Fixation of Intertrochanteric Fractures: Dynamic Hip Screw versus Locking Compression Plate

Mardani-Kivi, Mohsen; Mirbolook, Ahmadreza; Jahromi, Sina Khajeh; Rad, Melina Rouhi

doi:10.5812/traumamon.10436

Cited by 15 publications

(10 citation statements)

References 21 publications

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“…Outcomes were independent of gender and body mass index of patients; nonetheless, relatively poor functional and radiological outcomes were observed in diabetic and elderly patients (>65). Our findings are comparable to past studies such as Mardani-Kivi et al [23]. According to this study, DHS is a more reliable and successful treatment option in intertrochanteric fracture as compared to locking compression plate (LCP).…”

Section: Discussionsupporting

confidence: 91%

“…Incidences of device failure and limb shortening were comparatively lesser in DHS groups after six months of follow-up. 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].…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 91%

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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“…Govindasamy et al 6 reported mean Harris Hip Score 85.5 (83-94) with no poor result in 18 patients treated with PFLCP. Mohsen Mardani et al 24 reported Harris Hip Score 24 patients treated with DHS with stable fracture was 87.08 and for unstable fracture (36 patients) score was 84.61, while score for patients treated with PFLCP having stable fractures was 85.43 and with unstable fracture was 81.20.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Various Methods of Trochanteric Fracture Fixation and Their Comparison- A Prospective Study

Singh¹,

Gautam²,

Ahmed³

et al. 2019

jemds

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BACKGROUND Trochanteric fractures are devastating injuries that most commonly affect the elderly and also the young; they have tremendous impact on both the health care system, and society in general. 1 The mainstay of the treatment of intertrochanteric fractures is fixation with DHS, intramedullary device, and proximal locking compression plate. The aim of the present study was to compare the result in terms of rate of union, time of ambulation and functional recovery of fracture intertrochanteric femur treated by either dynamic hip screw (DHS), proximal femoral interlocking nail (PFN) or proximal locking compression plate (PFLCP). METHODS This was a prospective study of 62 patients, 20 patients were treated by PFN (Group A), 32 cases were treated by DHS (Group B) and 10 cases treated by PFLCP (Group C). All Patients were followed up at 1 month, 3 months, 6 months and 1 year. Results were compared for functional outcome by using Harris Hip Score. RESULTS Comparison of Harris hip score at 12-month-follow-up period revealed that PFN group to be significantly more mobile (PFN-94.8 vs. DHS-90.8 vs. PFLCP-89.3). p-Value for PFN vs. DHS group is 0.12, p value for PFN vs. PFLCP is 0.073 (>0.05) and p value for DHS vs. PFLCP is 1.00. All p values show insignificant difference in functional outcome of patients. It shows that most of patients achieved approximately same level of functional outcome at the end of one year. CONCLUSIONS PFN is a biomechanically good device for fixation of comminuted intertrochanteric fracture femur. PFN allows faster mobilization, early rehabilitation, lower implant failure rate, and faster union as compared to DHS and PFLCP. In our study, PFLCP seems to be feasible alternative to PFN and DHS in certain complex, unstable, comminuted trochanteric fractures when weight bearing was restricted till radiological signs of fractures healing are seen. HOW TO CITE THIS ARTICLE: Singh G, Gautam S, Ahmed N, et al. Evaluation of various methods of trochanteric fracture fixation and their comparison-a prospective study.

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“…Approximately half of all hip fractures are intertrochanteric femoral fractures, defined as extracapsular fractures that occur between the greater and lesser trochanter of the proximal femur 3 . In patients over 50 years of age, more than 90% of hip fractures are intertrochanteric fractures with 20%-30% of these cases experiencing complications and a mortality rate of approximately 17% 4 .…”

Section: Introductionmentioning

confidence: 99%

“…Dynamic hip screw (DHS) as an extramedullary construct or intramedullary nail with a cephalomedullary screw is the standard surgical treatment option chosen by most surgeons. There is literature about comparisons between these implants, including biomechanical characteristics, indications, complications, and outcomes 4,[6][7][8][9] . The recent consensus is that the implant options for the treatment of intertrochanteric fractures are closely related to the stability of the fractures 10,11 .…”

Section: Introductionmentioning

confidence: 99%

Loss of Reduction after Cephalomedullary Nail Fixation of Intertrochanteric Femoral Fracture: A Brief Report

Pang

Zhu

et al. 2020

Orthopaedic Surgery

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Objective: At present, cephalomedullary nail is the most frequently used implant in the management of intertrochanteric fractures around the world. The implant design and fixation techniques of the cephalomedullary nail have been continuously improved to ensure uncomplicated bone union during the past decade. However, a degree of reduction loss during bone healing is still not rare in clinical work. Many attributed this complication to misoperation during the surgery and hold that a series of techniques and tips could help to avoid the loss of reduction. However, until now there has been no research to explore whether the reduction loss after the operation can be fully prevented in the best cases. The purposes of the study are as follows: (i) to evaluate the efficiency of the current established CMN techniques; (ii) to quantify the loss of reduction under an appropriately implanted CMN to anatomically realigned intertrochanteric fractures; and (iii) to explore the possible underlying causes for the inevitable loss of reduction. Methods: In the retrospective study, 163 consecutive cases with the intertrochanteric fractures fixed with standard cephalomedullary nail technique were reviewed. The anatomical reduction and optimal positioning of the nail were confirmed by postoperative imaging. The fracture types ranged from 31-A1.1-2.3 according to the OTA/AO fracture classification. One hundred and fifteen cases with stable fracture types (31A1.1-2.1) were allocated to Group A, and 48 cases with unstable 31A2.2-2.3 fracture types were allocated to Group B. The radiological measurements included femoral neck shortening, loss of the neck-shaft angle, cutout, and cut-through of the blade. The outcomes between postoperative and 1 year after the operation were evaluated and compared. Results: The patients consisted of 66 males and 97 females with an average age of 69.4 (range: 46-78, SD: 14.6) years. At the 1-year follow-up, no fixation failure or nonunion was observed in each group. The mean femoral neck shortening and loss of the neck-shaft angle were 4.

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Fixation of Intertrochanteric Fractures: Dynamic Hip Screw versus Locking Compression Plate

Cited by 15 publications

References 21 publications

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

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

Evaluation of Various Methods of Trochanteric Fracture Fixation and Their Comparison- A Prospective Study

Loss of Reduction after Cephalomedullary Nail Fixation of Intertrochanteric Femoral Fracture: A Brief Report

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