Dynamic hip screw fixation for unstable intertrochanteric femoral fractures in the elderly. (case study)
Abstract
Failure of dynamic hip screw (DHS) fixation occur frequently in the elderly with unstable intertrochanteric (IT) fracture, due to osteoporosis
and poor femoral calcar reduction.
Objective : To establish the technique of DHS fixation and factors associated with the treatment outcomes.
Material and method : A retrospective study of 4 cases of unstable IT fracture Evans’ classification type I, whom treated with DHS fixation. The patient age was over 55 years, and the fracture caused by low energy injury. Clinical outcome, postoperative radiograph, femoral calcar reduction, and duration of bone union were reviewed. Neck shaft angle (NSA), Tip-apex distance (TAD), leg length discrepancy (LLD) were measured
Result : Four patients were evaluated, 2 males and 2 females, Mean age was 75.5 years. The mean of NSA 140° and TAD 18 mm. The success rate of anatomical reduction of femoral calcar was 3:1, LLD were: 1 cm. longer 1 case, equal leg 1 case, and 2 cases 0.5 and 1 cm. shorter. The average time to union was 3.4 months.
Conclusion : The success factors of DHS fixation are stability of the fracture, anatomical reduction of femoral calcar, NSA ≥135 ํ, TAD≤ 25 mm. Post- operative, the patient walk with non-weight bearing for 6 weeks, then partial weight bearing after callus formation.
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