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European Journal of Orthopaedic Surgery & Traumatology

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Open Access 01-10-2021 | Dynamic Hip Screw | Original Article

Dynamic hip screw fixation of subtrochanteric femoral fractures

Authors: Zaki Arshad, Azeem Thahir, Jaikirty Rawal, Peter D. Hull, Andrew D. Carrothers, Matija Krkovic, Daud T. S. Chou

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 7/2021

Abstract

Introduction

A subtrochanteric proximal femur fracture occurs in the 5 cm of bone immediately distal to the lesser trochanter. UK national guidelines advise that adults with subtrochanteric fractures should be treated with an intramedullary nail (IMN). This study aims to compare peri-operative outcome measures of patients with subtrochanteric fractures treated with either an IMN or a dynamic hip screw (DHS) construct.

Materials and Methods

We retrospectively reviewed subtrochanteric fractures presenting at our institution over 4.5 years (October 2014–May 2019), classifying them into two treatment groups; IMN and DHS. These groups were compared on outcome measures including surgical time, blood loss, radiation dose area product (DAP), length of stay, re-operation rate and mortality.

Results

During the time period studied, 86 patients presented with a subtrochanteric fracture of the femur; with 74 patients (86%) receiving an IMN and 12 (14%) receiving a DHS. The comparative outcome measures reaching statistical significance were blood loss and radiation DAP. The DHS group showed a significantly lower mean blood loss of 776 ml compared to 1029 ml in the IMN group. Also, the DHS group showed a significantly lower mean DAP of 150.30 mGy cm² compared to 288.86 mGy cm² in the IMN group.

Conclusion

Although UK national guidelines recommend treating all subtrochanteric fractures with an IMN; the outcome measures assessed in our study did not show use of an IMN to be superior to a DHS. The DHS group showed a lower estimated blood loss and a reduced DAP. This, along with the reduced financial cost associated with a DHS, may support the use of DHS over IMN for certain subtrochanteric fractures of the femur. There may not be a single favourable implant for the treatment of subtrochanteric fractures as a whole; instead different subtypes of fracture may be amenable to a number of fixation devices. Choice of implant should be determined locally and based on existing and future clinical and health economic research.

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Title: Dynamic hip screw fixation of subtrochanteric femoral fractures
Authors: Zaki Arshad
Azeem Thahir
Jaikirty Rawal
Peter D. Hull
Andrew D. Carrothers
Matija Krkovic
Daud T. S. Chou
Publication date: 01-10-2021
Publisher: Springer Paris
Keyword: Dynamic Hip Screw
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 7/2021
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-021-02895-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Dynamic hip screw fixation of subtrochanteric femoral fractures

Abstract

Introduction

Materials and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and Methods

Results

Conclusion

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