Acta Chir Orthop Traumatol Cech. 2010; 77(5):395-401 | DOI: 10.55095/achot2010/068
Complications of Dynamic Hip Screw Treatment for Proximal Femoral FracturesOriginal papers
- Ortopedické oddělení Nemocnice Pelhřimov
PURPOSE OF THE STUDY:
To present the results of Dynamic Hip Screw (DHS) osteosynthesis for the treatment of proximal femoral fractures with a focus on specific complications of this method.
MATERIAL:
From 1997 till 2007, the authors performed 367 DHS osteosyntheses to treat 341 patients with fractures of the proximal femur. The average patient age was 81.8 years (21-101). Twenty-six patients had surgery for bilateral fractures.
METHODS:
Osteosynthesis was always carried out using a 135° DHS (Medin, Nové Město na Moravě, Czech Republic) to manage fractures of the femoral neck (13 ); trochanteric and basicervical fractures (349 ) and subtrochanteric fractures (5). At the end of 2009 the group was evaluated in terms of specific complications, i.e., intra-operative, early and late post-operative complications, and reoperation incidence. Hip radiographs were made before the patient was discharged, at 6 weeks, then at 3, 6 and 12 months post-operatively. When there were no complications, X-ray examination was repeated every 12 months.
RESULTS:
A total of 39 specific complications of the DHS system (11 %) were recorded. The 17 intra-operative complications included: insufficient reduction (10), broken tip of a K-wire (3), faulty technical procedure (2) and fracture of the distal fragment during surgery (2). In addition, 22 post-operative complications (both early and late) were recorded: "cut-out" phenomenon (6), avascular necrosis of the femoral head (5), progression of coxarthrosis (4), screw breakage (2), femoral fracture under the plate (2), pseudoarthrosis (2) and late infection (1).
Complications in relation to the fracture site were as follows: femoral neck fractures, 3/13 (23 %) all requiring revision surgery; trochanteric fractures, 35/349 (10 %), of these 12 reoperated; subtrochanteric factures, 1/5 (20 %) no revision surgery required. Of the 367 fractures treated by DHS osteosynthesis, 15 (4 %) required revision surgery for specific complications. The mortality rate within one year of surgery was 49 %.
DISCUSSION:
Enough information on treatment options for proximal femoral fractures can be found in the literature. However, less attention is paid to their complications. The authors used DHS osteosynthesis to treat 367 fractures during 11 years, and recorded 11 % of complications. These can be prevented by the correct indication (the final decision of the implant to be used is sometimes made only after a fracture reduction under an X-ray image intensifier on the operating theatre), correctly performed procedure and thorough post-operative care. The high one-year mortality was due to the high average age in the group.
CONCLUSIONS:
The authors regard DHS as an effective method to treat stable pertrochanteric fractures and fractures of the femoral neck in younger patients. Complications most often occur as a result of technical mistakes made by surgeons.
Keywords: hip fracture, dynamic hip screw, treatment complications
Published: October 1, 2010 Show citation
References
- BARTONÍČEK, J., DOUŠA, P., SKÁLA-ROSENBAUM, J., KOŠŤÁL, R.: Trochanterické zlomeniny - souborný referát. Úraz. Chir., 10: 13-24, 2002.
- CENTER, J. R., NGUYEN, T.V., SCHNEIDER, D., SAMBROOK, P. N., EISMAN, J.A.: Mortality after all major types of osteoporotic fractures in men and women: an observational study. Lancet, 353: 878-882, 1999.
Go to original source...
Go to PubMed...
- ČECH, O., KOŠŤÁL, R., VÁCHAL, J.: Nestabilní pertrochanterické zlomeniny - jejich biomechanika, klasifikace a terapie. Acta Chir. orthop. Traum. čech., 67: 17-27, 2000.
- DOUŠA, P., BARTONÍČEK, J., JEDLIČKA, D., SKÁLA-ROSENBAUM, J.: Osteosyntéza trochanterických zlomenin proximálním femorálním hřebem. Acta Chir. orthop. Traum. čech., 69: 22-30, 2002.
- DUNGL, P., MAJERNÍČEK, M.: Zlomeniny krčku femuru léčené DHS. Sborník přednášek a posterů, XII. Národní kongres ČSOT 2008. Praha, Galén 2008, s.120.
- DŽUPA, V., BARTONÍČEK, J.: Rozbor pacientů léčených v roce 1997 pro zlomeninu proximálního femuru - ekonomické aspekty léčení. Acta Chir. orthop. Traum. čech., 66: 277-279, 1999.
- DŽUPA, V., BARTONÍČEK, J., SKÁLA-ROSENBAUM, J., PŘÍKAZSKÝ, V.: Úmrtí pacientů se zlomeninou proximálního femuru v průběhu prvního roku po úrazu. Acta Chir. orthop. Traum. čech., 69: 39-44, 2002.
- FARAHMAND, B. Y., MICHAELSSON, K., AHLBOM, A., LJUNGHALL, S., BARON, J.A.: Survival after hip fracture. Osteoporosis Int., 16: 1583-1590, 2005.
Go to original source...
Go to PubMed...
- GEIGER, F., ZIMMERMANN-STENZEL, M., HEISEL, C., LEHNER, B., DAECKE, W.: Trochanteric fractures in the elderly: the influence of primary hip arthroplasty on 1-year mortality. Arch. Orthop. Trauma Surg., 127: 959-966, 2007.
Go to original source...
Go to PubMed...
- GOTFRIED, Y.: Percutaneus compresion plating of intertrochanteric hip fractures. J. Orthop. Trauma, 14:490-495, 2000.
Go to original source...
Go to PubMed...
- HAGSTROM, L. S., CALLAHAN, D. J., GREEN, J. W.: Injury to the colon during revision total hip arthroplasty. J. Bone Jt Surg., 90-A: 881-884, 2008.
Go to original source...
Go to PubMed...
- HOFFMANN, P.: Therapiewandel in der versorgung per-subtrochantarer femurfrakturen - eine retrospektive 10-jahres-analyse. Act. Traumatol., 24: 1-5, 1994.
- HRUBINA, M., SKOTÁK, M., BĚHOUNEK, J.: Komplikace osteosyntézy zlomenin proximálního femuru DHS dlahou. Sborník přednášek a posterů, XII. Národní kongres ČSOT 2008. Praha, Galén 2008, s.122.
- JAHODA, D., NYČ, O., POKORNÝ, D., LANDOR, I., SOSNA, A.: Antibiotika v prevenci infekčních komplikací u operací kloubních náhrad. Acta Chir. orthop. Traum. čech., 73: 108-113, 2006.
Go to original source...
- JAHODA, D., NYČ, O., ŠIMŠA, J., KUČERA, E., HANEK, P., CHRZ, P., POKORNÝ, D., TAWA, N., LANDOR, I., SOSNA, A.: Pozdní hematogenní infekce kloubních náhrad. Acta Chir. orthop. Traum. čech., 75: 88-92, 2008.
Go to original source...
- KOPP, L., EDELMAN, K., OBRUBA, P., PROCHÁZKA, B., BLŠŤÁKOVÁ, K., DŽUPA, V.: Rizikové faktory úmrtí seniorů operovaných pro zlomeninu proximálního femuru. Acta Chir. orthop. Traum. čech., 76: 41-46, 2009.
Go to original source...
- KOUDELA, K., KASAL, E., MATĚJKA, J., VYSKOČIL, V.: Geriatrická traumatologie - vize nebo skutečnost?. Acta Chir. orthop. Traum. čech., 76: 338-343, 2009.
Go to original source...
- MADSEN, J. E., NEASS, L., AUNE, A. K., ALHO, A., EKELAND, A., STROMSOE, K.: Dynamic hip screw with trochanter stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the Gamma nail and compression hip screw. J. Orthop. Trauma, 12: 241-248, 1998.
Go to original source...
Go to PubMed...
- MAJERNÍČEK, M., DUNGL, P., KOLMAN, J., MALKUS, T., VACULÍK, J.: Osteosyntéza intrakapsulárních zlomenin krčku stehenní kosti metodou DHS. Acta Chir. orthop. Traum. čech., 76: 319-325, 2009.
Go to original source...
- MAJERNÍČEK, M., DUNGL, P., VACULÍK, J., MALKUS, T.: Léčba zlomenin krčku stehenní kosti. Ortopedie, 6:292-298, 2009.
- MALKUS, T., VACULÍK, J., DUNGL, P., MAJERNÍČEK, M.: Problematika pertrochanterických zlomenin. Ortopedie, 6: 274-282, 2009.
- PAVELKA, T., HOUČEK, P., LINHART, M., MATĚJKA, J.: Osteosyntéza zlomenin horního konce diafýzy femoru pomocí PFN-long. Acta Chir. orthop. Traum. čech., 74: 91-98, 2007.
Go to original source...
- PAVELKA, T., KORTUS, J., LINHART, M.: Osteosyntéza zlomenin proximálního femoru krátkým proximálním femorálním hřebem. Acta Chir. orthop. Traum. čech., 70: 31-38, 2003.
- SCHWENK, W., EXSSEL, M., BADKE, A., HUCKE, H. P., STOCK, W.: Risk analysis of primary endoprosthetic management of proximal femoral fractures. Unfallchirurgie, 20: 216-222, 1994.
Go to original source...
Go to PubMed...
- SKLÁDAL, M., PINK, M., LISÝ, M., NOVOTNÝ, L.: Ošetření trochanterických zlomenin PC.C.P. dlahou. Acta Chir. orthop. Traum. čech., 76: 202-207, 2009.
Go to original source...
- SKOTÁK, M., BĚHOUNEK, J., KRUMPL, O.: Řešení pertrochanterických zlomenin proximálního femuru 130 st. dlahou - dlouhodobé výsledky. Acta Chir. orthop. Traum. čech., 66: 336-341, 1999.
- ŠIMEČEK, K., FIEDLER, J., SVOBODA, V.: PCC.P - operační postup a indikace na našem pracovišti. Sborník přednášek a posterů, XII. Národní kongres ČSOT 2008. Praha, Galén 2008, s. 123.
- VACULÍK, J., MALKUS, T., MAJERNÍČEK, M., DUNGL, P., PODŠKUBKA, A.: Závislost typu následné péče a mortality u pacientů po ošetření zlomeniny proximálního femuru na úrovni soběstačnosti a mobility před úrazem. Ortopedie, 6: 284-290, 2009.
- VACULÍK, J., MALKUS, T., MAJERNÍČEK, M., PODŠKUBKA, A., DUNGL, P.: Incidence zlomenin proximálního femuru. Ortopedie, 1: 62-68, 2007.
- VAN HELDEN, S., VAN GEEL, A. C. M., GEUSENS, P. P., KESSELS, A., NIEUWENHUIJZEN KRUSEMAN, A. C., BRINK, P. R. G.: Bone and fall-related fracture risks in women and men with a recent clinical fracture. J. Bone Jt Surg., 90-A: 241-248, 2008.
Go to original source...
Go to PubMed...