scholarly journals Dynamic Hip Screw for the Treatment of Femoral Neck Fractures: A Prospective Study with 96 Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Carlos Roberto Schwartsmann ◽  
Lucas Senger Jacobus ◽  
Leandro de Freitas Spinelli ◽  
Leonardo Carbonera Boschin ◽  
Ramiro Zilles Gonçalves ◽  
...  
Keyword(s):  
Femoral Head ◽  
Prospective Study ◽  
Avascular Necrosis ◽  
Dynamic Hip Screw ◽  
Level Ii ◽  
Hospital Patients ◽  
Hip Screw ◽  
Therapeutic Study ◽  
A Prospective Study ◽  
Study Type

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.

scholarly journals To analyze and use the parameters in post-operative unstable intertrochanteric fractures treated using dynamic hip screw fixation as guidelines for re-operation

2016 ◽  
Vol 2 (4) ◽  
pp. 273
Author(s):  
K. Thirusenthil Aathipan ◽  
T. R. Ashok ◽  
Ganesan G. Ram
Keyword(s):  
Prospective Study ◽  
Screw Fixation ◽  
Dynamic Hip Screw ◽  
Intertrochanteric Fractures ◽  
Anatomical Reduction ◽  
Pull Out ◽  
Hip Screw ◽  
Tip Apex Distance ◽  
Definite Indicator ◽  
A Prospective Study

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">The treatment of unstable intertrochanteric fractures is challenging due to the difficulty in obtaining anatomical reduction. The purpose of this study was to analyse and use the parameters (lateral femoral wall integrity and tip-apex distance) in post-operative unstable intertrochanteric fractures treated using dynamic hip screw (DHS) fixation as guidelines for re-operation.</span></p><p class="abstract"><strong>Methods:</strong> This was a prospective study and included 40 patients with unstable intertrochanteric fractures treated using DHS fixation from December 2014 to September 2016. The AO/OTA classification was used to classify each of the patients and their lateral femoral wall integrity and tip-apex distance was assessed in the post-operative radiographs.<strong></strong></p><p class="abstract"><strong>Results:</strong> In this study, 3 patients out of 40 (7.5%) had screw pull out within 5 months of surgery. 2 pull outs occurred when the screw was in the antero-superior zone and 1 when it was in the centre to centre zone. Thus, the rate of screw pull out was higher in the antero-superior zone. The 3 patients with screw pull out had a mean tip-apex distance (TAD) of 36.01 mm as compared to 32.96 mm of those who did not have screw pull out. We further found that pre-operatively 6 patients out of 40 (15%) had lost lateral femoral wall integrity whereas post-operatively 26 patients out of 40 (65%) had lost it. In summary, there is a 5 times higher risk of losing lateral femoral wall integrity if DHS is the implant of choice<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> On conclusion, unacceptable TAD limit with loss of lateral femoral wall integrity was found to be a definite indicator of DHS implant pull out. And also found that by using the DHS as an implant of choice, there is a 5 times higher risk of losing lateral femoral wall integrity intra-operatively and that its use for the treatment of unstable intertrochanteric fractures must be guarded<span lang="EN-IN">.</span></p>

scholarly journals A Prospective Study of Management of Fracture Dislocation of Hip (PIPKIN) by Safe Surgical Dislocation (2 Years 6 Months Follow-Up in a Tertiary Hospital at Visakhapatnam)

2021 ◽  
Vol 8 (26) ◽  
pp. 2248-2252
Author(s):  
Appala Raju Sanaboyina ◽  
Saraswathi Venkata Avula
Keyword(s):  
Femoral Head ◽  
Prospective Study ◽  
Functional Outcome ◽  
Avascular Necrosis ◽  
Motor Vehicle ◽  
Early Arthritis ◽  
Tube Placement ◽  
Fracture Dislocation ◽  
Surgical Dislocation ◽  
A Prospective Study

BACKGROUND High velocity motor vehicle injuries are associated with hip fracture dislocations especially dash board injuries. Most commonly posterior hip dislocations are associated with occasional femoral head fractures. Computerized tomographic imaging is done to look at the congruency of the hip joint. Safe surgical dislocation or Ganz approach was described in 2001 for exposing the hip in a 360-degree view without damaging the vascularity of the femoral head. In this study, we wanted to evaluate the radiological and functional outcome using modified Merle d' Aubigne-Postel and Harris hip scoring. METHODS The current study is a prospective study in a tertiary referral centre where 8 young adult males were followed up for a period of 2 years 6 months from August 2018 to February 2021 after safe surgical dislocation and reduction with headless Herbert screws to maintain congruent hip surface. RESULTS We had 1 patient with associated chest injury requiring intercostal tube placement, while none of them had developed avascular necrosis or early arthritis. We had used modified Merle d'Aubigne-Postel and Harris hip scoring to assess the functional outcome. We had six patients with excellent results and two patients with good outcome due to occasional pain. We followed all the patients for more than 2 years. We evaluated the radiological and functional outcomes. The results are comparable to other researcher’s studies. CONCLUSIONS Safe surgical dislocation is a very good choice for fixation of femoral head fractures where the complications like early arthritis of femoral head and acetabulum are less along with preserving the vascularity of the femoral head and preventing the chances of avascular necrosis of femoral head. It also provides a good intraoperative view for handling the fracture reduction. KEYWORDS Pipkin Fracture, Ganz Approach, Safe Surgical Dislocation Hip, Herbert Screw

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