Journal article
A RANDOMIZED, PROSPECTIVE STUDY COMPARING INTERTROCHANTERIC HIP FRACTURE FIXATION WITH THE DYNAMIC HIP SCREW AND THE DYNAMIC HELICAL HIP SYSTEM IN A COMMUNITY PRACTICE
The Iowa orthopaedic journal, Vol.31, pp.166-172
2011
PMCID: PMC3215131
PMID: 22096437
Appears in Diamond Open Access
Abstract
Objective
To evaluate the clinical performance of the Dynamic Helical Hip System (DHHS) spiral blade relative to the Dynamic Hip Screw (DHS) lag screw.
Design
Randomized prospective study.
Setting
One level-2 trauma center and one level-3 trauma center.
Patients
Fifty-one consecutive patients were recruited into the trial. Inclusion criteria included patients over 50 years of age with AO/OTA 31A1 or 31A2 fracture.
Intervention
Surgeries were performed by one of 15 participating community orthopaedic surgeons. The patients were randomized to either a DHHS or DHS implant. Follow-up occurred at two weeks and six weeks and then at six-week intervals until healing occurred.
Main Outcome Measures
Primary outcome variables included sliding of die implant on the final AP radiographs, failure by cut-out and implant failure.
Results
There were 24 patients in the DHS group and 27 in the DHHS group. There was no difference in age, gender, ASA score, fracture classification or in the quality of reduction measured on the immediate postoperative radiographs (p=0.28) between the two groups. The tip apex distance was 18.7 mm in the DHHS group and 18.5 mm in the DHS group (p=0.40). The DHHS group had average blade sliding of 7.4 mm while the DHS group had an average lag-screw sliding of 7.7 (p=0.45). The DHHS group had two failures by central protrusion of the blade through the femoral head without significant varus collapse or superior migration. One was revised to a DHS and healed, the other was revised to a proximal femoral locking plate, which also failed and eventually required revision to a total hip arthroplasty. Investigation of the implants post failure showed evidence of binding of the blade shaft in the barrel as a mechanism of failure in both cases. No DHS implants cut out in this series, although one patient was revised to a total hip arthroplasty for symptomatic segmental osteonecrosis.
Conclusion
Both implants performed well in a majority of cases. The higher incidence of failure in the DHHS group is concerning, despite the low numbers. The mechanism of failure of the DHHS implant left adequate bone stock for attempts at revision fixation.
Details
- Title: Subtitle
- A RANDOMIZED, PROSPECTIVE STUDY COMPARING INTERTROCHANTERIC HIP FRACTURE FIXATION WITH THE DYNAMIC HIP SCREW AND THE DYNAMIC HELICAL HIP SYSTEM IN A COMMUNITY PRACTICE
- Creators
- Daniel C FitzpatrickDaniel V SheerinBrian R Wolf - University of Iowa, Orthopedics and RehabilitationThomas K Wuest
- Resource Type
- Journal article
- Publication Details
- The Iowa orthopaedic journal, Vol.31, pp.166-172
- Publisher
- Dept. of Orthopaedics, The University of Iowa; United States
- PMID
- 22096437
- PMCID
- PMC3215131
- ISSN
- 1541-5457
- eISSN
- 1555-1377
- Language
- English
- Date published
- 2011
- Academic Unit
- Orthopedics and Rehabilitation; Physical Therapy and Rehabilitation Science
- Record Identifier
- 9984040204002771
Metrics
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