CLINICO-RADIOLOGICAL AND FUNCTIONAL OUTCOMES IN INTERTROCHANTERIC FRACTURES WITH DYNAMIC HIP SCREWS

Preoperatively or intra -operatively fractures of lateral femoral wall during triple reaming for DHS, invariably unites in versus while using DHS alone, so to achieve a stable fixation and allow early weight bearing, providing a buttress for the lateral wall is important. An effective reconstruction of lateral trochanteric wall with the addition of Trochanteric stabilisation plate (TSP) to this method can provide the better support and helpful in preventing complications such as excessive collapse and versus malunion. Patients of all age and gender with intertrochanteric fractures were included in the study while the patients with fractures extending into subtrochanteric region, ipsilateral or contralateral lower limb fractures, open fractures. Patients with psychiatric illness and those with history of previous hip surgery were excluded from the study. A standard 4 holed proximal tibial T-buttress plate for a customised TSP was used. Patients were operated under general anaesthesia in supine position and lateral approach was applied to the proximal femur for the implantation of dynamic hip screw. Out of the 50 selected patients, 3 patients did not turn up for regular follow up and 2 patients died before the final follow up. So the remaining 45 cases were analysed in this study. There were 30 males and 15 females. The average age was 60 years. The most common mode of injury was accidental fall at home (90%) with road traffic accidents being the second most common mode of injury (8%) and rest 2% cases belongs to the other type of injury. TSP when used with DHS in the treatment of inter-trochanteric fractures provides excellent results and prevents complications such as excessive femoral medialization, collapse, and lag screw cut out. A simple customization of the T-buttress plate can be easily done which can be used in the treatment of intertrochanteric fractures as effectively as a anatomical TSP.