Evaluation of functional outcome of inter-trochanteric fractures treated with dynamic hip screw and locking compression plate

Abstract

Dynamic Hip screw is the implant of choice for most inter-trochanteric fractures of the femur. But, its most common mode of failure is for the lag screw to cut out of the femoral head, the second is for the plate to be forced off the femur with the screws being pulled out of the osteoporotic bone. With the introduction of Locking plate osteosynthesis, in which fixed angle devices are used, which are not dependent on the holding power of screws alone, the bone-implant construct so formed is mechanically stable and fixation failure due to screw loosening in osteoporotic bone can be reduced. This study aims to evaluate DHS with a locking side-plate for fixation of inter-trochanteric fractures in elderly. Aim was to study the functional outcome of Locking Dynamic Hip Screw fixation in 30 patients admitted in MVJ Medical College and Research Hospital with trochanteric femur fractures in elderly age group. The clinical and radiological outcomes were evaluated with regular follow-up and the functional grading was done according to Modified Harris Hip Score. In our study, the mean time to radiological union was 19.73 weeks. There were two patients with superficial infection, one with screw cut-out and one with lateral cortex blowout. None of the patients in our study had varus collapse or side plate pull out. The average modified Harris hip score was calculated to be 83.73. Functionally, 26.67% had excellent, 50% had good, 16.67% had fair and 6.67% had poor results. The present study indicates that DHS with a locking side plate is a terrific treatment option for trochanteric fractures in elderly, with no major complications for fracture union. To accomplish the goal of early mobilisation and reduced failures, we need an implant which has an inherently stable construct independent of the bone quality, does minimal damage to the vascular supply of the bone and has a low complication rate. Locking DHS helps us achieve that goal.