Dynamic Hip Screw with Trochanteric Stablization Plate Fixation of Unstable Inter Trochanteric Fractures: A Prospective Study of Functional and Radiological Outcomes.
INTRODUCTION Management of unstable intertrochanteric fractures have posed a unique challenge to orthopaedicians over years. Several surgical techniques and implants have been developed for the same. Fractures of the lateral wall have been considered as the major cause of femoral medialization after fixation by Dynamic Hip Screw (DHS) Studies have shown that supplementation of trochanteric stabilization plate reduces the incidence of femoral medialization. AIM To assess the radiological union and hip function after fixation of unstable intertrochanteric fractures with DHS and Trochanteric Stabilization Plate (TSP) MATERIALS AND METHODS A prospective study was conducted with a total of 32 patients between age groups of 30 70 years with Evan Jensen unstable and very unstable type of intertrochanteric fractures, between August 2013 to March 2015 in the Department of Orthopaedics ARS Hospital, Tirupur, Tamil Nadu, India. They underwent open reduction and DHS and TSP fixation. They were started on full weight bearing mobilization on post op day three. They were reviewed at post op weeks 3,6,12 and 24. Hip mobilization and rehabilitation exercises were instituted during course of reviews. Radiographs were taken to assess fracture union and hip function was evaluated during follow ups. At the end of 24 weeks, degree of radiographic union was scored as per Radiological Union Score for Hip (RUSH) Hip function was scored with Harris hip score. Analyses were done using frequency and proportions. Chi square tests were used to assess the test of association. RESULTS Fifteen patients had RUSH scores between 10 20 and 17 patients had scores between 20 30 points. RUSH score had mean of 21.03+ 2.132 points. 9 of 32 patients had excellent results as per Harris hip score, 10 had good, nine had fair and four had poor. On comparison of Harris hip score with RUSH score: Interval between 10 20 points, of 15 patients; two had excellent results, five had good, five had fair and three had poor. Of 17 patients between 20 30 points, seven had excellent, five had good, four had fair and one had poor results. CONCLUSION DHS and TSP fixation of unstable intertrochanteric fractures is an effective technique with good radiological and functional outcome.
Journal of clinical and diagnostic research JCDR