Dynamic Hip Screw with Trochanteric Stablization Plate Fixation of Unstable InterTrochanteric Fractures: A Prospective Study of Functional and Radiological Outcomes

Shetty, Asode Ananthram; Ballal, Arjun; Sadasivan, Anand Kumar; Hegde, Anoop

doi:10.7860/jcdr/2016/20275.8415

Cited by 14 publications

(20 citation statements)

References 18 publications

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“…15 patients (46%) had poor bony union, while 17 (53.5%) patients had good bony union. Regarding the functional outcome; 9 (28%) patients had excellent results, 10 (31%) had [13]. However, this study lacked the comparative quality with other management options (Table 3).…”

Section: Discussionmentioning

confidence: 96%

Management of unstable pertrochanteric fractures, evaluation of forgotten treatment options

Selim

Beder

Algeaidy

et al. 2020

SICOT-J

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Introduction: Unstable trochanteric fractures are challenging with a high rate of implant failure and re-operation. Cephalomedullary nails proved to be a rational management choice for these injuries, yet other management options have not been well assessed. The aim of this study was to compare the use of DHS with trochanteric stabilizing plate (TSP) and proximal femoral locked plate (PFLP) in unstable pertrochanteric fractures. Methods: This randomized controlled trial (RCT) included 40 patients (22 males, 18 females) with unstable pertrochanteric fractures (AO/OTA 31A2.2/A2.3). The patients were randomized into group 1 managed by DHS with TSP while group 2 was managed by PFLP. All patients were followed up for 1 year. Patients were assessed radiographically and clinically using Harris hip score (HHS) at 3, 6 and 12 months. Operative time, estimated blood loss and time to union were also compared. Results: The difference of intra-operative variables, including operative time and intra-operative blood loss, between both groups was statistically insignificant. Time to bony union was faster in the first group with a statistically significant P value (p = 0.04). Functional outcome per HHS was significantly better in group 1 (p < 0.01) and implant failure in group 1 occurred statistically lesser (p < 0.01). Discussion: DHS with TSP appears to be a good option of management for unstable pertrochanteric fractures. In contrast, the use of PFLP in unstable pertrochanteric fractures in the elderly does not appear to be a good alternative.

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Section: Discussionmentioning

confidence: 96%

Management of unstable pertrochanteric fractures, evaluation of forgotten treatment options

Selim

Beder

Algeaidy

et al. 2020

SICOT-J

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“…Based on the Harris Hip Score, outcomes were classified as excellent in 31.7%, good in 63.3%, and fair in 5.0% of the patients [23]. Similarly, Shetty et al also reported good functional and radiological outcomes of DHS fixation of unstable intertrochanteric fractures with excellent to a good outcome in 59.4% as per the Harris Hip Score [24]. Another study by Barwar et al reported excellent outcomes at one year in 45.8% and radiologically united fracture after the third month was found in 66.7% of the patients [25].…”

Section: Discussionmentioning

confidence: 99%

Functional and Radiological Outcome of Unstable Intertrochanteric Fracture Post Dynamic Hip Screw Fixation

Lakho

Jatoi

Azfar

et al. 2019

Cureus

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Introduction Intertrochanteric fractures are the most frequently operated fracture type and have the highest postoperative fatality rate. The most commonly used devices are the dynamic hip screw (DHS) with side plate assemblies and proximal femoral nail (PFN). The aim of this study was to determine the functional and radiological outcome of unstable intertrochanteric fracture post DHS fixation at a tertiary care hospital in Karachi, Pakistan. Methods A study was carried out in the department of orthopedics at the Jinnah Postgraduate Medical Center (JPMC), from 12th June 2016 to 8th September 2017. A total of 106 patients between 18 and 75 years of age with unstable intertrochanteric fracture were included. Those patients who had multiple injuries and open fractures, subtrochanteric fractures, intracapsular fractures neck of femur, pathological fractures and patients who were non-ambulatory prior to their injury were excluded. Functional outcomes were measured both during pain using the visual analog scale and range of motion on goniometer between 80 and 100 degrees. Satisfactory outcomes were measured after three months. Results A total of 106 patients with the radiological diagnosis of the unstable intertrochanteric fracture having post DHS fixation were included in this study. Out of which, 69.8% (74) were males and the mean age was 66.61 ± 7.79 years over the range of 50 to 80 years. Patients with type II diabetes were 22.6% (24) with a mean duration of 4.3 ± 8.37 years. At the end of three months, no pain was reported in 82.1% (87) patients and 85.8% (91) patients had normal function. The satisfactory radiological outcome was observed in 86.8% (92) patients. Overall, acceptable outcomes were observed in 81.1% (86) patients at the end of three months. Conclusion The treatment of unstable intertrochanteric fracture with dynamic hip screw (DHS) fixation results in better outcomes. In our study, we observed acceptable outcomes in a vast majority, 81.1%, of patients after three months of DHS fixation of the unstable intertrochanteric fracture.

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“…Over several years, the DHS has demonstrated effective stabilisation of trochanteric fractures with excellent functional outcomes. 10 The DHS comprises a plate and screws applied to the lateral side of the femur and allows the fracture to collapse in a controlled fashion, providing stability while allowing prompt postoperative weight bearing. 11,12 The DHS is used extensively in NHS practice, and results from the National Hip Database for 2016 show that around 80% of trochanteric fractures receive the DHS implant.…”

Section: Clinical Medicine Insights: Trauma and Intensive Medicinementioning

confidence: 99%

Is There Evidence that the Percutaneous Compression Plate Method of Internal Fixation for Intertrochanteric Hip Fractures Leads to Better Intraoperative and Postoperative Outcomes than the Dynamic Hip Screw?

Halle‐Smith

Carnegy

Carr

et al. 2018

Clinical Medicine Insights: Trauma and Intensive Medicine

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BACkgROunD: Hip fractures are common, expensive and lead to considerable morbidity and mortality. An ageing population in the United Kingdom means that rates of this injury are increasing, making them a pressing public health issue. The National Institute of Health and Care Excellence (NICE) recommends that extramedullary implants are used over intramedullary nails to fix intertrochanteric fractures, which make up half of all hip fractures. However, there is currently no guidance on the preferred type of extramedullary device whether this be the commonly used dynamic hip screw (DHS) or another newer device. It has been suggested that a percutaneous compression plate (PCCP) can reduce complications and improve functional outcome compared with the traditional DHS. REvIEw QuESTIOn: In patients with intertrochanteric hip fractures, is the PCCP more effective than the DHS in terms of relevant intraoperative and postoperative outcomes such as blood loss, implant failure, and mortality? LITERATuRE SEARCH: We first searched for relevant information in the NICE Clinical Guideline on Hip Fracture Management (CG124), then National Health Service (NHS) evidence for Clinical Knowledge Summaries, then the Cochrane library for systematic reviews. Finally, we conducted an electronic search of the PubMed database. REvIEw FInDIngS: We selected five systematic reviews and eight primary studies for review. The main findings were that the PCCP was associated with significantly less blood loss, fewer blood transfusions, and shorter operating times compared with the DHS. However, no significant differences were found in postoperative pain, orthopaedic performance, and mortality rates between the two methods. There was no comparison of cost-effectiveness between the two methods. COnCLuSIOnS: The PCCP is superior to the DHS in terms of intraoperative blood loss and, potentially, non-orthopaedic postoperative complications such as deep vein thrombosis and nosocomial infection. However, there was no significant difference in mortality rates between the two methods. Current studies on this topic have several methodological issues and some are of relatively poor quality. Further higher quality research and cost-effectiveness are necessary to further evaluate the efficacy of these methods.

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Dynamic Hip Screw with Trochanteric Stablization Plate Fixation of Unstable InterTrochanteric Fractures: A Prospective Study of Functional and Radiological Outcomes

Cited by 14 publications

References 18 publications

Management of unstable pertrochanteric fractures, evaluation of forgotten treatment options

Management of unstable pertrochanteric fractures, evaluation of forgotten treatment options

Functional and Radiological Outcome of Unstable Intertrochanteric Fracture Post Dynamic Hip Screw Fixation

Is There Evidence that the Percutaneous Compression Plate Method of Internal Fixation for Intertrochanteric Hip Fractures Leads to Better Intraoperative and Postoperative Outcomes than the Dynamic Hip Screw?

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