The principle behind the importance of properly placing the Dynamic Hip Screw plate

The Dynamic Hip Screw has the unique property of being a fixed angle implant, allowing controlled, dynamic settling of the fracture by allowing compression of the fracture to occur as the patient starts to bear weight since the screw can slide back into the barrel.

Review our new Stabilization using the Dynamic Hip Screw procedure now available on the Touch Surgery app to learn how our orthopaedic key opinion leaders Dr. Yves Acklin and Dr. James C. Krieg describe how to safely perform this procedure.

Key facts:

  • The dynamic hip screw (DHS) is designed to provide strong and stable internal fixation of a variety of intertrochanteric, subtrochanteric, and basilar neck fractures, with minimal soft tissue irritation.
  • The design of the plate allows maximized number of fixation points with a smaller incision.

The standard 38 mm barrel (left) length is most commonly indicated. The 25 mm short barrel (right) is indicated for specific clinical situations including:

  • cases in which the standard barrel may not provide sufficient glide for the lag screw (expected long impaction distance)
  • unusually small femurs (lag screw length is less than 85 mm)

 

The Dynamic Hip Screw (DHS) was designed to provide strong and stable internal fixation of a variety of intertrochanteric, subtrochanteric and basilar neck fractures, with minimal soft tissue irritation. It can also stabilize pertrochanteric femur fractures (AO type 31A1 and 31A2). It has the unique property of being a fixed angle implant, allowing controlled, dynamic settling of the fracture by allowing compression of the fracture to occur as the patient starts to bear weight since the screw can slide back into the barrel. The fixation achieves stability with weight bearing.

It has been expanded to basilar femoral neck fractures (AO type 31B) when combined with an anti-rotation screw and can be used for unstable intertrochanteric femur fractures (AO Type 31A3) when it is used with a universal locking trochanteric stabilizing plate (ULTSP) to prevent a medial shift of the shaft during fracture healing.

Results are good provided the DHS is correctly used in fractures of an appropriate type.

Key opinion leader Dr. James C. Krieg advises caution during the reaming key phase in this procedure:

“It is important to be aware of the guide wire when reaming; the cannulated reamer can bind to the guide wire and cause inadvertent advancement of the guide wire into the acetabulum. Therefore, it is important to insert the reamer carefully over the guide wire and to observe its position under image intensification to prevent this.”

Furthermore, key opinion leader, Dr. Yves Acklin, highlights the importance of proper DHS plate positioning:

“Before, during, and after insertion of the DHS plate, it is important to ensure that both the insertion wrench shaft and the DHS plate are aligned with the femoral shaft. Failure to do so can lead to functional failure of the device.”

Learn and prepare for surgery with our free simulation available here

Authors

James C.Krieg, MD
Director of Orthopaedic Trauma
Professor of Orthopaedic Trauma
Rothman Institute at Thomas Jefferson University

Yves Acklin, MD, DMedSc, EBSQ Trauma
Kantonsspital Baselland Bruderholz
4101 Bruderholz
Switzerland