Dynamic hip screw with locking side plate: a viable treatment option for intertrochanteric fracture

Dynamic hip screw (DHS) is recommended for the fixation of stable intertrochanteric fractures. Its postoperative cut-out rate ranges from 1% to 6%. In osteoporotic bone, normal screws in DHS blade provide less anchorage compared to locking screws. This study aims to compare DHS with locking side plate and conventional side plate.

Fifty consecutive patients with intertrochanteric fractures were randomly allocated for fixation with a standard DHS (group A) and locking DHS (Combi plate, group B). We compared the clinical and radiological outcomes for the conventional DHS and locking DHS in intertrochanteric fractures. Functional outcome was evaluated using the Parker mobility score.

Coxa valga was found more frequently in group A than in group B (12% vs. 0%, P=0.42). Coxa vara showed the same trend (12% vs. 8%, P=0.81). Rate of restoration of postoperative neck-shaft angle within 20° of sound side was higher in group B (8% cases) than in group A (4% cases, P=0.98). The rate of anteversion angle restoration within 10° of sound side was also higher in group B (100% vs. 88%, P=0.85). The average lag screw slippage in group A and group B was 3.2 mm and 4.2 mm, the average fracture union duration was 17.1 weeks and 16.4 weeks, and the mean Parker score was 5.6 and 5.8 respectively. Screw cut-out was seen in one patient in group A. No cut-out was seen in any of the patient in group B. No patient developed deep infection, avascular necrosis, deep vein thrombosis or any other significant complications.

The present study demonstrated that treating intertrochanteric fracture with a locking DHS allows sound bone healing and is not associated with any major complications. Although this report is promising, it should be interpreted with caution because only a prospective study with a large sample size would allow definitive conclusion.