Abstract
Currently, approximately half of all hip fractures are extracapsular, with an incidence as high as 50 in 100,000 in some countries. The common classification systems fail to explain the logistics of fracture classification and whether they all behave in the same manner. The Muller AO classification system is a useful platform to delineate stable and unstable fractures. The Dynamic hip screw (DHS) however, has remained the ‘gold standard’ implant of choice for application in all extracapsular fractures. The DHS relies on the integrity and strength of the lateral femoral wall as well as the postero-medial fragment. An analysis of several studies indicates significant improvements in design and techniques to ensure a better outcome with intramedullary nails. This article reviews the historical trends that helped to evolve the DHS implant as well as discussing if the surgeon should remain content with this implant. We suggest that the gold standard surgical management of extracapsular fractures can, and should, evolve.
Highlights
A proximal femoral fracture refers to any fracture of the femur between the articular surface of the hip joint, and a point 5 cm distal to the distal part of the lesser trochanter
The optimal implant for the surgical treatment of extracapsular hip fractures remains a contentious matter, with opinion divided over dynamic hip screw (DHS) devices and intramedullary nails (IMN)
Not all fractures behave in the same manner and it is increasingly apparent that recognition of subtypes of extracapsular fractures is an important factor in implant selection
Summary
A proximal femoral fracture refers to any fracture of the femur between the articular surface of the hip joint, and a point 5 cm distal to the distal part of the lesser trochanter. With the exception of fractures of the femoral head, these injuries are divided into two groups by their relationship to the capsular attachments of the hip joint. Intracapsular fractures occur proximal to the point at which the hip joint capsule attaches to the femur. Extracapsular fractures occur distal to the hip joint capsule. The optimal implant for the surgical treatment of extracapsular hip fractures remains a contentious matter, with opinion divided over dynamic hip screw (DHS) devices and intramedullary nails (IMN). Not all fractures behave in the same manner and it is increasingly apparent that recognition of subtypes of extracapsular fractures is an important factor in implant selection.
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