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Dynamic Hip Screws
ARABELLA BOWERS
201305715

Introduction
Over 70,000 people suffer a fracture in the hip region each
year in the UK
Dynamic Hip Screws (DHS) are a femoral head-sparring
orthopedic device
Treat extracapuslar / intertrochanteric neck of femur (NOF)
fractures
Extracapsular fractures are when the break occurs outside the
capsule
Figure 1: Front and side view of DHS (Surgery for
hip fracture: Dynamic hip screw, 2013)

Are a collapsible fixation device
Failure rate: 6
...
flexion-extension
2
...

3
...

2-5% of patients experience:
◦ Blood clots
◦ Bleeding
◦ Pain

1-2% of patients experience:
◦ Infection
◦ Catheterisation
◦ Altered leg length

<1% of patients experience:
◦
◦
◦
◦
◦
◦

AVN
Altered wound healing
Hip stiffness
Nerve damage
Bone damage
Blood vessel damage

Diseases of the Hip
OSTEOARTHRITIS

RHEUMATOID ARTHRITIS

Wears away the cartilage between the femoral Chronic inflammatory disease
head and the acetabulum
Results in joint pain, stiffness and swelling
Leads to the two bones scraping against each
Can lead to the deterioration of multiple joints
other
Symptoms: pain, loss of appetite, fever,
Is a degenerative disease
anemia and rheumatoid nodules
First symptom: pain in the hip or groin area
when walking

Diseases of the Hip
DYSPLASIA OF THE HIP (DDH)
1 in 1000 people suffer
Women and first born children are at a higher
risk
mainly down to having a family history of the
disorder
Symptoms: diminished leg movement in the
hip, shortening of the leg on the affected side,
asymmetry in leg positions

AVASCULAR NECROSIS (AVN) /
OSTEONECROSIS
Alcoholism and corticosteroids are the main
causes
As a result of poor blood circulation which
starves the bones that form the hip joint
Symptom: gradual pain

Non-Traumatic Femur Bone Diseases
Legg-Calve-Perthes Disease
◦ Affects the head of the femur
◦ Usually only affects children (more common in boys)
◦ Degenerative condition

Ewing’s Sarcoma
◦ Type of bone cancer
◦ Most common in people from the age of 10-20

Osteoporosis
◦ Patient has a bone mineral density a lot less than normal people
◦ More vulnerable to fractures, which most commonly occur in the hip

The Implant
A barrel length of 38 mm is most common, however sometimes a 25 mm short barrel is used
A 135° plate angle is used for anatomic reduction
150° plate angle is used for unstable fractures

◦ In a small hip, or one with a deformity, a surgeon cannot place a sliding device at a very high angle

In a study of 20 patients with DHS, the nails had:
◦ a uniform length of 25 mm
◦ a proximal diameter of 17 mm
◦ a distal diameter between 9 – 12 mm
...
9 mm in size
◦ Length from 55 – 115 mm
...

DHS plates are made of 316L stainless steel
◦ Corrosion resistant
◦ Available in a wide range of sizes and barrel angles

Lag screws are available in lengths from 50 mm to 145 mm
There are many studies comparing the use of titanium alloy to stainless steel
...

However, Multiple Cannulated Screws (MCS) are an alternative to using DHS
...

Failure rate for MCS: 15
...
, 2014)

Relatively quick post operation recovering time

References
Abdulkareem, I
...
A review of tip apex distance in dynamic hip screw fixation of osteoporotic hip
fractures
...
184
...
(2011)
...
[online] Available at:
https://www
...
org
...
2017]
...
and Lieberman, J
...
Surgery of the Hip
...
California: Elsevier Saunders, pp
...


Questions and Answers about Osteonecrosis (Avascular Necrosis)
...
National Institute of Arthritis
and Musculoskeletal and Skin Diseases (NIAMS), 15, pp
...


Byrne, D
...
and Baker, J
...
Anatomy & Biomechanics of the Hip
...
51-57
...
, Caeiro, J
...
, Morales, A
...
and Mesa, M
...
Complications of hip
fractures: A review
...
402-411
...
(2015)
...
[ebook] Ontario: Synthes, pp
...

Available at:
http://synthes
...
llnwd
...
pdf [Accessed 9 Mar
...

Grant, J
...
and Thalava, D
...
Enhanced Recovery Programme: Hip Fracture – Dynamic
Hip Screw, Cannulated Screws, Nailing
...
Ashton-under-Lyne: Tameside Hospital
NHS Foundation Trust, pp
...

Mirza, S
...
, Panesar, S
...
, Gangoo, S
...
(2010)
...
The Open Orthopaedics Journal, 4, pp
...

NHS
...
Rheumatoid Arthritis
...
nhs
...
aspx [Accessed 27 Mar
...

Orthopedics
...
Femur Bone Diseases
...
ygoy
...
2017]
...
Information and exercises following dynamic hip screw
...
1-8
...
(2014)
...
1st ed
...
38-157
...
mch-orth
...
Prabhoo%20Tanay%20Ramachandra
...
2017]
...
, Schipper, I
...
and van der Werken, C
...
Open reduction; sliding
hip screw
...
AO Foundation, pp
...

Regazzoni, P
...
, Winquist, R
...
(1985)
...

1st ed
...

Schwartsmann, C
...
, Spinelli, L
...
, Gonçalves, R
...
, Barreto, R
...

(2014)
...
ISRN Orthopedics, 2014, pp
...

Tanvir, S
...
DHS (dynamic hip screw)
...
youtube
...

Turnberg Building Orthopaedics, (2015)
...
The Information Standard
...
2-6
...
, Barrett, A
...
and Caron, H
...
Cancer In Children
...
Oxford: Oxford
University Press, pp
...


Insertion of the guide
wire (Raaymakers et al
...
, 2017)

Any Questions?

Screw insertion
(Raaymakers et al
...
, 2017)



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