DYNAMIC COMPRESSION HIP SCREW

Indications

Sliding compression hip screw devices are used to stabilize

1. (a) Inter-trochanteric hip fractures (Fig. 9.1a,b).

2. (b) Intracapsular fractured neck of femur.

Pre-operative planning

Clinical assessment

• Pain localized in the affected hip site with radiation of pain to the knee.

• Limb is shortened and externally rotated.

• Assess and document neurovascular status of the leg.

• In young patients carefulexaminationforotherinjuries must be made, as they are a result of high-energy trauma.

• A complete medical examination in elderly patients.

Radiological assessment

• Anteroposterior (AP) radiograph and a lateral view of the affected hip to demonstrate the fracture geometry.

Operative treatment

Anaesthesia

• Regional (spinal/epidural)and/orgeneral anaesthesia.

• At induction, administer prophylactic antibiotic as per local hospital protocol (e.g. 3rd generation cephalosporin).

Table and equipment

• DHS instrumentation set – ensure the availability of the complete set of implants (Fig. 9.2).

• A radiolucent table or a fracture table with the appropriate traction devices.

• An image intensifier.

Table set up

• The instrumentation is set up on the side of the operation.

• Image intensifier is from the contralateral side.

• Position the table diagonally across the operating room so that the operating area lies in the clean air field.

Patient positioning

• Supine with awell-padded radiolucent pudendal post.

• Position the uninjured leg in a leg holder (i.e. Lloyd Davies withadequatepaddingover the peroneal nerve) or in wide abduction by a footplate attached to the leg extensions of the fracture table.

• A footplate attached to the other leg extension of the fracture table holds the injured leg (Fig. 9.3).