Comparative evaluation of internal fixation using dynamic hip screw (DHS) and primary hemiarthroplasty in unstable trochanteric fractures

Abstract

Background: Fractures of the trochanteric region are some of the most common fractures encountered by an orthopaedic surgeon. The Dynamic hip screw (DHS) may result in cut-out, risk of instability, and delayed weight bearing. Different types of arthroplasty such as the Leinbach and bipolar hip arthroplaties were then used. Hence; the present study was undertaken for comparatively evaluating efficacy of internal fixation using dynamic hip screw (DHS) and primary hemiarthroplasty in unstable trochanteric fractures. Materials & methods: A total of 60 patients with unstable trochanteric fractures were analyzed and broadly divided into two study groups with 30 patients in each group as follows: DHS group: Patients treated with Dynamic hip screw; andPHA group: Patients treated with primary hemiarthroplasty. All the patients underwent treatment according to their respective groups. Pre-operative and post-operative follow-up radiographs were analyzed. Harris hip score (HHS) was analyzed at follow-ups. Incidence of complications was analyzed and compared. Results: Mean HHS among the patients of DHS group and PHA group on final follow-up was found to be 76.13 and 90.69 respectively. While comparing the mean HHS among the patients of the two study groups, significant results were obtained. Three cases of non-union and two cases of delayed union were encountered in the DHS group while none of the patients of the PHA group exhibited non-union or delayed union. Incidence of complication was significantly higher in the DHS group.Conclusion: In patients undergoing treatment for unstable trochanteric fractures, better outcome with lesser complications are associated with primary hemiarthroplasty in comparison to dynamic hip screw.