Key result
DHS fixation failure is linked to unstable fractures, poor reduction, thin lateral walls, and non-central screws.
Why the study?
There has been no clear consensus regarding the relative importance of various factors influencing implant failure and outcomes in DHS fixation of intertrochanteric fractures.
What factors influence the outcome of dynamic hip screw fixation for intertrochanteric fractures?
Cohort (n=121)
No
What factors influence the outcome of dynamic hip screw fixation for intertrochanteric fractures?
p-value: p=<0.05
Good fracture reduction, adequate lateral femoral wall thickness, ideal screw position, and tip-apex distance less than 25mm are essential to prevent implant failure in dynamic hip screw fixation of intertrochanteric fractures.
Supports attention to reduction quality and implant positioning in DHS fixation; leaves open need for prospective validation of these associations.
Background: Dynamic hip screw (DHS) is a standard device for intertrochanteric fractures (ITF).Implant failure in form of screw cut out leading to varus collapse of neck shaft angle is associated with various factors like bone quality, fracture pattern, fracture reduction, lateral femoral wall thickness (LFWT), screw position and tip-apex distance (TAD).But there has been no clear consensus to the relative importance of each factor.The purpose of our study is to assess individual factors for a favorable outcome in DHS fixation of ITF. Materials and methods: 121 hips sustaining ITF treated with DHS between-June 2014 and July 2016 were reviewed in our prospective study with a mean period of 12 months.Factors under study were bone quality, fracture pattern, fracture reduction, LFWT, screw position and TAD, which were recorded and used for statistical analysis using SPSS.Chi-square test, Independent t-test and Paired t-test were used to evaluate the significance of the differences.Final analysis involved clinical and radiological assessment using Harris Hip Score (HHS) and radiographs respectively.Results and Analysis: The mean age of patient at the time of surgery was 65.27±3.21years (range 24-85) with 80 males and 41 females.There was no statistical significant relation found between implant failure and osteoporosis even though cases of failure were found in weak osteoporotic bones.Implant failure in relation to unstable fracture pattern, non-anatomical fracture reduction, LFWT< 21.77 mm, screw placement in position apart from centre-centre or centre-inferior and TAD greater than 25mm was found to be statistically significant (p<0.05).The final functional and radiological assessment revealed 68.85% and 86.88% of hips respectively in good to excellent category.Conclusion: DHS is a well-accepted implant for ITF with lower rate of complications only if proper surgical technique is followed.Good fracture reduction, adequate LFWT, ideal screw position and TAD less than 25mm are must to prevent implant failure.Level of Evidence: Level IV
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Bhandari Gaurav Singh (2020) conducted a cohort in Intertrochanteric fractures (n=121). Surgical and anatomical factors (fracture pattern, reduction, LFWT, screw position, TAD) vs. Optimal surgical and anatomical parameters was evaluated on Implant failure (screw cut-out) (p=<0.05). Implant failure in DHS fixation of intertrochanteric fractures was significantly associated with unstable fracture pattern, poor fracture reduction, lateral femoral wall thickness <21.77 mm, non-central screw placement, and tip-apex distance >25 mm (p<0.05 for all).
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