DHS Fixation Research Articles

Different surgical interventions for unstable intertrochanteric fracture of the femur: Network meta-analysis.

Although a large body of evidence has reported on surgical approaches for the treatment of unstable intertrochanteric femoral fractures, studies that comprehensively evaluate treatment outcomes are limited. The purpose of this study was to compare the effectiveness of extramedullary fixation (i.e., dynamic hip screw [DHS]), intramedullary fixation (i.e., the proximal femoral nailing [PFN]), and hemiarthroplasty (HA) for the treatment of unstable intertrochanteric femoral fractures using network meta-analysis. This study meets the preferred reporting items for systematic reviews and meta-analyses criteria. The Patient, Intervention, Comparison and Outcome search protocol framework was used to search the Google Scholar, PubMed, Embase, and Cochrane Library databases were searched from inception until June 2023. A total of 15 randomized controlled trials, including 1282 patients were analyzed. The Harris hip score (HHS) after DHS fixation was the lowest compared with that of PFN fixation and HA. DHS fixation had a significantly longer operation time than that of PFN fixation. Compared with HA, a lower incidence of superficial wound infection was observed with PFN and DHS fixations. PFN was significantly more likely to be implant cut out compared with HA. Compared with DHS, PFN and HA showed a lower incidence of fracture healing malunion. HA and PFN have good efficacy in improving the HHS and preventing joint deformities. However, HA showed a higher incidence of superficial infection than that observed with PFN, whereas a higher risk of screw cutout is observed with PFN than with HA.

TWO-HOLE DYNAMIC HIP SCREW (DHS) FIXATION OF GARDEN I AND II NECK OF FEMUR FRACTURES: RADIOLOGICAL OUTCOMES AND PREDICTIVE FACTORS OF AVASCULAR NECROSIS

The aim of this study is to analyse the radiological outcomes and predictors of avascular necrosis following 2-hole DHS in Garden I and II neck of femur fractures in patients more than 60 years with a minimum follow up of one year.We retrospectively reviewed 51 consecutive patients aged more than 60 years who underwent DHS fixation for Garden I and II fractures. Demographics, fracture classification, time to surgery, pre-operative AMTS, preoperative posterior tilt angle, quality of reduction, pre and post-operative haemoglobin(hb), creatinine and comorbidities were analysed for correlation with AVN using Chi-Square test, Independent Sample and paired t test.There were 40 (78.4%) females and the mean age of the cohort was 77 years. 28 and 23 were Garden I and II NOF fractures respectively. Union was observed in all our patients except one(kappa =1). 12/51(23.5%) developed AVN of the femoral head. Statistically significant higher incidence of AVN was noted in patients with a pre-op tilt angle > 200 (p = 0.006). The mean drop in Hb was higher in patients who developed AVN (21.5 g/L) versus the non-AVN group (15.9 g/L) (p = 0.001). There was no difference in AVN rates with respect to laterality, mean time to surgery, pre-op AMTS and Charlson comorbidity index. 4/52 (7.6%) had re-operations (one hardware prominence, two conversions to arthroplasty, one fixation failure during the immediate post-op period). The 30-day and one year mortality rates were 1.9 % and 11.7 % respectively.2-hole DHS fixation in undisplaced NOF fractures has excellent union rates. A pre-operative posterior tilt angle of >200 and a greater difference in pre and post operative haemoglobin were found to correlate positively with the progression to AVN . No correlation was observed between AVN and time to surgery, laterality, quality of reduction and comorbidities.

Evaluation of the neck shaft angle after DHS fixation in intertrochanteric hip fractures

Introduction: The characteristic morphology of the proximal extremity of the femur and the muscle balance of the hip are factors that make weight bearing possible among patients. Restoration of neck shaft angle is as important as union because if neck shaft angle is not restored, it can lead to disability. Recent studies have been conducted with the intention of showing the relationship between fracture of the proximal extremity of the femur and the anatomical configuration of the hip. This study was a prospective one to evaluate neck shaft angle after DHS fixation in intertrochanteric fractures. Patients and Method: Prospective study done on 25 (13males and 12 females) patients who were operated by a single surgeon. Evaluation of neck shaft angle in non-fractured side and the restoration/change in neck shaft angle on the operated side after surgical fixation with DHS, radiographs taken with both hips in 15 degrees of internal rotation.Result: All fractures got united, average age of patients was 58 years, varus malunion in 2 cases and valgus in 4 cases. Average NSA on normal side was 136±4 and on operated side it was 126±4 degrees.Conclusion: The neck-shaft angle is the most important parameter after fixation of intertrochanteric fracture by DHS, we must preserve the near normal angel after fixation to avoid valgus and varus malunion.

Radiation Exposure during Dynamic Hip Screw Fixation: A Comparative Study

Background: The safe amount of radiation permissible during fixation of neck of femur fractures has long been studied. Factors including surgeons’ experience have been highlighted. We aimed in this study to compare different factors for quality and safety improvement. Methods: It was a retrospective study, including all patients who had undergone a standard DHS fixation between January 2018 and June 2019 for inter-trochanteric neck of femur fractures. Two groups were stratified; (Group A) had the procedure performed by a specialist non-consultant surgeon (NCG) and (Group B) by an established consultant (CG). The Dose Area Product (DAP) and the duration of radiation exposure were recorded. Results: Over a period of 18 months, 91 cases were included with a mean age of 82 years old. The mean weight was 62 kg. 42 patients had complex fractures, and 49 patients had simple fractures. 12% of patients were ASA II, 70% of cases were ASA III and 18% of the patients were ASA IV. The mean DAP for group A was 345.131 CGYCM2 (SD 273.65) and for group B 234.63 CGYCM2 (SD 165.30). The time of exposure was 8.6 sec and 13.16 sec in groups B and A respectively. Conclusion: The data collected from this study were comparable to others. The amount of radiation exposure was of difference related to the decision-making intra-operatively. Other factors were not statistically significant.

BIOLOGICAL PLATING OSTEOSYNTHESIS IN COMMINUTED SUBTROCHANTERIC FRACTURES WITH DYNAMIC HIP SCREW

Background: Comminuted subtrochanteric fractures represent a challenge for trauma surgeons. Fractures in the subtrochanteric region present challenges to achieving stable fixation and appropriate reduction because the subtrochanteric region of the femur is one of the highest stressed zones in the human skeleton where tensile or compressive stresses can exceed several multiples of body weight. Aim: The aim of this study is to observe the results of biological DHS fixation in the management of comminuted subtrochanteric fractures of femur in adults. Method: A prospective study was conducted on a group of 25 patients in the Postgraduate Department of Orthopaedics, Government Medical College, Srinagar. In all the patients along with personal data, mode of trauma, type of fracture, intra-operative & post-operative complications, follow up examination including hip joint examination, duration of full weight bearing was considered. Patients were assessed clinically for pain, hip and knee range of motion, angular and rotational deformities and leg-length discrepancy. Union was assessed radiographically. Results: Majority of the patients had trauma due to RTA (76%), fall from height/stairs/standing position (20%), and direct impact (4%). There were 5 type 3A, 6 type 3B, 8 type 4 and 6 type 5 fractures according to Seinsheimer classification. According to criteria laid by Trauma hip rating scale, excellent results were achieved in 16 patients, good in 8 patients and poor in 1 patient. However, no case of failure was reported. Union occurred in all cases. None of the patients had clinical pain or dysfunction. Conclusion: Biological DHS is an effective and reliable option in the treatment of comminuted subtrochanteric fractures as, DHS allows good fixation of a fracture that extends into piriformis fossa (type 5). This procedure offers the significant advantage of being less technically demanding, simple and familiar to most surgeons and Leads to less blood loss.

Comparison of DHS and PFNA Fixation in the Treatment of Intertrochanteric Fractures in the Elderly

Comparison of DHS and PFNA Fixation in the Treatment of Intertrochanteric Fractures in the Elderly

Dynamic hip screw versus intramedullary nailing for the treatment of A1 intertrochanteric fractures: A retrospective, comparative study and cost analysis.

Objectives This study aims to compare sliding hip screw and intramedullary nail perioperative results and costs in two-part femoral fractures.Patients and methods Between January 2015 and December 2019, a total of 85 patients (70 males, 15 females; mean age: 85.6±9.5 years; range, 33 to 99 years) who were treated for intertrochanteric two-part femoral fractures were retrospectively analyzed. The patients were stratified and divided into two groups according to type of implant used for surgical fixation: one group treated with intramedullary proximal femoral nail (EBA) and the other with sliding hip screw (DHS). Comorbidity, hemoglobin level (Hb), hematocrit (hct) level, number of transfusions, and days of hospitalization details were evaluated. Postoperative X-rays were analyzed to assess the quality of reduction and to identify non-union, malunion, mechanical failures, and heterotopic ossifications. The modified Harris Hip Score, fracture mobility score, and Parker Mobility Score were calculated. Cost analysis considered the orthopedic device, operating room, transfusion, and hospital costs for the primary hospital stay.Results Of the patients, 44 were treated with DHS and 41 were treated with EBA nail by a single surgeon. No significant differences were found in the baseline demographic data. There was a significant increased operative time (p<0.001) and decreased fluoroscopy X-ray exposure time (p=0.031) in the subgroup of patients who underwent DHS fixation. The patients who underwent EBA nail fixation had a significantly higher transfusion rate during hospitalization (p=0.001) and a significantly lower Hb level and hct level on postoperative Day 1 and Day 3 (p<0.05). There were no significant differences in the clinical and functional scores, radiographic outcomes and mortality (p>0.05). The patients who underwent intramedullary nail fixation had higher costs.Conclusion Sliding hip screws showed decreased postoperative anemization, lower transfusion rates, and similar clinical outcomes compared to the intramedullary nail for two-part femoral fractures. Sliding hip screws should be preferred for A1 intertrochanteric fractures.

Evaluation of the effect of preoperative hemoglobin level and proinflammatory factors on intertrochanteric fracture union.

Intertrochanteric fractures are associated with high mortality and morbidity, so these patients should undergo fracture fixation surgery immediately. Despite surgery, the possibility of fracture fusion may not occur due to the association with various causes. Therefore, our aim is to investigate these factors (TNF‑a, IL‑1, Hb) and their effect on fracture union after fixation. From 2018 to 2020, at our orthopedic trauma center, 163patients older than 50years with intertrochanteric fractures underwent DHS fixation surgery. Patients were divided into anemic and non-anemic groups in terms of preoperative hemoglobin level (standard hemoglobin 11 mg/dl). For 3 months, patients were assessed for union and failure fixation criteria, levels of proinflammation (TNF‑α, IL-1) and level of hemoglobin. The results show that out of 163patients with fractures, at the time of initial admission, 74patients had less than 11hemoglobin g/dl. Patients with union fractures had higher hemoglobin levels than patients with non-union (11.71 ± 1.51 versus 11.24 ± 1.96), which was statistically significant between hemoglobin and union level (p = 0.030). At the end of the third visit (third month), 44 (59.5%) anemic patients received union completly, while among the patients with normal hemoglobin level, 32 (36%) received union bread, which was statistically significant (p = 0.003). There were no statistically significant differences between proinflammatory factors before surgery and 3 months after surgery (p > 0.05). Due to the effect of anemia and proinflammatory factors in the process of healing fractures and bone formation and creating musculoskeletal balance, low hemoglobin level before surgery has asignificant effect on fracture union and failure of fixation. So it is recommended to correct this anemia in these patients before surgery and during follow-up.

A comparative Study of Novel Extramedullary Fixation and Dynamic Hip Screw in the Fixation of Intertrochanteric Fracture: A Finite-Element Analysis.

BackgroundDynamic hip screw (DHS) is one of the most widely internal fixations for stabilizing intertrochanteric fracture, however, with a high risk of postoperative complications. The triangle support fixation plate (TSFP) is developed to reduce the postoperative complications. The purpose of study is to evaluate the biomechanical performance of the DHS and TSFP and demonstrate the rationality of triangular internal fixation for stabilizing intertrochanteric fractures.MethodsThe CT data of the proximal femur were used to establish finite-element models. Evans type I and IV intertrochanteric fracture were constructed and stabilized with the DHS and TSFP. The Von-Mises stress, maximum principal stress, minimum principal stress, and displacement were used to evaluate the biomechanical effect of two implants on intertrochanteric fracture.ResultsUnder a 600N axial load, the maximum stress and displacement of an intact proximal femur were 13.78 MPa and 1.33 mm, respectively. The peak stresses of the bone in the TSFP were 35.41 MPa and 68.97 MPa for treating Evans type I and IV intertrochanteric fractures, respectively, which were lower than those in the DHS. The maximum overall displacement and relative distance of the fracture surface in the DHS fixation model were 1.66 mm and 0.10 mm for treating Evans type I intertrochanteric fracture, which was 29.59% and 150% higher than that in the TSFP, and were 2.24 mm and 0.75 mm for treating Evans type IV intertrochanteric fracture, which was 42.58% and 650% higher than that in the TSFP.ConclusionsIn conclusion, the TSFP has obvious advantages in stress distribution and stability than the DHS, providing a promising option for the treatment of intertrochanteric fractures.

Intertrochanteric fracture PFN vs DHS

Background: DHS fixation has remained a well-established gold standard in intertrochanteric fractures of femur for a long time. 1 However, it has shortcomings and pitfalls. In inter-trochanteric fractures of femur, DHS fixation has shown higher failure rates. PFN is a new fixation device proposed for fixation of unstable intertrochanteric fractures. 1 Being intramedullary, it is a biomechanically advantageous device which should allow better fixation of unstable intertrochanteric translating into lesser failure rates of fixation and also permitting early mobilization and faster rehabilitation especially in elderly patients. We present a study comparing outcomes of managing unstable intertrochanteric fractures with PFN and DHS. Materials and Methods: We evaluated 30 (PFN: 15; DHS: 15) cases of intertrochanteric fractures of femur out of which 26 were unstable and 4 stable type, from January 2017 to December 2018, with minimum 12 months follow up period. Mean age was 60 years for both PFN and DHS group. We studied the surgical complications in both groups and also compared functional and radiographic results of both groups. Results: There was significantly more clinical shortening in DHS group than in PFN group (average 1- 1.9 cm versus 0.5-0.9 cm). There were 3 cases of superficial and 2 cases of deep infection in the DHS group while there was one case of infection in PFN group. There was no case of implant failure in the DHS group compared to one case in PFN group (due to screw breakage). Harris hip score at follow up was fair to excellent in PFN as compared to DHS. This difference was statistically significant. Discussion: DHS despite remaining a gold standard for fixation of intertrochanteric fractures of femur for a long time, it may not be suitable for certain fracture patterns and in older age groups with more medical co-morbidities and osteoporosis. PFN is a biomechanically sound device for fixation of comminuted intertrochanteric fractures of femur2 which has lesser surgical morbidity and should be especially beneficial in elderly, osteoporotic and medically compromised patients. Its load sharing capability provides a more stable fixation allowing early mobilization and rehabilitation.Conclusion: PFN is unequivocally a better choice of implant for fixation of unstable intertrochanteric fractures of femur, especially in osteoporotic and medically compromised patients as compared to DHS fixation device.

Pertrochanteric hip fracture fixation with 3 hole and 4 hole dhs side plates - A retrospective patient record review

Introduction: Dynamic hip screw fixation (DHS) with a 4-hole side plate and 4 bi-cortical screws is considered by many to be the standard implant for extracapsular hip fractures. The 4-hole side plate, however, has several disadvantages including longer incision, increase in operating time, bleeding and increased wound morbidity. Biomechanical studies have shown that most of the force in a 4-hole DHS fixation is borne by the proximal three screws. This study (specifically) compares the outcome of fixation using 3-hole and 4-hole DHS in extracapsular hip fracture fixations (with the hypothesis being that 3-hole plate is adequate even in unstable intertrochanteric fractures. Patients and Methods: A total of 72 consecutive patients who had DHS fixation with either a 3 hole or 4 hole DHS side plate and who were either directly operated or supervised by a single consultant were recruited. Fractures were classified using the AO fracture classification system as stable (AO/OTA 31A1–31A2.1) and unstable (31A2.2–31A3.3 subtypes) for ease of comparison. Failure was defined as metalwork breakage, nonunion, screw cut-out or pull out or any other complications of bone healing requiring a revision. Results: A total of 23 patients (68.1%) were female, whereas 49 patients (31.9%) were male. Fractures in 33 patients were classified as stable with the (AO/OTA 31A1–31A2.1) and unstable in 39 patients with (31A2.2–31A3.3 subtypes). Thirty-three (45.8%) patients had fixation with 3-hole side plate, whereas 39 (55.2%) patients had fixation with 4-hole side plate. In the 3 hole group, 17 patients had stable fractures, whereas 16 patients had unstable fracture configuration while in the 4-hole DHS side plate group, 16 patients had stable fracture configuration, whereas 23 patients had unstable fracture. The mean change in hemoglobin was lower for the 3-hole DHS group (3 hole-6.64 g/l versus 4Hole 12.41 g/l) (t = 1.732, P = 0.090, P ≤ 0.05). One patient in each group also had metalwork failure with screw cut-out through the head and the other being (screw breakage) complete failure of the screw necessitating conversion to total hip arthroplasty. Conclusion: Three-hole DHS plate offers comparable outcome with its 4-hole counterpart even with unstable intertrochanteric fractures, with slightly less blood loss and smaller scars.

PFN versus DHS fixation in the management of inter-trochanteric fractures

PFN versus DHS fixation in the management of inter-trochanteric fractures

274 Use of DHS For Fixation of Unstable Hip Fractures – Are Outcomes Any Different from Nails?

Abstract Aim To determine if the outcomes and rate of complications differ based on choice of implant for unstable hip fractures. Method Retrospective analysis of 105 hip fractures operated in 2015 + 2016 with AO classification A2.2. A2.3 or A3. These were divided into 2 groups depending on whether DHS/Plate implant was selected (n = 86) or Nail implant was used (n = 19). Any complications occurring in their subsequent management or performance of any revision procedures were recorded. 6-month mortality rate was also calculated for both groups. Results When A2 and A3 fractures were assessed together the rate of acute complications was similar in both groups. 21% for nails and 19% for plates. The rate of delayed complications was not significantly different either, 16% for nails and 10% for plates. Revision procedures were more common where nails had been used (16%) compared to only 6% of plate fixations. Mortality rates were identical. When looking at A3 fractures in isolation, the rate of delayed complications is significantly higher when plates are used (24%) compared to 12% when nails are selected. Conclusions We did not identify any significant difference in acute complications including bleeding and infection based on choice of implant. This goes against common arguments raised against use of nails. Successful use of DHS fixation in unstable A2 hip fractures is possible, as evidenced by similar rates of delayed complications. Revisions were higher when nail was selected. It is however noted that for reverse oblique fractures nails perform demonstrably better, with half as frequent delayed complications and revisions.

Use of Antibiotic Beading Technique in Treatment of Osteomyelitis in a Local Hospital of Islamabad, Pakistan

Despite the advancement in prevention and treatment against infection, osteomyelitis has always remained a challenge for an orthopedic surgeon. Although this problem is more prevalent in developing countries rather than developed countries, still it cannot be overlooked. That's why we have aimed this case study to consider the therapeutic plan and techniques used for the treatment of osteomyelitis. A 67 years old male was presented in a local public hospital of Islamabad, Pakistan with severe pain in right lateral thigh unable to move hip and knee joint and swelling. Emergency treatment included diclofenac. X-rays result showed fracture of right femur. Cultures DHS fixation (Dynamic Hip Screw fixation) was done, pus was drained and culture reports indicated Staphylococcus areas that was sensitive to Cefotaxime. The therapy plan included antibiotics along with pain killers, but the infection was not treated. Beside x-ray. Finally this infection was treated using antibiotics beading technique.

Outcome of proximal femoral nail antirotation in peritrochanteric fractures: A prospective study

Background: The incidence of peritrochanteric fractures are increasing worldwide. Early mobilization in these fractures prevents from other medical complications. There are many methods of treatment but the ideal method should be less invasive procedure, intramedullary device and stable fixation of fracture. Proximal femoral nail antirotation (PFNA) is biomechanically considered one of the most effective methods of treatment with promising results.&#x0D; Aims and Objectives: The aim of our study was to evaluate the clinical and radiological outcomes in patient who were treated with PFNA in peritrochanteric fracture.&#x0D; Materials and Methods: This study was a prospective study which included 37 patients, conducted in Manipal Teaching Hospital from 1st October 2019 to 30th September 2020. All the patients were clinically evaluated and detail history was obtained. After the anaesthesia clearance the patients were operated. Operating time, intraoperative blood loss and complications were noted. Postoperatively the duration of hospital stay, time of partial and full weight bearing, time for radiological union and complications were noted. At the final follow up Harris Hip Score was used for functional outcome.&#x0D; Results: The mean age of the patient in this study was 64 years (45-88 years). The average time to complete the surgery was 62.49 minutes (45-75 minutes) and the average blood loss was 129.32 ml (65-210 ml). Partial weight bearing was started at the mean time of 8.57 weeks (6-12 weeks) whereas full weight bearing was done at the mean of 14.43 weeks (10-20 weeks). Fracture union was seen at the average of 11.41 weeks (8-18 weeks). The mean Harris Hip score at final follow up was 84.73 (65.8-95.0) with the functional status of 35.1% excellent result, 45.9% good, 13.5% fair and 5.4% poor.&#x0D; Conclusion: Proximal femoral nail antirotation in peritrochanteric fracture is a good method of fixation. The procedure is easy with reduced operative time and radiation exposure. Since this is minimally invasive procedure the blood loss is very less compared to DHS or plate fixation. The patient could be mobilized early from the bed that reduced the complication of immobilization. So we strongly recommend using PFNA for fixation of peritrochanteric fracture of hip.

Breakage of sliding hip screw after fixation of pertrochanteric hip fracture: A rare complication.

IntroductionThe authors report a rare case of lag screw breakage in a patient treated using locking DHS with home-made trochanteric stabilizing plate (TSP) for pertrochanteric hip fracture.Case presentationA 67 year-old female was operated for pertrochanteric hip fracture with incompetent lateral wall using locking DHS with home-made TSP. At seven months postoperative, there was radiographic nonunion with breakage of the sliding lag screw. Patient was consequently scheduled for total hip replacement.DiscussionBreakage of DHS lag screw has been attributed to multiple-cycle, low-stress fatigue failure associated with nonunion. Predisposing factors are: situation of the medial edge of the barrel at the level of the fracture site prohibiting fracture compression, and mechanical obstacle to the lag screw back sliding into the barrel. In our case, the use of handmade TSP interdicted lag screw back sliding and prevented fracture impaction which was already impaired by the location of the medial edge of the barrel at the fracture level. Additionally our fixation construct was very rigid because of the use of locking screws in the DHS side plate.ConclusionWhen DHS fixation is planned for unstable or potentially unstable trochanteric hip fracture the surgeon should be prepared by making available a TSP from the manufacturer in the operative room rather than improvising intra-operatively with handmade TSP; this augmentation device shouldn't interfere with lag screw back sliding. Furthermore the DHS barrel should ideally not impinge with the fracture site, and the use of locking screws in the DHS plate should be cautious.

Assesment of tip apex distance in intertrochanteric fractures treated with dynamic hip screw

Fractures of proximal femur account for 30% of all hospitalization for fractures. Most fractures occur in the elderly usually in association with osteoporosis and as a result of only moderate or minimal trauma. Literature suggests, Despite being a great option, the failure chance of DHS fixation is high if negligence made to Tip Apex Distance. This study is to assess the outcome of DHS with regards to Tip Apex distance.

A prospective study of treatment of intertrochanteric fractures of femur by fixation with dynamic hip screw or proximal femur nailing

Purpose: Fractures of the proximal femur are more than ever, an important challenge in the field of traumatology. An anatomical reduction obtained at the expense of total devascularisation of the fracture is not a well-planned or well-executed procedure. One must always remember that any form of fixation is at best a splinting device with a definite life span and there is always a race between fracture union and failure of implant. Aims & Objectives: The aim is to study the clinical and radiological outcomes in case of reduction and stabilization of intertrochanteric femur fractures through DHS or PFN. The objectives are to study the advantages and principles of reduction and stabilization methods by DHS or PFN fixation for the treatment of intertrochanteric fractures of femur, to study the range of motion of hip and knee joints and functional outcome, to study complications of the technique. Material &Methods: After ethics committee clearance, subject recruitment procedure was followed. The sample size is total 100 cases with age between 18 to 100 years. The inclusion criteria include 1.Unstable intertrochanteric fractures with posteromedial comminution. 2. Patients with co-morbid conditions like diabetes, hypertension and ischemic heart disease. 3. All patients were ambulatory before the injury. The exclusion criteria include fractures other than intertrochanteric femur and non-ambulatory patients. Standard lateral approach was followed for the fixation of intertrochanteric femur fractures using dynamic hip screw or proximal femur nailing. Results: Out of 100 patients (48 males and 52 females), we have follow up of 67 patients with intertrochanteric femur fracture between July 2013 to May 2016. Majority of the patients in our series were male (53.7%) compared to females (46.3%). The average of male patient was 56 years and that of female patients was 69.9 years. Discussion: The mean Harris Hip Score of DHS is 89.07 and PFN is 89.00. Thus, there was no statistical significance for using DHS or PFN in per-trochanteric femur fractures. Conclusion: Implant selection for the patients must be based on the ability of the implant to withstand long term cyclical loading, the implant should splint the entire femur to bridge other potential areas of unrecognized or future metastatic disease. One must develop mastery over the usage of the implant in a particular fracture and then one can convert that implant as Gold standard for that fracture.

The role of valgus osteotomy with DHS fixation in the management of fracture nonunion of the neck of femur

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Management of fracture non-union of the neck of femur is age specific and is quite demanding. There is a need to salvage the femoral head&lt;/span&gt;&lt;span lang="EN-IN"&gt;in younger individuals which demands a procedure which suits the requirements. The aim of this study was to evaluate the role of valgus osteotomy with dynamic hip screw fixation&lt;/span&gt;&lt;span lang="EN-IN"&gt;(DHS) in the management of these fractures and to compare the results with studies of other authors as available in literature&lt;/span&gt;.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This was a prospective study of 15 patients with fracture nonunion of the femoral neck conducted between January 2012 to January 2013 with a follow up period of 3 years&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;There were 9 males and 6 female patients in our study with the right side being more commonly affected. The mean age of the patients was 45.2 years ranging from 36 to 58 years. All fractures united at the end of 6 months. Post operatively the mean Pauwels angle was 34&lt;sup&gt;0&lt;/sup&gt; while the neck shaft angle was 135.2&lt;sup&gt;0&lt;/sup&gt;. There was a significant increase in the Oxford score from a mean of 20.4 preoperatively to 37.9 in the postoperative period. All patients were happy with the procedure and the functional outcome. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Valgus osteotomy with DHS fixation is a good option for the management of fracture nonunion of the neck of femur in younger patients where there is a need to salvage the femoral head and it gives good functional results.&lt;/span&gt;&lt;/p&gt;

Intraoperative lateral wall fractures during Dynamic Hip Screw fixation for intertrochanteric fractures-Incidence, causative factors and clinical outcome

IntroductionThe intact lateral wall plays a key role in stabilization of trochanteric fracture. Hence extreme precaution should be taken to prevent lateral wall damage during DHS fixation. Present study is aimed at evaluating the determinants of lateral wall fracture and its effect on outcome in intertrochanteric fracture femur treated with DHS. Material and methodsThis is a prospective study involving intertrochanteric fractures treated with DHS fixation from July 2013 to June 2014. Out of 135 patients 49(36.3%) had stable fractures and 86(63.7%) unstable fractures. Cortical thickness index (CTI) was measured to evaluate osteoporosis. Lateral wall thickness in anteroposterior radiograph was also measured.All patients underwent 135° DHS fixation.Postoperative x-rays are assessed for implant position, intactness of the lateral wall, tip apex distance (TAD) and medialization. Functional outcome was measured at the end of fracture union by modified Harris hip score and Parkers mobility score. Clinical information including age, gender, fracture classification, TAD, lateral wall thickness and functional outcome of the patients were subjected to statistical analysis. Results34 (19.5%) patients had lateral wall fractures. Medialization was found in 22 out of these 34 (64.7%) patients. The mean preoperative lateral wall thickness of these patients is 19.2mm, compared with 26.8mm in patients with intact lateral wall (p<0.001). The mean values of CTI and TAD are comparable in both the groups. In patients with intact lateral wall, mean Harris hip score is 73.1 compared to 65.5 in lateral wall fracture group (p<0.001). Preinjury mobility status was achieved in 70.2% of intact lateral wall patients, whereas only 32.3% (11) achieved that in lateral wall fracture group. Threshold for lateral wall thickness that could predict lateral wall fracture was found to be 21mm with 95% sensitivity and 88.2% specificity. ConclusionLateral wall fractures during DHS fixation are not uncommon and osteoporosis has no bearing on its occurrence. It alone can lead to poor radiological and functional outcome independent of TAD. Lateral wall thickness is a reliable predictor of intra operative lateral wall fracture during DHS fixation and nailing is a good option especially when lateral wall thickness is <21mm.