DHS Osteosynthesis for Proximal Femoral Fractures: Infectious Complications

Abstract

PURPOSE OF THE STUDYEvaluation of infectious complications in patients with proximal femoral fractures treated by osteosynthesis using dynamic hip screws (DHS). MATERIALThe group included 501 patients with 532 DHS procedures performed in the years 1996-2010. In 31 patients osteosynthesis was carried out bilaterally. METHODSOsteosynthesis was indicated for femoral neck fracture in 18 hips and for pertrochanteric fracture in 514 hips. Prophylactic antibiotic therapy was administered within 48 hours of surgery. The occurrence of infectious complications (surface and deep wound infection), presence of infectious agents, risk factors, and the course of treatment and its outcome were investigated. RESULTSOf 532 fractures treated by DHS osteosynthesis, seven were infected (1.3%) as follows: one fracture of the femoral neck with methicillin-resistant Staphylococcus aureus, and, of six pertrochanteric fractures, four with Staphylococcus aureus, one with Escherichia coli and one with Staphylococcus epidermidis. Surface wound infection was diagnosed in one case (0.2%) and deep infection in six cases (1.1%). Five revision DHS procedures were carried out in five patients. One or more risk factors were found in each patient with infected DHS. The treatment of infection included wound dressing and abscess drainage without reoperation in two cases, implant removal in three, and implant removal with femoral head resection and spacer insertion in two cases. Second-stage total hip arthroplasty (THA) was performed in one case. Of the seven infected fractures, five (71%) healed successfully. DISCUSSIOnDHS osteosynthesis is a reliable method for treating proximal femoral fractures. The 1.3% infection rate in our group is comparable with other relevant studies. This complication is serious and requires prolonged treatment but is not as devastating as an infected THA. For the treatment of infected DHS osteosynthesis, standard methods from screw removal to second-stage THA were employed. COnCLUSIOnSInfectious complications following osteosynthesis with dynamic hip screws are rare events in the treatment of proximal femoral fractures. Staphylococcus aureus was the most frequently isolated infectious agent. Each infectious complacation was associated with one or more risk factors. Antibiotic prophylaxis is important particularly in patients at risk.

Dynamic hip screw in proximal femoral fractures followed by “single-stage” hip arthroplasty—retrospective analysis

“…The correct indication for the primary treatment of proximal femoral fracture is absolutely essential, with the focus on the minimalising complications [16]. But some complications will inevitably occur [17,18]. DHS revision is a relative rare procedure.…”

Factors Influencing Complication Rates in the Orthopaedic Theatre

“…A prolonged case time, excessive number of cases on the operating table and being at the end of the case order increase the infection risk by causing an increase in particle count in the operating theater, colonization and contamination in the surgery site (8,9,18,19). Naranje et al analyzed the effect of the duration of surgery on the infection rates in total knee arthroplasty and stated that the infection incidence rate increases with a prolonged operation time (24).…”