Dynamic Hip Screw Failure: Should We Blame The Surgeon Or The Patient?

Description: Abstract Aims: To examine the roles of fracture stability, anatomical reduction and screw position on cut through failure of Dynamic Hip Screw (DHS) implants. Methods: This is a retrospective study of consecutive patients treated with a DHS implant following intertrochanteric fractures of the proximal femur. Fracture stability was assessed from fracture configuration in the initial presentation films. Adequacy of reduction and screw position within the head and neck were recorded using standardized measurements on AP and lateral radiographs taken intra-operatively and post-operatively. Outcome of surgical fracture fixation was assessed at a minimum of 12 months post-operatively. Results: 135 patients were treated during the study period but 40 had died by 12 months and radiographic records were incomplete in 8 patients.87 patients were included in the final analysis. 32 fractures were incompletely reduced. In 6 cases (6.9%) out of 32,fracture fixation was seen to have failed by way of the screw cutting out of the femoral head.Analysis of screw position in this group showed a 5.4% failure of screws placed centrally and 8.0% failure of screws placed off centre. Conclusions: Incomplete reduction is a strong predictor of implant failure by cut out (p=0.0018). Full Text Citation: Arshad Bhatti, Sohail Quraishi, Simon Tan, D.M. Power: Dynamic Hip Screw Failure: Should We Blame The Surgeon Or The Patient?. The Internet Journal of Orthopedic Surgery. 2004. Volume 2 Number 1.