Sliding Screw Implants for Extracapsular Hip Fractures

Abstract

Hip fractures are associated with significant mortality and morbidity for the patients, more dependent residual status, and increased socio-economic cost. Many hip-fracture patients experience severe functional impairment, and most never recover their pre-fracture level of function. Current research has sought to identify the most effective treatments to reduce the incidence of hip fractures, improve survival and quality of life, and minimize complications and disability. The treatment of these fractures in the elderly aims to return these people to their pre-fracture mobility and functional level. This article reviews the surgical treatment options for extracapsular hip fractures and discusses their associated advantages, disadvantages, and complications. Two types of implants are currently available: the dynamic hip screw (DHS), and the intramedullary hip nail with one or two sliding screws. In this review, no clear advantage of one implant over another for the treatment of extracapsular hip fractures was evident. Both the DHS and hip nails can be used successfully for the treatment of stable hip fractures; for unstable fractures and low subtrochanteric fractures, hip nails are preferred. Although hip nails are associated with limited exposure, lower blood loss and transfusion requirements, and shorter operative time, complications are more common with hip nails. Long-term survival and function are similar in the two approaches. Hip nails with two sliding screws do not seem to make the difference in clinical practice that is reported in biomechanical studies.

Predictors for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary nailing

“… 5 , 6 Adunsky et al 7 has shown that blood transfusion requirement is greater in per-trochanteric fractures than subcapital fractures. There are studies that support increase blood loss in patients with extra-capsular fractures treated with intramedullary device 8 , 9 while a few reports no difference 10 , 11 , 12 , 13 and some demonstrate lower blood loss with intramedullary devices. 14 An extensive meta-analysis done by Huang et al 15 has shown that proximal femoral nailing and dynamic hip screw operations had comparable operation time, blood transfusion, hospital stay, wound complications, reoperation and mortality rate.…”

“…The choice depends upon fracture personality, surgeon's preference and availability of the hardware. There is no consensus on the superiority of one over the other, 8 but cephalo-medullary device has gained popularity in recent years in which concerns are blood loss and transfusion requirement in patients treated with an intramedullary device. 9 We undertook this study to determine predictive factors and requirement of perioperative blood transfusion in patients with extra-capsular neck fractures treated with an intramedullary device and whether there should be a selective or liberal transfusion policy.…”

Intertrochanteric hip stress fracture in a male ultramarathon runner

“…The optimal time for surgery is not well defined, but it is believed that operative fixation within a few days of the injury leads to the best outcomes 19. Standard options for operative fixation include the DHS and the intramedullary hip nail with one or two sliding screws,20 as in our case, in which a DHS plate was used.…”

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

“…Dynamic hip screw (DHS) is a recommended implant designed for the fixation of unstable intertrochanteric fractures [13,19]. However, a number of complications have been reported associated with DHS fixation.…”

“…Intramedullary stabilization of unstable fractures can play an essential role in the selection of an intramedullary implant. It must be ensured that it also finds suitable support in the distal fragment [13]. However, with respect to unstable fractures, intramedullary fixations with shorter lever arm have a theoretical advantage over the extramedullary implants.…”