An unusual failure of a sliding hip screw in the immediate post-operative period (original) (raw)
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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.
Minimal Invasive Dynamic Hip Screw for Intertrochanteric Fractures
Intertrochanteric fracture of femur is one of the most common fracture of the hip especially in elderly with osteoporotic bones, usually due to low energy trauma like simple falls. With rise in Osteoporosis and geriatric population the risk of getting intertrochanteric fracture is on rise. Rigid fixation with early mobilization of patients is the standard treatment. There is lot controversy about the choice of implant, between Dynamic Hip screw plate and the intra-medullary implants. The Intramedullary implants in treatment of Intertrochanteric fractures, are thought to be a superior choice because of minimal Invasiveness in its application, biomechanical stability and minimal loss of blood. For unstable fractures they are the gold standard now. But many studies still suggest that Dynamic hip screw fixation first introduced by Clawson in 1964 is still a gold standard for fixation of stable intertrochanteric fractures. To develop and evaluate role of minimal invasive approach for Dynamic Hip screw (MIDHS) for the treatment of stabIe intertrochanteric fracture. This is a prospective study of 28 patients of intertrochanteric fracture of OTA 31-A1, A2 and Boyd's I ,-II fracture and Evan's stable fracture who underwent treatment by MIDHS with 4 hole side Dynamic compression plate. They were operated with minimal invasive approach. Patients were reviewed immediate postoperatively and at one, two, three, four, six, and 12 months after fracture. They were evaluated for outcomes pertaining to approach, fixation and union.The mean length of incision was 4 cms, mean amount of blood loss.-75ml,and Mean time taken for completion of surgery was 42 minutes. The mean size of Hip screw was85 mm, 4 DCP plate was used , Hip screw were mostly placed Centrally and Posterio-inferior, Tip apex distance was within 5mm in 21cases and >5mmin 7 cases. There was 1 case of DVT, no screw cut through and no infection. Mean fall in postoperative hemoglobin was 0.5 5gm/dl. The Vas pain score was mean of 3.5 /10 after 24 hrs. Mean Time to mobilization to partial weight bearing was within 3 days. Mean radiological union time was10.6 weeks and mean follow up is 48.4 weeks. MIDHS is a innovative improvised technique for Dynamic hip screw fixation with small wound size, low blood loss, low pain, requires less hospital stay, low hospital cost, allows early mobilization and have low incidence of wound infection. It is a very effective way of maintain the adherences to gold standard of Dynamic Hip Screw fixation for Stable Intertrochanteric fracture of femur.
2019
Background: One of the leading causes of death and disability among the elderly are hip fractures. Approximately half of these injuries are intertrochanteric fractures and the incidence is continuously increasing. Different types of implants were tried at different times for internal fixation of these fractures, of which dynamic hip screw has remained the most popular one. But with the advent of some newer implants, the efficacy of dynamic hip screw is being questioned. Aim: To determine the failure after DHS fixation of intertrochanteric fracture and identify causes (instability, increased tip apex distance and high angle side plate) leading to failure after DHS fixation. Methods: This was a descriptive interventional case study. Forty five cases fulfilling the inclusion criteria were included after taking informed consent. There were 32 males and13 females with male to female ratio of 2.5:1. They were operated under standard surgical protocol for DHS by senior residents. Pre, per ...
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.
Letter to the editor on the study “Dynamic hip screw fixation of subtrochanteric femoral fractures”
European Journal of Orthopaedic Surgery & Traumatology, 2021
1. Regarding choice of implant—In cases of subtrochanteric fractures where plating was required, dynamic condylar screw or proximal femoral locking plates have been traditionally been used. For the sliding hip screw to act as per its biomechanical principle, it requires an intact lateral cortex. We would like to know what was the rationale for choosing the implant (both biomechanical and clinical perspective) when there was a clinical guideline in the country advocating intramedullary nailing as mentioned by the authors. Was it non-availability of the desired implant or other factors beyond their control that forced them to use DHS or was it a well thought strategy, in which case we would like to know about it. 2. Regarding clinical outcomes—DHS have traditionally had high failure rates in cases with medial comminution and in subtrochanteric fractures because of which it was replaced by better implants [2, 3]. But the results of the study show union without any failure even in cases...
Background. Intertrochanteric fractures of the proximal femur are one of the most common fractures encountered, and dynamic hip screw with a side plate is the standard treatment. We compared a minimally invasive surgical technique with the conventional surgical technique used in the fixation of intertrochanteric fractures with the dynamic hip screw (DHS) device. Methods. Thirty patients with such fractures were treated with the conventional open technique and 30 with a new minimally invasive technique. Patients in both groups were followed up for 1 year. Results. There was less blood loss, minimal soft tissue destruction, shorter hospital stay, and early mobilization with the minimally invasive technique. Conclusion. The present study finds minimally invasive technique superior to conventional (open) DHS.
Evaluation of Outcome of Treatment of Intertrochanteric Fracture with Dynamic Hip Screw (DHS)
Ibrahim Cardiac Medical Journal, 2020
Background & Objective: Intertrochanteric femur fractures are becoming increasingly common as our population ages. Effective treatment strategies that result in high rates of union of these fractures and low rates of complication are important. This study was designed to evaluate the clinical outcome of intertrochanteric fracture treated with dynamic hip screw, among many other fixation techniques available to fix intertrochanteric fractures. Methods: This prospective interventional study was done in the Department of Orthopaedics & Traumatology Department of Dhaka Medical College Hospital, Dhaka between June 2013 to November 2014. A total of 30 patients having intertrochanteric femur fracture were treated with Dynamic Hip Screw (DHS) after doing all necessary investigations for anesthetic fitness. Regular follow up was done up to six months after each operation and was observed for fracture healing, stability, complications and functional outcome by the prescribed scoring system (H...
Minimally Invasive Dynamic Hip Screw for Fixation of Stable Intertrochanteric Fractures of The Femur
2015
Objective: To determine outcome of minimal invasive dynamic hip screw procedure for fixation of stable intertrochanteric fractures of the femur. Methodology: A total of 40 patients with closed stable intertrochanteric femur fractures (AO type A1.1 to A2.1) were operated with MIDHS technique. Reduction of postoperative haemoglobin and haematocrit, pain score, theatre time, length of hospital stay, evidence of wound infection, hip screw position and tip apex distance were studied. Results: Of 40 patients, 22 (55%) were female and 18 (45%) were male. 14 (35%) had left hip while 26 (65%) had right hip involvement. Mean age at the time of surgery was 54.5 years. Based on AO classification: 12 had A1.1, 17 had A1.2 and 11 had A2.1. Mean reduction of post-operative hemoglobin was 1.2g/dl and haematocrit was 0.07. The mean post-operative pain score was 2.8 (using Visual Analogue Scale). The mean duration of surgery was 38.6 minutes and mean time to discharge from hospital after surgery was ...