BIOLOGICAL PLATING OSTEOSYNTHESIS IN COMMINUTED SUBTROCHANTERIC FRACTURES WITH DYNAMIC HIP SCREW

Background: Comminuted subtrochanteric fractures represent a challenge for trauma surgeons. Fractures in the subtrochanteric region present challenges to achieving stable fixation and appropriate reduction because the subtrochanteric region of the femur is one of the highest stressed zones in the human skeleton where tensile or compressive stresses can exceed several multiples of body weight.

Aim:  The aim of this study is to observe the results of biological DHS fixation in the management of comminuted subtrochanteric fractures of femur in adults.

Method: A prospective study was conducted on a group of 25 patients in the Postgraduate Department of Orthopaedics, Government Medical College, Srinagar. In all the patients along with personal data, mode of trauma, type of fracture, intra-operative & post-operative complications, follow up examination including hip joint examination, duration of full weight bearing was considered. Patients were assessed clinically for pain, hip and knee range of motion, angular and rotational deformities and leg-length discrepancy. Union was assessed radiographically.

Results: Majority of the patients had trauma due to RTA (76%), fall from height/stairs/standing position (20%), and direct impact (4%). There were 5 type 3A, 6 type 3B, 8 type 4 and 6 type 5 fractures according to Seinsheimer classification. According to criteria laid by Trauma hip rating scale, excellent results were achieved in 16 patients, good in 8 patients and poor in 1 patient. However, no case of failure was reported. Union occurred in all cases. None of the patients had clinical pain or dysfunction.

Conclusion: Biological DHS is an effective and reliable option in the treatment of comminuted subtrochanteric fractures as, DHS allows good fixation of a fracture that extends into piriformis fossa (type 5). This procedure offers the significant advantage of being less technically demanding, simple and familiar to most surgeons and Leads to less blood loss.