Does Modular Extension of DHS Fix the Unstable Trochanteric Fractures

Abstract

Nowadays, the use of DHS in unstable trochanteric fractures has been associated with significant medial displacement of the shaft resulting from excessive sliding of screw within the barrel and a higher incidence of screw cut out. To emphasise the importance of the modular Trochanter Stabilizing Plate (TSP) in addition to the Dynamic Hip Screw (DHS) prevents excessive telescoping/varus malposition and limb shortening in all unstable trochanteric fractures with lateral wall communitions. MATERIAL AND METHODTwenty five consecutive patients with unstable intertrochanteric fractures were treated with an additional TSP superimposed on the regular DHS at our institution between October 2013 and November 2015. Three patients migrated to other states, one patient was lost to follow-up and another patient refused follow-up. Thus, twenty patients were followed for at least mean of 19 months (Range 6 to 28 months). RESULTSLateralization of the greater trochanter was successfully prevented in all fractures. Functional results were excellent and good in 87 percent of patients and fair in 13 percent according to the Harris Hip score. CONCLUSIONTSP with DHS is a biomechanically stable construct allowing reconstruction of lateral wall to maintain adequate lever arm and abductor strength (Power arm) in unstable intertrochanteric fractures with lateral wall comminution. Two point fixation provides additional rotational stability. Superior functional and radiological outcome favours its use in unstable intertrochanteric fracture.