Trochanteric Fractures

Objectives:To study the effectiveness of Dynamic HIP Screw in surgical management of trochanteric fractures and to follow up the patients operated upon and note the functional recovery and movement at hip-joint. Methods:The study group consisted of TF treated surgically with DHS at Osmania General Hospital during the period of one and half years from June 2015 to July 2016. For the purpose of evaluating the results, 30 patients with TF treated with DHS were followed up. Only the patients who reported regularly for follow up were included in the study group. The results were recorded and discussed. The average follow up period was for 6.64 months varying from 5 months to 1 ? years. The age of the patients ranged from 20 years to 77 years with an average of 55.56 yrs. 40% were less than 50 yrs. Males outnumbered the females(19:6). Right sided fractures outnumbered left sided fractures.(14:11). Results:5 out of 25 patients(20%) had an excellent result. 4 out of these patients had Type I fracture, the other had a Type II fracture. In 15 patients(60%) we had a result which are characterized as good. Only in 2 cases we noticed coxa vara of 10 deg. Out of the 15 patients with good result, 3 belonged to Type I, 7 to Type II and 4 to Type IV.4 patients had an outcome which was classified as fair.Among these 4 patients one belonged to Type II and Type III and 2 were Type IV fractures. One patient had a poor result. All cases with Type I fracture had an excellent or a good result. 80% of Type II fractures had an excellent or good result.50% of Type III and 57% of Type IV fractures had a good result.2 out of the 25 patients(8%) we had operated on coxa vara. One of them had coxa vara which developed after implant failure. This incidence of coxa vara similar to other studies(8.57% reported by Hornby and Grimley Evans).6 out of the 25 patients(24%) had shortening>1/2inch. This is higher compared to other studies.We had 2 cases(8%) of implant failure. Conclusion:After evaluation of the results in the present series, which were quite satisfactory and encouraging we have come to the following conclusions regarding the role of DHS fixation in the surgical management of TF. This technique is not very demanding with experience it is a simple procedure which can be performed by any average surgeon. The device facilitates impaction at the fracture site and provides rigid internal fixation. The device allows for controlled collapse at the fracture site without a change in the neck shaft angle. Hence it does not alter the biomechanics at the hip. Thus the incidence of coxa vara is low. The fixation is rigid in the osteoporotic bone because of innovative truncated thread design of the lag screw. The incidence of femoral head penetration due to absorption and collapse at fracture site is low even in an osteoporotic bone because of rounded tip design of lag screw and a provision for its telescopy. Patients treated with this device have recovered early with painless hip movements. Most of the patients were young males. Hence there is an absolute need for anatomical reduction.