Valgus Reduction with Dynamic Hip Screw: The Answer to Unstable Peritrochanteric Fractures
Journal Title: Journal of Bone and Joint Diseases - Year 2017, Vol 0, Issue 0
Abstract
Introduction: Peritrochanteric fractures are amongst the most common fractures sustained in elderly population. Numerous methods of fixation and implant choices are available for management of such fractures. The dynamic hip screw and sliding plate remains the most commonly used implant for surgical management in such fractures. Despite the widespread use of Dynamic hip screw akin to being considered as one of the most forgivable implant, many complications have been reported in the literature. Of these the most commonly described is screw cut out rates of 5-17%. Various attempts have been made to reduce these cut out rates and the most widely accepted method is Baumgartner method of screw placement with Tip apex distance less than 25 mm. The present study was conducted to evaluate the clinical and functional outcome of valgus reduction in peritrochanteric fractures fixed by 1350 Dynamic hip screw. Materials and Methods: The 90 cases of peritrochanteric fractures (51 males and 39 females) with mean age of 65.4 years were treated with valgus reduction and internal fixation with Dynamic hip screw. Mean follow up was 28.03 months (range, 12-50 months). Results: The mean neck shaft angle of hip was 1290 (range, 1180 to 1400). The mean neck shaft angle of operated hip was 1380 (range, 1270 to 1480). Union was achieved in all the patients. The average time of union was 9.3 weeks (range 8.1-14 weeks). No patient had cut out or implant failure. 78 patients had limb length equalization and 10 had shortening and five had limb lengthening at final follow up. Average Harris hip score was 94.8 points. Conclusion: We advocate valgus reduction of peritrochanteric fractures to achieve reliable functional and radiologic outcome. Valgus reduction reduces the chance of shortening of the leg, and prevents implant cut out.
Authors and Affiliations
Arunim Swarup, Karan Siwach, Abhay Shanker Dube, Avinash Rastogi, Sunil Malhotra, Gaurav Dev Sharma
Keywords
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