Journal of Clinical and Diagnostic Research. 2019 Jun, Vol-13(6): RC01-RC03 1 1 DOI: 10.7860/JCDR/2019/26357.12914 Original Article Orthopaedics Section Evaluation of Dynamic Hip Screw Blade in Extracapsular Fracture Neck of Femur in the Elderly INTRODUCTION Intertrochanteric fractures account for 50% of all fractures of the proximal femur, with women to men ratio ranging from 2:1 to 8:1, the average age of incidence being 66 to 77 years. Some of the factors associated with intertrochanteric fractures include advancing age, increased number of comorbidities, increased dependency in activities of daily living and a history of other osteoporosis related (fragility) fractures [1]. Operative stabilisation permits early mobilisation and minimises complications of prolonged recumbency [2]. The DHS was introduced by Clawson DK, in 1964 [3] and has been widely adopted as the implant of choice for these fractures [4]. With respect to failure mechanisms, a common form is cut-out i.e., migration of the implant through the cancellous bone of the femoral head, which significantly relates to the bone mineral density of the proximal femur [5]. The failure rates associated with the DHS vary between 5% [6] and 23% [7]. However, a more recent study reported improved results, with a failure rate of fixation of 3.2% and a cut-out rate of 1.9% [8]. The most common mode of failure with the DHS is collapse of the femoral neck into varus, leading to cut-out of the screw [4]. Recently, a helical shaped implant design was introduced in order to enhance implant anchorage. The DHS blade was developed in an attempt to enhance anchorage of the implant in the bone. The mechanical purchase mechanism of the DHS blade comprises four helical blades at the head of the implant [5]. Biomechanical studies [5,9] have shown improved resistance to cut-out and increased rotational stability of the femoral head fragment with helical implants when compared with traditional hip lag screws, but limited published studies are available on the clinical outcome of this implant [9]. In order to evaluate the above claimed biomechanical properties of the DHS blade, this study was carried out to analyse the outcome of the DHS blade in intertrochanteric fractures of femur in the elderly osteoporotic patients. MATERIALS AND METHODS This descriptive observational study was carried out in the Departement of Orthopaedics, Himalayan Institute of Medical Sciences from October 2011 to September 2013. The inclusion criteria for the study were: Age over 60 years, AO classification- AO31A1 to A3, Singh’s Index Grade ≤3. Fractures were classified as per AO/ASIF classification. Osteoporosis was graded as per Singh’s Index [10] which was assessed from anteroposterior radiographs of the contralateral hip. In this study, 32 patients were enrolled, out of which two were excluded (one died due to causes unrelated to orthopaedics and one patient did not turn up for follow-up). So, overall 30 patients were included in the present study with a follow-up period of 24 weeks. Pre-operatively, all the patients were subjected to routine haematological investigations and pre-anaesthetic check-up. Technique After positioning the patient on the fracture table, closed reduction of the fracture was done under C-arm control. After painting and draping of the affected hip were done, a four inches long incision was given starting from the greater trochanter along the lateral aspect of thigh. The DHS guide wire was placed in the middle of the femoral head extending into the subchondral bone. After reaming with the triple reamer, appropriate size of DHS blade was inserted. The DHS plate was fixed to the blade and attached to the femoral shaft followed by locking of the DHS blade. Closure of the surgical wound was done in layers. TEJASVI BHATIA 1 , ANIL JUYAL 2 , RAJESH MAHESHWARI 3 , ATUL AGRAWAL 4 , DIGVIJAY AGARWAL 5 Keywords: Intertrochanteric fracture, Osteoporosis, Spiral blade ABSTRACT Introduction: Intertrochanteric fractures account for 50% of all fractures of the proximal femur, the average age of incidence being 66 to 77 years. Dynamic Hip Screw (DHS) fixation is considered to be one of the standard treatments of trochanteric fractures. The most common mode of failure with the DHS is cut- out of the screw which significantly relates to the bone mineral density of proximal femur. DHS blade was developed in an attempt to enhance anchorage of the implant in the osteoporotic bone. Aim: To assess the radiological and functional outcome of extracapsular fracture neck femur in osteoporotic patients treated with DHS blade. Materials and Methods: In this descriptive observational study, DHS blade fixation was done in 30 osteoporotic patients with intertrochanteric fracture of the femur. Osteoporosis was graded as per Singh’s Index. The patients were followed up for a minimum of six months with radiological and clinical evaluations. Descriptive statistics were used to analyse data. Results: The male to female ratio was 1:2.75. The mean age of patients was 73.4±8.64 years (range 60-97 years). Thirty patients were operated with DHS blade and followed up for a minimum of six months. Pre-operatively, the patients were categorised as per Singh’s Index; 66.7% (20 cases) were in Grade 3 while 33.3% (10 cases) fell in Grade 2. Postoperatively, the average Tip Apex Distance (TAD) was 21.66 mm (range 18-28 mm), 25 cases (83.3%) had TAD <25 mm. Neck-shaft angle of the contralateral hip was measured for comparison. No change in neck-shaft angle was observed in 21 cases (70%) however varus collapse more than 4° was seen in 2 cases (6.6%). In 2 cases (6.66%), we encountered screw penetration leading to varus collapse, shortening of the limb and medialization of the distal fragment. Conclusion: It was seen that DHS blade is reliable and safe fixation devise for intertrochanteric fractures in elderly patients with similar cut-out rates as for DHS.