Evaluation of peri-trochanteric fractures treated with cement-augmented dynamic hip screw in elderly patients

Background: Dynamic hip screw (DHS) has been the standard treatment for stabletrochanteric fracture patterns. However, primary stabilization with dynamic/sliding hipscrew is not always successful, especially in osteoporotic fractures. Internal fixation insuch a situation may achieve a satisfactory initial fracture site reduction, but latefracture collapse into varus during weight bearing, can lead to a high failure rate. Since1975, polymethylmethacrylate (PMMA) cement-augmented DHS have been used as asolution by adding an anchoring ability to the lag screw.Methods: A series of 20 osteoporotic intertrochanteric fractures were operated withcement augmented dynamic hip screw. One patient lost to follow up. All patientswere then allowed partial weight bearing walker aided ambulation under theguidance of physiotherapist on the second postoperative week . The patients werefollowed radio logically and clinically at regular intervals (1.5 month, then at 3rdmonth and then at 6th month interval after surgery). Results were graded as excellent(score >31), good (score 24-31), fair (score 16-23), and poor (score <16). Clinicalresult was given according to Salvati and Wilson scoring.Results: All 20 patients were taken for the study they were followed for minimum 6months and at 6 months the clinical outcome was rated as per the Salvati and Wilsonscoring system. One patient lost to follow-up. Final clinical results as evaluated bySalvati and Wilson scoring were; excellent in 8 cases (42.1%), good in 8 cases(42.1%), fair in 2 case (10.5%) and poor in 1cases (5.2%). There were no non-union,AVN, implant failure and screw cut-out in our study.Conclusions: The surgical management of intertrochanteric fractures with PMMAaugmented DHS provide a stable fixation with moderate pain free early mobilisationand better outcome in osteoporotic patients without the complications of superior screwcut-out, sliding collapse, and with the appropriate placement of bone cement along withproper amount (7-9 ml) of cement we can also reduce the cement related complicationssuch as delayed healing, nonunion, heat necrosis and avascular necrosis