Evaluation of Dynamic Hip Screw Blade in Extracapsular Fracture Neck of Femur in the Elderly RC01-RC03
Bhatia Orthopaedic Centre, Kunpura Road, Karnal, Haryana, India.
Introduction: Intertrochanteric fractures account for 50% of all fractures of the proximal femur, the average age of incidence being 66 to 77 years. Dynamic Hip Screw (DHS) fixation is considered to be one of the standard treatments of trochanteric fractures. The most common mode of failure with the DHS is cut-out of the screw which significantly relates to the bone mineral density of proximal femur. DHS blade was developed in an attempt to enhance anchorage of the implant in the osteoporotic bone.
Aim: To assess the radiological and functional outcome of extracapsular fracture neck femur in osteoporotic patients treated with DHS blade.
Materials and Methods: In this descriptive observational study, DHS blade fixation was done in 30 osteoporotic patients with intertrochanteric fracture of the femur. Osteoporosis was graded as per Singh’s Index. The patients were followed up for a minimum of six months with radiological and clinical evaluations. Descriptive statistics were used to analyse data.
Results: The male to female ratio was 1:2.75. The mean age of patients was 73.4±8.64 years (range 60-97 years). Thirty patients were operated with DHS blade and followed up for a minimum of six months. Pre-operatively, the patients were categorised as per Singh’s Index; 66.7% (20 cases) were in Grade 3 while 33.3% (10 cases) fell in Grade 2.
Postoperatively, the average Tip Apex Distance (TAD) was 21.66 mm (range 18-28 mm), 25 cases (83.3%) had TAD <25 mm. Neck-shaft angle of the contralateral hip was measured for comparison. No change in neck-shaft angle was observed in 21 cases (70%) however varus collapse more than 4° was seen in 2 cases (6.6%). In 2 cases (6.66%), we encountered screw penetration leading to varus collapse, shortening of the limb and medialization of the distal fragment.
Conclusion: It was seen that DHS blade is reliable and safe fixation devise for intertrochanteric fractures in elderly patients with similar cut-out rates as for DHS.