Dynamic hip screw fixation versus multiple screw fixation for intracapsular hip fracture

Area of Science:

• Orthopedic surgery
• Trauma surgery
• Geriatric medicine

Background:

• Intracapsular hip fractures are common in elderly patients.
• Internal fixation is a standard treatment for these fractures.
• Choosing the optimal fixation method is crucial for patient outcomes.

Purpose of the Study:

• To compare dynamic hip screw (DHS) fixation with multiple screw fixation for intracapsular hip fractures.
• To evaluate differences in complication rates and need for revision surgery (hemiarthroplasty or total hip arthroplasty - THA).

Main Methods:

• A retrospective analysis of 52,884 patients aged ≥50 years undergoing internal fixation for intracapsular femoral neck fractures.
• Data extracted from the NHS hospital admission database (Sept 2007 - Sept 2013).
• Comparison of outcomes between dynamic hip screw (DHS) and multiple screw fixation groups, including complications and revision rates at 1 and 4 years.

Main Results:

• Multiple screw fixation was associated with a shorter hospital stay (13 vs. 15 days) and lower rates of 30-day myocardial infarction, 30-day lower respiratory tract infection, 90-day mortality, and avascular necrosis compared to DHS fixation.
• However, multiple screw fixation showed a significantly higher rate of conversion to hemiarthroplasty or THA at both one and four years post-surgery.
• All reported differences were statistically significant (p<0.001 for most outcomes).

Conclusions:

• Multiple screw fixation for intracapsular hip fractures is linked to reduced short-term complications and mortality compared to DHS fixation.
• Despite these benefits, multiple screw fixation demonstrates a higher long-term risk of requiring conversion to hemiarthroplasty or THA.