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Dynamic hip screw for treatment of intertrochanteric fractures of 33 cases around the_5867

By Bonnie Gibson,2014-10-30 19:01
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Dynamic hip screw for treatment of intertrochanteric fractures of 33 cases around the_5867

    Dynamic hip screw for treatment of intertrochanteric fractures of 33 cases around the

     Key Words femur injuries

     Abstract: [Objective] To analyze the use of open reduction and compression hip screw fixation of intertrochanteric fractures around the clinical efficacy. [Methods]

    open reduction and dynamic hip screw (dynamic hip screw, DHS) fixation for the treatment of intertrochanteric fractures of 33 cases. [Results] 33 patients were treated with DHS fixation, with an average follow-up of 8 months, 24 cases of excellent, good in 5 cases and poor in 4 cases. [Conclusion] DHS fixation for treatment of intertrochanteric fractures is simple, less complications and the treatment of intertrochanteric fractures in a good way around.

     Keywords: rotor around the fracture; femur injuries; DHS; effect

     1 General Information

     The group of 33 cases, 28 males and 5 females; aged 16 to 83 years old, with an average age of 62. Injury causes: falls 24 cases, car accident injuries, 9 cases were

    closed fracture, according to Evan's standard classification, ?-type 10 cases, ? type in

    8 cases, ? in 12 cases, ? type 3 cases.

     12 Material

     Domestic pressure with 130 ? sliding hip screw (dynamic hip screw, DHS), DHS screw length of 65 ~ 85 mm, the length of the steel sleeve 4 to 12 holes.

     13 surgical methods

     Preoperatively tibial tubercle traction 3 ~ 10 d, surgery to take continuous epidural anesthesia, the affected side hip booster, the greater trochanter into the lateral incision,

    exposed parts of the greater trochanter and femur fractures below the 5 ~ 6 cm, at the top of the greater trochanter below 10 cm at an angle of instrument, adjusting the anteversion, the femoral neck through the perspective of the direction of penetrating

    instrument to guide needle, needle-ray films to determine lead in place, the drilling

    tapping with exploratory probe to determine pore pore does not wear out femoral neck, select the appropriate length of the DHS screw, according to the rotor around the

    fracture line to select the appropriate length of the sleeve plate, to be screw fixed, so hip joints to determine the fracture fixation satisfied with screws in the femoral head within the next 10 cm.

     Operative time was 120 ~ 150 min, blood loss 200 ~ 400 ml, after routine use of

    antibiotics 3 ~ 5 d, after 1 week, doing hip and knee passive activity, six weeks Fu crutches to walk, according to fracture healing, decided to lower limb load time, usually after 3 to 4 months.

     14 Results

     The longest follow-up of 30 months, a minimum of 3 months and an average of 8

    months. The group of 33 cases, 31 cases were bone healing, healing time, 2 ~ 6 months, an average of 4 months (Figure 1,2). MerleD'Aubignc scoring criteria according to [1]:

    excellent in 24 patients (73%), good in 5 cases (15%) and poor in 4 cases (12%), of which one cases of traumatic brain injury due to the merger, three weeks after injury side-line operation, fracture callus formation had been affected reset, 1 cases of DHS

    lead to fracture of the femoral head screw piercing displacement, and 1 hip varus, and 1 lower limb shortening 2cm, caused slight limp. Reposted elsewhere in the paper for free download http://

     Figure 1 Preoperative X-ray films of Figure 2 Postoperative X-ray films of

     2 Discussion

     21 peritrochanteric fractures, common in the elderly, mostly because injury falls, followed by traffic injuries, with the aging population and the means of transport increased, and its incidence has gradually increased. Traditional treatment methods

    are skeletal traction, but the bed a long time, high incidence of cardio-pulmonary and

    urinary complications, such as nursing is not in place, prone to bedsores, and the high incidence of coxa vara. With the improvement of internal fixation techniques, most

    scholars advocate that medical circumstances permit, seek to surgery. The group of 33 cases with surgical treatment, the average length of stay from 6 to 8 weeks reduced to 3 ~ 4 weeks, the incidence of coxa vara fell 55%, no heart and lung complications occur,

    to improve the quality of life of patients is very useful.

     22 Selected DHS for internal fixation is recommended. DHS simple, surgical trauma, the hospital can also be carried out at the grassroots level. Pressure screw has its own

    role, to be effective in maintaining fracture stability, and the sleeve extend the femoral plate for comminuted fracture of the backbone will have to choose from porous, it applies not only to simple intertrochanteric fractures, comminuted fracture of the

    subtrochanteric will also apply. When you do screw length should be controlled at a distance of femoral head cartilage 1 cm under the Department, the plate length of the fracture line under the four screws and effective fixed, screw-plate maintained at 130 ?

    ~ 135 ?, screw in the femoral neck in the bottom to prevent the screw partial before or after partial cutting femoral head and neck [2].

     23 intertrochanteric fractures with small reset most scholars emphasize the

    importance of [3], and that the fixation of fractures of small tuberosity bone must be fixed, otherwise it will result in failure of internal fixation. In my opinion, a small protuberance at the pressure side of bone, such as to get anatomical reduction and

    restoration of bone structural integrity, is very important to prevent the hip varus. However, the small tuberosity bone for the iliopsoas attachment, anatomic reduction is difficult, and too much spin-off will certainly affect the blood supply, even free bone

    fragments to increase the surgical trauma also affects bone healing, it should not demand that anatomic reduction. Authors in dealing with this type of fracture in the top of the first hole drilling steel sleeve, it will be transferred back in the direction of

    drill, direct a small tuberosity, using a long screw fixation of small tuberosity bone, such as the fracture gap greater may be bone, after an appropriate extension of time to load, but also to obtain better results. At the top of greater trochanter fracture of the

    merger, DHS can not effectively fixed, the author plus screws with coarse grain, for subtrochanteric and proximal femur fracture, we do not advocate the use of wire bundle to reduce the wire down the fracture, affecting bone healing.

     24 surgical timing and load time of

     Authors are first tibial tubercle traction, generally 5 ~ 7 d, this could make to achieve better fracture reduction surgery to reduce the difficulty of reduction, but should normally be within 2 weeks after injury, surgery [4]. More than two weeks,

    hematoma or callus formation machine-oriented, will greatly increase the difficulty

    reset. Postoperative weight-bearing time are based mainly on fracture healing,

    osteoporosis and fracture in patients with an appropriate extension of time, but should

    guide the patient in bed to do active or passive activities, the same can be achieved to reduce complications and lower disability rates purposes.

     References:

     [1] Xiong Wei, Li Feng, Xia-yun. AO dynamic hip screw in intertrochanteric

    fracture of the surrounding complex [J]. China's comprehensive clinical, 2004,20 (5): 451.

     [2] Yu-wei, Jiang literature. Compression screw for treatment of intertrochanteric fractures of femur in the elderly Clinical and X-ray analysis [J]. Chinese Journal of

    Orthopedic Surgery, 1999,6 (6): 407.

     [3] Hong Jia source, Guo Lin Xin, Lian Kejian, et al. 38 cases of young adults the

    treatment of intertrochanteric fractures [J]. Chinese Journal of Orthopedic Surgery, 2001, 3 (8): 285.

     [4] Shen Dong. Dynamic hip screw for treatment of intertrochanteric fracture analysis of 82 cases [J]. Nanjing Medical University, 2002,22 (3): 255. Reposted

    elsewhere in the paper for free download http://

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