[Osteosynthetic material breakage in patients treated with DHS for proximal femoral fracture]

In the literature, there are only few articles about the metal breakage after the Dynamic Hip Screw (DHS) osteosynthesis. We have evaluated our group of patients focusing on these specific complications.

We have evaluated a group of 428 patients (321 female and 107 male subjects) who underwent a total of 456 135 degrees 1"-collar DHS osteosyntheses, for primary proximal femoral fractures. The patients were aged 82.3 years on average, the procedures were performed during 1996-2009. We focused on the ostesynthetic material breakage (K-wire, sliding screw, hip plate, cortical screws). The follow-up period was 2 years.

Out of 16 DHS used for intracapsular femoral neck fractures, metal breakage was recorded in one case (6.25%)-(K-wire) and no reoperation was required. Out of a total of 436 DHS procedures performed for stable pertrochanteric fractures, metal breakage complications were recorded in 8 cases (1.8%)-(3 times K-wire, 3 times cortical screws, 2 times sliding screw), and reoperation was indicated in 4 cases (2 times sliding screw, 2 times cortical screws). Out of a total of 4 DHS procedures used for subtrochanteric fractures, osteosynthetic material breakage was recorded in two cases (50%)-(1 times K-wire, 1 times cortical screws) and no reoperation was required. No cases of hip plate breakage were recorded. Out of a total of all 456 DHS procedures metal breakage was recorded in 11 cases in total (2.4%), reoperation was required in 4 cases (0.9%).

In the literature, the authors found only several articles related to the osteosynthetic material breakage after DHS surgery. Correct indication and operation technique can reduce occurence of this specific complication and the reoperation rates. In future, the authors plan to employ computer modelling methods and biomechanic analysis.