Delay Fixation of Trochanteric Fractures Using Dynamic Hip Screw: A Minimally Invasive Technique

Abstract

Summary: Fixation using dynamic hip screw (DHS) is well accepted as a treatment method for stable type trochanteric fractures. In delayed fixation cases, the conventional technique for DHS fixation with large exposure may disturb fracture callus and retard fracture healing. To minimize the disturbance of the fracture area, a minimally invasive method of DHS insertion has been developed. The method includes the insertion of lag screw guide-wire by free hand technique. Tapping and lag screw insertion is performed as in the conventional technique. The position of the T-handle is rotated 90 degrees clockwise before removal. The barrel is inserted with the side-plate in 90 degrees upward direction until the side-plate reaches the cortex. The side-plate is gradually rotated counter-clockwise until it is parallel to the femoral shaft. The screw insertion to fix the side-plate to the femoral shaft is performed using fluoroscopic assisted technique. This method was successfully applied in 15 patients whose ages ranged from 67–86 years with an average of 78 years. The mean operation time was 37 minutes (range, 30–50) with average fluoroscopic time of 45 seconds (range, 30–80). Blood loss averaged 40 ml (range, 30–70). The mean length of skin incision was 3.5 cm (range, 3–5). The proposed method had minimal blood loss, short skin incision, and was performed without open manipulation at the fracture zone. There was no intra-operative complication. Fourteen cases were followed up until fractures healed with average fracture healing time of 14 weeks (range; 10–18) after surgery.