Dynamic Hip Screw Fixation in Unstable Intertrochanteric Fractures: A Three-Year Retrospective Analysis of Clinical Outcomes and Complications

Prasanna Biradar, Audhithyan Satishbabu, Tarun Garg
Author(s)
1Assistant Professor, Department of Orthopaedics, Kodagu Institute of Medical Sciences, Madikeri, Karnataka, India
2Senior Resident, Department of Orthopaedics, Ashwini Trauma Center, Cuttack, Odisha, India
3Senior Resident, Department of Orthopaedics, Yatharth Super speciality hospital, Noida extension, Uttar Pradesh, India

Abstract

Background: The study aims to evaluate the clinical outcomes and complications associated with Dynamic Hip Screw (DHS) fixation in unstable intertrochanteric fractures over a three-year period. Material and Methods: This retrospective study was conducted at Audithya Ortho Hospital, Palani, from 2020 to 2024, involving 115 patients with unstable intertrochanteric fractures treated with DHS fixation. Of these, 110 patients completed a one-year follow-up, with five patients lost to follow-up. Clinical outcomes were assessed using the Modified Hip Score and Oxford Hip Score at four key intervals: preoperatively, 6 weeks postoperatively, 6 months postoperatively, and 1 year postoperatively. The study also analyzed adverse outcomes, including fracture collapse, implant failure, non-union, and limb shortening, with a particular focus on body mass index (BMI) as a potential risk factor. Results: DHS fixation demonstrated favorable clinical outcomes, with significant improvement in hip function over the follow-up period as indicated by both hip scores. However, notable complications were observed in certain patients. Specifically, 3 patients (BMI > 35%) experienced excessive fracture collapse, 2 patients (BMI 25%–35%) showed moderate collapse, and 3 patients presented with implant failure. Additional complications included external rotation deformity in 2 patients, non-union in 2 patients, limb shortening (>2 cm) in 3 patients, and medialization of the shaft in 2 cases. Anterior spike malreduction was noted in 2 patients. Despite these adverse effects, DHS fixation remains an effective method for managing unstable intertrochanteric fractures. Conclusion: DHS fixation provides satisfactory clinical outcomes in unstable intertrochanteric fractures. However, complications such as fracture collapse, implant failure, and deformities were associated with higher BMI, suggesting a need for tailored surgical approaches in obese patients.

Keywords: Dynamic Hip Screw (DHS), Intertrochanteric Fractures, Clinical Outcomes, Retrospective Study, Hip Scores, Fracture Collapse, BMI.


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