Cement-augmented dynamic hip screw (DHS) to manage intertrochanteric fractures (ITFs) in the elderly: a prospective case series

Abstract

Background: The purpose of this study was to report early results in managing intertrochanteric fractures (ITF) in an elderly patient cohort using a cement augmented dynamic hip screw (DHS) by a relatively easy technique with cheap instruments available in any operative room. Methods: In this prospective study, 25 patients aged 70 yr or more who were diagnosed with ITF were included. Conventional DHS instruments were used for fixation. An endotracheal tube, and a disposable 50-cc plastic syringe with a nozzle were used to inject low viscosity polymethylmethacrylate (PMMA) bone cement inside the lag screw tract to obtain cement augmentation. Results: After an average follow-up of 8.3±2.1 mo, 20 patients (11 women and nine men) with a mean age of 76.9±5.8 yr were available for assessment. Sixteen patients were classified as AO/Orthopaedic Trauma Association (AO/OTA) type 31-A2, and four were classified as AO/OTA 31-A1. The average operative time was 70.3±9.5 min. All patients achieved radiographic fracture union by the last follow-up with an average tip apex distance of 21.8±1.9 mm. the average functional outcome according to the Salvati and Wilson scoring system was 27.4±5.9; 80% of the patients scored excellent and good. No complications were reported to the cement augmentation technique particularly lag screw cut out, implant failure, and femoral head avascular necrosis. Conclusions: Managing ITFs in elderly patients using a cement-augmented DHS revealed an acceptable functional and radiographic outcome with the use of a relatively easy, inexpensive, and safe technique. Level of Evidence: Level IV.