Dynamic Hip Screw Fixation of Intertrochanteric Fractures of Femur: A Comparison of Outcome With and Without Using Traction Table

Sg Gooi,Yacoob Yacoob,Benny Ewe,Eh Khoo

doi:10.5704/moj.1103.005

Abstract

Intertrochanteric fracture of the femur is one of the common fractures in the elderly. Dynamic Hip Screw (DHS) fixation is the gold standard for treatment of intertrochanteric femoral fracture. Conventional methods of achieving reduction prior to instrumentation require utilization of a traction table. A manual traction technique applied in the supine position using only a translucent table was devised to do away with the use of traction table. The rationale for this technique includes enhanced ease of set up, the ability to perform multiple procedures without repositioning and prevention of traction table related complications. Use of the reduction method with a traction table or application of manual traction during dynamic hip screw fixation of intertrochanteric femoral fracture was both feasible and safe.

Highlights

Intertrochanteric hip fracture is a common injury treated by orthopaedic surgeons
The objectives of this study were to assess the feasibility of performing intertrochanteric hip fracture reduction and dynamic hip screw (DHS) fixation without using a traction table
A variety of hip fracture fixation devices are available for treatment of intertrochanteric fracture, and dynamic hip screw (DHS) has been the gold standard treatment of intertrochanteric fracture of femur

Summary

Introduction

Intertrochanteric hip fracture is a common injury treated by orthopaedic surgeons. A variety of hip fracture fixation devices are available for treatment of intertrochanteric fracture, and dynamic hip screw (DHS) has been the gold standard treatment of intertrochanteric fracture of femur .1-2 DHS is based on the concept of allowing fracture fragments to impact, thereby achieving bone-on-bone stability, and reducing chances of implant failure, so called “controlled collapse”. A variety of hip fracture fixation devices are available for treatment of intertrochanteric fracture, and dynamic hip screw (DHS) has been the gold standard treatment of intertrochanteric fracture of femur .1-2. DHS is based on the concept of allowing fracture fragments to impact, thereby achieving bone-on-bone stability, and reducing chances of implant failure, so called “controlled collapse”. Such collapses continue until proximal fragment rests on, stable, intact distal fragments. Traction tables are presently used universally as a standard tool for DHS fixation to achieve and maintain satisfactory reduction before instrumentation is performed. There have not been many reports on traction table associated complications during DHS fixation, problems such as pudendal, sciatic or femoral nerve injury, due to traction or

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