous impact on both the health care system and society in general. The mainstay of treatment of intertrochanteric fracture is fixation with a screw slide plate device or intramedullary device. The purpose of this retrospective study to review the long term functional outcome of Intertrochanteric femoral fractures treated with dynamic hip screw (DHS) v/s proximal femoral nail (PFN). Methods: This study was conducted on 1000 patients of both sexes with intertrochanteric femoral fractures above 16 years of age group which were operated for intertrochanteric femoral fracture by DHS (500patients) and PFN (500patients) from January 2009 to December 2012. Functional results were assessed by Harris hip scoring system. Results: In our study Mean age-62.66±16.99. The ratio of males to female was 1.23:1. 85.2% of patients were found with domestic fall and both sides were equally involved. In our study 5.2% cases of infection notated in the PFN group and 9.4% in the D.H.S group. Peri-Implant fracture occurred in 8 cases (1.6%) in PFN group and 19 cases (3.8%) in DHS group. Mechanical complications like (Breakage of PFN/ DHS screw and PFN/ DHS plate) occurred in 24 cases (4.8%) in PFN group and in DHS group were found in 16 cases (3.2%). Deformity (varus deformity and external rotation) occurred in 11 cases (2.2%) in PFN group and 44 cases (8.8%) in DHS group. Mean HHS of PFN was 92.064 and of DHS was 91.753(p=0.425). Conclusions: We conclude that long term functional outcome measured by HHS of Intertrochanteric femoral fractures treated with dynamic hip screw v/s proximal femoral nail have no significant difference but complication like peri-implant fracture, Shortening, Screw cutout , varus deformity were more in patient operated by DHS.
Outcome of Surgical Fixation of Intertrochanteric Femoral Fractures with Dynamic Hip Screw
International Journal of Science and Research, 2019
Intertrochanteric fracture of the femur is one of the common fractures in the elderly with osteoporosis due to trivial fall. When occurs in the young, intertrochanteric fracture is usually due to high-energy injuries such as motor vehicular accident or fall from height. Dynamic Hip Screw (DHS) fixation has remained the gold standard for the treatment of stable intertrochanteric femoral fractures to which other options are compared.The aim of this study was to assess radiological and functional results in stable intertrochanteric femoral fractures treated with Dynamic Hip Screw fixation.This study was a prospective, interventional study involving 48 consecutive patients with stable intertrochanteric femoral fractures that were treated using internal fixation with DHS between December 2015 and November 2018 at the National Orthopaedic Hospital, Dala - Kano. All patients were followed up for a minimum of 6 months. The mean age of the patients was 56.8 ± 15.0 years. There was a preponderance of males over females in a ratio 4.3:1. At the end of 6 months postoperatively, 45 (93.8%) patients had their fractures united with mean RUSH score of 27.1 ± 3.1. The mean HHS in the preoperative period was 19.2 ± 24.8. At the end of 6th postoperative month, the mean score was 91.7 ± 12.5. It was concluded that DHS is a reliable implant in surgical treatment of stable intertrochanteric fractures
Dynamic Hip Screw for the Treatment of Femoral Neck Fractures: A Prospective Study with 96 Patients
ISRN Orthopedics, 2014
Objectives. To study the correlation between avascular necrosis and the demographics, time elapsed from fracture to surgery, quality of reduction, Garden classification, and the position of the screw following use of the dynamic hip screw (DHS) in the treatment of subcapital neck fractures. Methods. A prospective study of 96 patients with subcapital neck fractures was carried out in a faculty hospital. Patients underwent surgery with closed reduction and internal fixation with DHS. Results. There were 58% male and 42% female patients, with a mean age of 53 years (+/−14). In terms of Garden classification, 60% were Garden IV, 26% were Garden III, and 14% were Garden II. Nonunion was observed in three cases (3%) and was treated with valgus intertrochanteric osteotomy, in all cases leading to successful healing. Avascular necrosis was observed in 16% of patients. The positioning of the screw into the femoral head showed a significant correlation with necrosis. Conclusions. The incidence of necrosis in patients under the age of 50 years is twice as high as that in older patients. Displacement is a predictive factor regarding osteonecrosis and is associated with a high and anterior position of the screw in the femoral head. Level II of evidence. Study Type: therapeutic study.
Journal of Arthroscopy and Joint Surgery, 2022
Proximal femoral fractures are one of the most common causes of disability in the adult population, with femoral neck and intertrochanteric fractures accounting for the vast majority of these fractures. [1,2] Several implants are available for their treatment, including dynamic hip screws, cannulated cancellous screws, dynamic compression screws, intramedullary devices like proximal femoral nails, among others. [1-4] Extensive literature has demonstrated similar and equivocal outcomes for these techniques, with no implant being absolutely superior to the other. [3-8] The use of internal fixation for proximal femoral fractures may fail due to multiple reasons, including nonunion, loss of fixation, femoral head osteonecrosis, posttraumatic arthritis, malunion, infection, or symptomatic hardware. Haentjens et al. reported failure rate with internal fixation for intertrochanteric fracture in the range of 3%-12% with device penetration (2%-12%), nonunion (2%-5%), and malunion causing varus Introduction: Total hip arthroplasty (THA) has a demonstrated utility in the surgical management of patients with proximal femoral fractures that fail internal fixation, with good outcomes reported from high-income countries. Given the lack of data from resource-limited settings, this work sought to report the clinical outcomes of THA for failed proximal femoral osteosynthesis from a low-and middle-income country (LMIC). Methods: The work was conducted and reported in accordance with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. A retrospective cohort study was carried out on all patients who underwent rescue THA for failed osteosynthesis of proximal femoral fractures, from January 2016 to June 2020, at a tertiary care center in Northern India. Primary study outcomes were functional outcomes as assessed by Harris Hip Score (HHS) at 1-year postoperatively and the frequency of perioperative complication as assessed by Clavien-Dindo-Sink Grading System. Results: Twenty-eight patients with mean age of 43.25 ± 10.5 years were included, with 18 males and 10 females. For their femur fracture stabilization, the most common method used had been dynamic hip screw (n = 16, 57.1%), followed by cannulated cancellous screw (n = 6, 21.5%), proximal femoral nail (n = 3, 10.7%), dynamic condylar screw (n = 2, 7.1%), and Schanz Screw (n = 1, 3.6%). Causes of failure had included cutout of screw (n = 14, 50.0%), avascular necrosis (n = 8, 28.6%), back-out of screw (n = 3, 10.7%), non-union (n = 2, 7.1%), and secondary osteoarthritis (n = 1, 3.6%). THA was carried out after mean 26.64 ± 9.01 months after index procedure. HHS improved significantly from 39.71 ± 10.89 preoperatively to 79.54 ± 4.22 at 1-year follow-up (mean difference 39.82, 95% confidence interval 43.66-35.98, P < 0.001). Perioperative complications occurred in two patients of Clavien-Dindo-Sink Grade III and another of Grade II, with no mortality occurring by 1 year. Conclusions: In resource-limited settings like LMICs, THA may be a safe and efficacious surgical modality for failed osteosynthesis of proximal femoral fractures.
Comparative Study Between Proximal Femoral Nailing and Dynamic Hip Screw Fixation
Journal of Evolution of Medical and Dental Sciences, 2018
BACKGROUND Hip fractures are usually common in elderly patients with osteoporosis intertrochanteric fracture accounting for approximately half of the hip fractures in these elderly patients, out of this more than 50% fractures are unstable. Internal fixation is appropriate for most intertrochanteric fractures, because of worldwide acceptance in the last 15-20 yrs. Dynamic hip screw (DHS) has behaved as the standard device and considered for comparison of outcomes. Though complications are few Dynamic hip screw has shown good results, specifically in stable intertrochanteric fracture. The proximal femoral nail's advantage over DHS is that it provides a more biomechanically stable construct, as there is reduced distance between implant and hip joint. In this study, our main aim is to study the radiological and clinical result of PFN and DHS for treatment of intertrochanteric hip fracture, i.e. load sharing vs. load bearing device. The mainstay for treatment of intertrochanteric fracture is fixation with a proximal femoral nail or dynamic hip screw.
Dynamic hip screw fixation of subtrochanteric femoral fractures
European Journal of Orthopaedic Surgery & Traumatology, 2021
Introduction A subtrochanteric proximal femur fracture occurs in the 5 cm of bone immediately distal to the lesser trochanter. UK national guidelines advise that adults with subtrochanteric fractures should be treated with an intramedullary nail (IMN). This study aims to compare peri-operative outcome measures of patients with subtrochanteric fractures treated with either an IMN or a dynamic hip screw (DHS) construct. Materials and Methods We retrospectively reviewed subtrochanteric fractures presenting at our institution over 4.5 years (October 2014–May 2019), classifying them into two treatment groups; IMN and DHS. These groups were compared on outcome measures including surgical time, blood loss, radiation dose area product (DAP), length of stay, re-operation rate and mortality. Results During the time period studied, 86 patients presented with a subtrochanteric fracture of the femur; with 74 patients (86%) receiving an IMN and 12 (14%) receiving a DHS. The comparative outcome me...
Intertrochanteric femoral fractures are common among older age group and are associated with substantial morbidity and mortality .Open reduction and internal fixation using dynamic hip screw (DHS) device remains the gold standard in the management of these fractures, but the fixation failure rate remains high especially in unstable fractures. This study was conducted on failures of dynamic hip screw fixation in the management of interochanteric femoral fractures between 2009 to 2011.Pre and post operative radiographs were assessed for fracture reduction. Using Evan's classification and Singh's index fractures were categorized and assessed for osteoporosis. Fracture pattern, fracture reduction, implant placement and degree of osteoporosis have been analyzed and shown to affect the rate of implant failure.