dynamic hip screw
TRANSCRIPT
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DYNAMIC HIP SCREW
DR ANURAG MITTALORTHOUCMS
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INDICATION• Stable intertrochanteric fracture till 2.1 –study by evans and another by
Hornby-non operative vs operative• Low complication ,mortality rate,pain, leg swelling, sores –same in both• But shorter hospitalization• Better restoration of normal anatomy• Ability to live independently
• Basicervical neck of femur # with derotation screw• Unstable # with• TSP• Axial dynamic compression plate• IHS
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TSP
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Biaxial compression plate
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IHS
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Principle
• Controlled collapse
• Dynamic action reduces incidence of screw cut out and penetration of screw into hip joint
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Procedure
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Position
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Reduction • Undisplaced #-no reduction,slight IR • Displaced#-
• extension ,• Abduction-corrects varus • IR –”screw home” the distal fragment
• Evaluation • #displacement• Neck shaft angle• Anteversion• Femoral shaft ‘sag’• Rotation checked clinically
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Lateral approach to the proximal femur
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Guide pin insertion • For 135 angled plate• If higher angled plate-entry
moved 5 mm distally for 5 degree increase
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ANGLE GUIDE
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VARIABLE ANGLE GUIDE
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• Why 135 ideal??• Hip joint resultant force-159-
difficult insertion/cut out• 130-high bending load
• Influence of nail plate angle on bending moment: Larger angle results in smaller moment because of shorter distance (d); conversely, smaller angle results in larger moment because of longer distance
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TIP APEX DISTANCE• Should be <25mm• Tip of screw should lie under 10
mm of subchondral bone• Screw should ideally lie in centre
on ap and lateral views• Superior and anterior location
avoided-cut out
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Lag screw length• Measuring guide used• Tip extension and immediate telescoping must be taken into account
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Short vs long barrel• <85 mm—short barrel• >=85 mm—standard barrel• WHY??• Thread length-22mm• Recommended sliding -25 mm(min 10 mm)• Standard barrel length-38 mm(short-25 mm)• So 22+25+38=85mm
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COMPONENTS
SHORT BARREL
LONG BARREL
TRIPLE REAMER
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Implant insertion and fixation• Long vs short side plate• More dissection• Complicate future surgery• no improvement in proximal purchase• Inherent stability of fracture/reduction not altered• Reduces tensile forces on prox two screws but no additional protection• Same rate of failure
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Keyed system
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• Traction released• Angled plate acts as an aid to
reduction• Intraop prox displacement of
femoral shaft along the plate before screw insertion• Post op as lag screw collapses into
the barrel by impaction
• Compression screw-also prevents postop hip screw barrel disengagement
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Complication
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•
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