Evaluation of Outcome of Treatment of Intertrochanteric Fracture with Dynamic Hip Screw (DHS)

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 (Harris Hip Score). Result: Nearly one third (30.0%) of the patients belonged to 7th decade and male to female ratio was 1:1.3. According to Harris Hip Score, 13(44.82%) patients were rated as excellent, 9 (31.03%) good, 5(17.24%) fair and 2(6.89%) poor. Conclusion: Dynamic hip screw (DHS) is a reliable method of fixing the stable intertrochanteric femur fractures. The reliability and long-term effect of dynamic hip screw used to treat intertrochanteric fractures of unstable variety are unsatisfactory and not up to the mark. Ibrahim Card Med J 2019; 9 (1&2): 36-41

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386 Proximal Femoral Nail (PFN) Versus Dynamic Hip Screw (DHS) In Unstable Intertrochanteric Fractures of Femur -A Comparative Clinical Study

British Journal of Surgery ◽

10.1093/bjs/znab134.267 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

V Dubey ◽

B Spiegelberg ◽

S Shahane ◽

A Samant

Keyword(s):

Blood Loss ◽

Randomized Study ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Leg Length ◽

Femur Fractures ◽

Intertrochanteric Femoral Fracture ◽

Duration Of Surgery ◽

Hip Screw

Abstract Introduction The goal of treatment of an intertrochanteric femoral fracture is restoration of patient's mobility as early as possible. The dynamic hip screw (DHS) has been used for several decades to treat these fractures. Proximal femoral nails (PFN) are reported to have an advantage in such fractures. This study aims at comparing the results of unstable intertrochanteric fractures femur treated with PFN and DHS. Method This was a prospective, randomized study which includes sixty patients. All patients were available for follow up with 30 patients in each group. The data about intraoperative blood loss, time to union, leg length shortening was collected. The functional outcome at the end of one year was evaluated using Harris Hip Score. Results Blood loss, duration of surgery, time to union and leg length shortening was significantly less in the patients treated with PFN (p < 0.05). The mean harris hip score for patients managed with PFN was significantly more than in DHS group, 12 months after surgery (p = 0.05). Conclusions PFN requires a smaller incision, lesser operative time, less blood loss and has improved functional results. In our opinion PFN may be a better fixation device for most of the unstable intertrochanteric femur fractures.

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A study to assess proximal femoral nailing versus dynamic hip screw device in surgical management of intertrochanteric fractures: a comparative study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20184719 ◽

2018 ◽

Vol 5 (1) ◽

pp. 23

Author(s):

E. S. Radhe Shyam ◽

K. Ashwin

Keyword(s):

Functional Outcome ◽

Intertrochanteric Fracture ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Technical Failure ◽

Intertrochanteric Fractures ◽

Femoral Nail ◽

Fracture Management ◽

Hip Screw

Background: The incidence of inter trochanteric fracture is expected to have doubled by 2040. Inter trochanteric fractures account for about 45% to 50% of all hip fractures in the elderly populationand out of these, near about 50% to 60% are classified as unstable intertrochanteric fractures. The goal of treatment is restoring mobility safely and efficiently, while minimizing the risk of medical complications and technical failure. This study as performed to assess functional outcome with dynamic hip screw and proximal femoral nail in intertrochanteric fracture management.Methods: It was prospective observational study done for a period of 1year from January 2016-January 2017 among patients who attended OPD or emergency department with intertrochanteric fracture. Two different implants were used dynamic hip screw (DHS) and proximal femoral nail (PFN).Results: Excellent results in functional outcome was more in case of PFN (66.6%) compared to DHS (50%). The type of trauma in DHS group was road traffic accident in 38.8%, domestic fall in 50% and others such as assault was in 11.1% while in PFN group intertrochanteric fracture was seen in 61.1% due to domestic fall.Conclusions: The functional outcome was more better with proximal femoral nail (PFN) compared to dynamic hip screw (DHS). Therefore, proximal femoral nail (PFN) should be preferred for management of intertrochanteric fractures.

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Dynamic Hip Screw with Trochanter-Stabilizing Plate Compared with Proximal Femoral Nail Antirotation as a Treatment for Unstable AO/OTA 31-A2 and 31-A3 Intertrochanteric Fractures

BioMed Research International ◽

10.1155/2020/1896935 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Chun-Wei Fu ◽

Ji-Ying Chen ◽

Yueh-Ching Liu ◽

Kuang-Wen Liao ◽

Yung-Chang Lu

Keyword(s):

Intertrochanteric Fracture ◽

Operation Time ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Intertrochanteric Fractures ◽

Residual Pain ◽

Unstable Intertrochanteric Fracture ◽

Hip Screw ◽

Proximal Femoral Nail Antirotation ◽

Im Nailing

Background. The dynamic hip screw (DHS) with the addition of an angular stable trochanter-stabilizing plate (TSP) has been considered the ideal treatment for the unstable intertrochanteric fracture type. However, there have been few comparisons between DHS+TSP augmentation with intramedullary (IM) nailing. The aim of this retrospectively registered study was to compare the clinical outcomes of patients with the unstable type of intertrochanteric fractures treated with DHS+TSP or IM nailing (proximal femoral nail antirotation (PFNA)). Methods. From June 2013 to April 2018, 358 patients with proximal femur fracture AO/OTA type 31A2 and 31A3 treated with PFNA or DHS+TSP and followed for ≥10 months postoperatively were included. The surgical-dependent outcome evaluation included the operation time, intraoperative blood loss, postoperative decrease in hemoglobin, and blood transfusion amount. Functional status was also measured. Radiographic findings and postoperative complications were recorded and analyzed. Result. The operation time was significantly shorter in the DHS+TSP group than that in the PFNA group for both A2 and A3 fractures (A2 type: 84.0 vs.96.4 min; p<0.05; A3 type: 102.4 vs.116.1 min; p<0.05). Postoperative decrease in hemoglobin was more significant in the PFNA group than that in the DHS+TSP group for both fracture types (A2 type: −1.88 vs. −1.29 (mg/dL); p<0.05; A3 type: −1.63 vs. −1.04 (mg/dL); p<0.05). However, the patients treated with DHS+TSP had significantly more residual pain than those treated with PFNA during the final follow-up (Visual Analog Scale score, A2 type: 28.4 vs.23.2; p<0.05; A3 type: 27.5 vs.23.6; p<0.05) and complained of greater implant irritation. Conclusion. We found that DHS+TSP was associated with less operation time and less postoperative decrease in hemoglobin but more residual pain and implant irritation than those of PFNA. As a treatment for unstable intertrochanteric fracture, DHS+TSP provided ideal surgical outcomes which were not inferior to the PFNA.

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Randomized control trial comparing the functional outcomes of dynamic hip screw and locking plate dynamic hip screw in intertrochanteric fractures of femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201090 ◽

2020 ◽

Vol 6 (3) ◽

pp. 525

Author(s):

Kiran Ramachandran ◽

Dileep Sasidharan ◽

Oommen Mathew

Keyword(s):

Functional Outcomes ◽

Locking Plate ◽

Dynamic Hip Screw ◽

Research Centre ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Neck Shaft Angle ◽

Operative Care ◽

Significant Difference ◽

Hip Screw

Background: The objective of the study was to compare the functional outcomes of intertrochanteric fractures of the femur treated with dynamic hip screw (DHS) and locking plate DHS in elderly.Methods: 48 participants (23 in DHS and 25 in locking plate DHS) aged ≥ 50 years with intertrochanteric fracture of femur were enrolled in the present randomized open label parallel group trial conducted at Pushpagiri Institute of Medical Sciences and Research Centre during a period of 1 year. Open, pathological, other fractures in the same limb and participants with neurological involvement were excluded. Standard of care (pre and post-operative care) was given to all participants. Sociodemographic, radiological findings, fracture type and Singh’s index were recorded at baseline, 6 weeks, 3 and 6 months. Study commenced after approval from Institutional Ethics Committee and written informed consent was obtained from all study participants. Participants were randomized in 1:1 ratio using coin flip method. Quantitative variables were expressed means and medians and qualitative variables were expressed as proportions. Tests of significance were independent sample t test, Mann Whitney U test, Friedman test and Chi square test.Results: Between DHS and locking plate DHS, no significant difference in baseline parameters, neck shaft angle, tip apex distance, shortening, Harris hip score, range of motion score and length of hospital stay were observed.Conclusions: The functional outcomes and complications between DHS and locking plate DHS were not significantly different.

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A comparative study on the functional outcome of intertrochanteric fractures treated by proximal femoral nailing or dynamic hip screw fixation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20205559 ◽

2020 ◽

Vol 7 (1) ◽

pp. 51

Author(s):

Gineshmon Chandy ◽

Saju S.

Keyword(s):

Functional Outcome ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Femoral Nailing ◽

Hip Screw ◽

Group 2 ◽

Proximal Femoral Nailing ◽

Radiological Union ◽

Unstable Fractures

Background: Intertrochanteric fractures are one of the commonly occurring injuries in elderly patients and are high among females and those with osteoporosis. They were treated with either dynamic hip screw (DHS) fixation or proximal femoral nailing (PFNA2) here at our institution. The study was conducted in order to find which method of surgical fixation has better functional outcome. Methods: Total 96 patients of intertrochanteric fractures admitted during the study period of November 2017 to April 2019 were included for the study. These patients were randomly divided into two groups; DHS was used as implant in group1 and PFNA2 in group 2. Postoperatively patients were followed up after 1 month, 3months and 6 months of the surgery and were assessed using Harris hip score.Results: Harris hip score was higher with PFNA2 group compared to DHS group in all follow-ups. In unstable fractures DHS group had poor outcome compared to PFNA2. Radiological union occurred in 27.1 % cases by 3 months and 72.9% cases by 6 months with DHS whereas 70.8% and 97.9% respectively with PFNA2. Conclusions: PFNA2 gives a better functional outcome when compared to DHS. Even though DHS gives good functional outcome in stable fractures it is not so in the case of unstable fractures. The radiological union also is faster with proximal femoral nailing. Hence in our opinion PFNA2 can be the better fixation device compared to DHS especially in unstable fractures.

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A comparative study between proximal femur locking compression plate and dynamic hip screw fixation in management of intertrochantric femur fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164163 ◽

2016 ◽

Vol 2 (4) ◽

pp. 327

Author(s):

Mithlesh Kumar Meena ◽

Vinay Joshi

Keyword(s):

Locking Plate ◽

Locking Compression Plate ◽

Dynamic Hip Screw ◽

Intertrochanteric Fractures ◽

Trochanteric Fractures ◽

Superficial Infection ◽

Femur Fractures ◽

Compression Plate ◽

Hip Screw ◽

The Mean

Background: Proximal femur fractures are one of the commonest fracture encountered in orthopaedic trauma practice. Dynamic hip screw (DHS) is the gold standard procedure for treatment for stable intertrochanteric fractures, however problem arises with unstable fractures in maintenance of neck shaft angle and proper reduction. Here we are giving results of trochanteric fractures treated with proximal femoral locking compression plate (PFLCP) as compared with dynamic hip screw (DHS).Methods: This study was a prospective study. Two groups of trochanteric fractures of 25 patients operated with DHS and LCP were taken. Each patient was followed-up from July 2011 to October 2012 for minimum of 12 month or till the bony union. Every fracture was classified according to AO classification. Functional results will be assessed as per modified Harris hip evaluation score.Results: Among 25 patient treated with PFLCP, length discrepancy was .857 cm while that for DHS was 1.2 cm. The mean time of unaided walking with LCP Was 14.20 weeks while for DHS it was 16.20 weeks. The mean varus angulation for LCP 8 degree while for DHS 10.2 degree. In LCP in 1 case screw cut out from head and neck of femur while in DHS, same is seen in 2 cases and in addition loss of position of lag screw seen in 5 cases.one case was found with superficial infection in LCP while in case of DHS 3 cases with deep infection for that implant was removed and 6 cases were found with superficial infection.Conclusions: Proximal femoral locking plate (PFLCP) is simple, stable for fixation with fewer complications, and is an effective method for unstable intertrochanteric fractures. Comparing with DHS group, the locking plate has shorter operative time, fewer blood loss and drainage.

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Functional and radiological outcome of osteosynthesis using proximal femoral nail antirotation II system in intertrochanteric femoral fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210619 ◽

2021 ◽

Vol 7 (2) ◽

pp. 267

Author(s):

Wajahat Ahmad Mir ◽

Mohmad Nawaz Rather ◽

Rasiq Rashid

Keyword(s):

Morbidity And Mortality ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Common Source ◽

Intertrochanteric Fractures ◽

College Hospital ◽

Femur Fractures ◽

Femoral Nail ◽

Proximal Femoral Nail Antirotation

Background: Intertrochanteric fractures are relatively common injuries in adults and a common source of morbidity and mortality among the elderly. Incidence of fractures is increasing because the general life expectancy of the population has increased significantly during the past few decades. Stable fixation and early mobilization is needed in these fractures to reduce the morbidity and mortality. Extra-medullary implants are biomechanically inferior in these cases. The proximal femoral nail antirotation-II (PFNA-II) is an intra-medullary nail system designed for such fractures. The purpose of this study was to assess the results and complications of PFNA-II in intertrochanteric femur fractures.Methods: After seeking approval from institutional Ethical committee, this study was conducted on 30 patients attending our emergency department with intertrochanteric femur fractures at SKIMS Medical College Hospital Bemina, Srinagar from February 2018 to June 2019. The patients were treated with proximal femoral nail antirotation-II. Follow up was done at 2, 6, 12 and 24 weeks. The functional outcome was assessed at 6 months follow up using the Harris Hip Score.Results: Based on the Harris hip score, 18 (60%) patients had excellent results, 10 (33%) had good results and 2 (7%) had Fair results. None of the patients had poor result. Average time to union was 12.27 weeks.Conclusions: This study found the PFNA-II to be a versatile, easy to use and dependable implant for stable as well as unstable intertrochanteric fractures. PFNA II is distinct advance over the previous methods of treatment, though it has an initial learning curve.

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Comparative study between proximal femoral nail and dynamic hip screw with trochanteric stabilizing plate in unstable intertrochantric femur fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173198 ◽

2017 ◽

Vol 3 (5) ◽

pp. 936

Author(s):

Siddaram N. Patil ◽

Pandurangaiah Srinivas

Keyword(s):

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Unstable Fracture ◽

Intertrochanteric Fractures ◽

Femoral Nail ◽

Hip Screw ◽

Mobility Score ◽

Unstable Fractures ◽

Parker Mobility Score

Background: Unstable fractures accounts for approximately 50 to 60% of all intertrochanteric fractures. Failure rates of (DHS) dynamic hip screw for unstable fracture patterns are as high as 50%. Proximal femoral nail is technically more demanding surgery and also associated with complications like implant failure, femoral shaft fracture, improper reduction, screw cut-out and non-union. This study was done to compare the results of using Trochanteric stabilization plate in addition to dynamic hip screw versus proximal femoral nail which is considered as a better implant for unstable fractures.Methods: A prospective study was conducted comparing outcomes of proximal femoral nailing versus trochanteric stabilization plate with dynamic hip screw for 44 patients with unstable intertrochanteric fractures (22 each). Harris hip scoring system and Parker mobility score was used for evaluation.Results: In our study, Average time of union in all 22 patients of PFN group was about 12 weeks while average time of union in all 22 patients of DHS with TSP group was about 14 weeks. The Harris hip score was 85.45 in DHS with TSP group while it was 84.72 in the PFN group (p=0.846). The Parker mobility score was 7.81 in the DHS with TSP group while it was 7.95 in the PFN group (p=0.728). Conclusions: Use of TSP with DHS can give good results in unstable IT fractures. Addition of TSP to DHS gives good lateral wall buttress which prevent excessive medialisation of shaft and gives comparable result to PFN.

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Factors determining failure of intertrochanteric fracture fixation with a dynamic hip screw: a retrospective analysis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20183422 ◽

2018 ◽

Vol 4 (5) ◽

pp. 720

Author(s):

Ravi K. Jain ◽

Abhineet Verma ◽

Arjun Jain ◽

Yogesh Patel

Keyword(s):

Femoral Head ◽

Intertrochanteric Fracture ◽

Dynamic Hip Screw ◽

P Value ◽

Unstable Fracture ◽

Intertrochanteric Fractures ◽

High Positive Correlation ◽

Lag Screw ◽

Loss Of Reduction ◽

Hip Screw

Background: The intertrochanteric fractures are extra capsular fractures of proximal femur in the trochanteric region. Different fixation techniques were tried for intertrochanteric fractures, with variety of implants but the dynamic hip screw fixation is most widely accepted treatment. However, several authors have concluded that sliding compression screws may be associated with several complications such as perforation of the femoral head, loss of reduction caused by excessive sliding of the lag screw, non-union, shortening of the affected limb and pain. This study was carried out to ascertain the factors that contributed to mechanical failure at our institute.Methods: We retrospectively reviewed 92 patients with unilateral intertrochanteric fracture treated with a sliding hip screw between July 2015 and April 2017. Postoperative radiographs were studied for any loss of reduction, which was defined as a varus deformity greater than 10°, perforation of the femoral head, extrusion of the lag screw of more than 20 mm, or metal failure. The Pearson chi-square test was used to assess the relationship between failure and osteoporosis. A p value of less than 0.05 was considered to be significant.Results: Results revealed a significant relationship between failure and osteoporosis. A possible relationship between the stability of the fracture on Evans’ classification and osteoporosis on Singh’s index was investigated which revealed a high positive correlation between the failure rates of unstable fractures with osteoporosis.Conclusions: An unstable fracture combined with osteoporosis, has higher percentage of fixation failure leading to other methods of treatment like hemiarthroplasty.

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Comparative analysis between dynamic hip screw with trochanteric stabilisation plate and dynamic hip screw alone in the management of unstable intertrochanteric femur fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20204597 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1280

Author(s):

Rajeev Anand ◽

Amit Dwivedi ◽

Anupinder Sharma

Keyword(s):

Comparative Analysis ◽

Functional Outcome ◽

Normal Function ◽

Dynamic Hip Screw ◽

Intertrochanteric Fractures ◽

Trochanteric Fractures ◽

Femur Fractures ◽

Good Score ◽

Hip Screw ◽

Fractures Of The Femur

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 patientsOf 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.

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