Praveen Duraisamy1, Vivekanandan Andavar2, Balachander Rajendran3, Girish Chandra Rangaswamy4
BACKGROUND
Trochanteric fractures are commonly encountered in elderly patients, and the
outcome may be bad, if not intervened early. Dynamic hip screw (DHS) fixation
is the most common treatment in stable trochanteric fracture. In unstable
trochanteric fractures, there is high incidence of failure in view of excessive
collapse seen with dynamic hip screw. In order to limit the collapse, we have
done a modification on dynamic hip screw implant. Here we have assessed
fracture healing, collapse and implant failure, in unstable trochanteric fractures
(Evan’s unstable fractures) treated by modified dynamic hip screw fixation.
METHODS
The present retrospective case record analysis was conducted among 31 patients
with unstable trochanteric fracture classified according to Evan’s classification
who were operated with modified DHS in a tertiary care hospital. The details
about fracture healing, collapse of fracture fragments, implant failure were
assessed in a structured checklist through the case record analysis.
RESULTS
Out of 31 patients in this study, 29 patients showed fracture healing (93.5 %)
with or without minimal collapse and 2 patients had non-union (6.5 %) at the
end of 5 months follow up. Ultimately, all fractures united at the end of 1-year
follow-up. Out of 31 patients in this study, at first month follow-up, 26 patients
showed no implant failure (83.9 %), 5 patient had implant migration not
breaching cortex (16.1 %), at third month follow-up, out of 5 patients who had
implant migration, two patients had implant migration not breaching cortex (6.4
%), 3 patients had implant migration breaching cortex (11.0 %), at fifth month
follow-up, two patients had implant migration not breaching cortex (6.4 %), 3
patients who had implant migration breaching cortex underwent revision surgery
(11.0 %).
CONCLUSIONS
Modified dynamic hip screw has shown improved results as compared to normal
dynamic hip screw in treating unstable trochanteric fracture, which limits the
collapse at fracture site.
