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

Abstract

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.

Clinico-radiological and functional outcome of intertrochanteric fractures by dynamic hip screw

“…The medial and posteromedial fracture fragments were the most important elements in determining the severity of intertrochanteric fracture [4,5] . Lakho et al observed acceptable outcomes in 81.1% (86) patients at the end of three months treated with DHS for unstable intertrochanteric fractures in 106 patients [6] . Mardani et al reported despite the complications of fixation with the DHS device, it remains the most successful for treatment of intertrochanteric fractures over LCP [7] .…”

Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients aged 85 years or more

“…Although multiple operation methods: dynamic hip screws, Medoff sliding plate, percutaneous compression plating, less invasive stabilization system, Gamma nail and PFNA, can be used for fixation in elderly ITFs, intramedullary fixation especially PFNA is considered as the gold standard for elderly ITFs treatment. [ 9 , 16 , 17 ] But, due to failures of PFNA have also been reported in elderly ITFs patients, [ 7 ] lots of researchers tried BPH as the primary treatment option for elderly ITFs patients, however, the conclusion of BPH as the primary option for elderly ITFs patients differs in different papers. [ 4 – 7 ] In this study, we as the first study to investigate clinical data of elderly ITFs patients aged 85 or more treated with PFNA or BPH, and found that although BPH and PFNA have similar functional outcome and mortality rates 12 months after operation, BPH has more postoperative complications in elderly patients aged 85 years or more with ITFs, BPH is not a good primary treatment for ITFs in elderly patients aged 85 years or more.…”

Современный Взгляд На Конструкции Для Экстрамедуллярного Остеосинтеза Вертельных Переломов Бедренной Кости (Обзор Литературы)

“…(2015) очередной раз доказано, что при стабильных переломах вертельной области бедренной кости DHS конструкция по-прежнему считается незаменимым вариантом фиксации [27,28]. По сообщению Muhammad T. et al, (2019), при использовали DHS конструкций у 106 пациентов с нестабильными межвертельными переломами бедренной кости в возрасте от 18 до 75 лет у 81% пациентов после трех месяцев наблюдения достигнуты хорошие результаты [29]. Mattia Alessio-Mazzola et al, (2022) провели ретроспективный анализ лечения двух групп пациентов с меж-вертельными переломами бедренной кости (всего 85 пациентов), средний возраст которых оставил 82 года.…”