Dynamic Hip Screw - DHS: Difference between revisions
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FAITH (2014) Fixation using alternative implants for the treatment of hip fractures (FAITH): design and rationale for a multi-centre randomized trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures ''BMC Musculoskeletal Discorders'' 15(219) doi: 10.1186/1471-2474-15-219 | FAITH (2014) Fixation using alternative implants for the treatment of hip fractures (FAITH): design and rationale for a multi-centre randomized trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures ''BMC Musculoskeletal Discorders'' 15(219) doi: 10.1186/1471-2474-15-219 | ||
== | == Precautions post surgery == | ||
* [[Surgery and General Anaesthetic|Post surgical complications]] | |||
[ | * Intra-capsular surgery may require a period of partial or protected weight bearing to ensure no displacement of the humeral head | ||
== References == | == References == |
Revision as of 23:28, 27 September 2020
Top Contributors - Rhiannon Clement, Lucinda hampton and Kim Jackson
Purpose[edit | edit source]
The Dynamic Hip Screw (DHS) or Sliding Hip Screw can be used as a fixation for neck of femur fractures. This would usually be considered for fractures that occur outside the hip capsule (extracapsular), often stable intertrochaneric fractures[1]. This is because there is a reduced chance of interruption to the blood supply to the head of the femur, and so it may be possible to preserve the joint. However, it may also be appropriate for younger patients with fractures within the hip capsule (intracapsular) if there is a good chance that the blood supply is preserved, reducing the risk of avasular necrosis.
Technique[edit | edit source]
History of the DHS[edit | edit source]
Prior to the use of DHS sliding screws, angled blade plates were used[2]. These fixed plates matched the angle of the femural head. These plates had a number of complications, including failure to purchase, requiring frequent osteotomies. They also did not allow any compression across the fracture site, leading to stress failures and frequent non-union[2]. Therefore, the DHS, with sliding barrel, was created to allow controlled compression across the fracture site. This is important for bone healing.
NICE Guidelines recommends: Use extramedullary implants such as a sliding hip screw in preference to an intramedullary nail in patients with trochanteric fractures above and including the lesser trochanter (AO classification types A1 and A2)[3].
Physiotherapy Interventions[edit | edit source]
Considerations post surgery:
- Post op instructions and weight bearing status
- Infections
- Neurovascular complications
- Pain
- Self-efficacy and motivation
- Fear of falling
Any transfer or mobility aids will be determined by the weight bearing status (usually highlighted in the op note). If the surgeon feels the hip needs protecting post surgery, they may advise partial or non-weight bearing for the patient.
Physiotherapy interventions:
- Transfers (bed, chair, toiletting).
- Mobility (+/- appropriate aid).
- Goal setting
- Advising patient and team on pain management and expectations post-surgery
- Advice on swelling management
- Exercises
- Balance retraining and confidence building
- Gait retraining
- Considering home environment.
- Interactions with family and carer
It is important that the patient is transferred out of bed, within these limitations, as early as possible to avoid complications of bed rest (e.g. chest infections, DVT, muscle atrophy). NICE guidelines advise, unless contraindicated, for patient's to mobilise the day after surgery. [3]
Physiotherapy exercises post hip surgery:
After surgery | After 6 weeks | ||
---|---|---|---|
Supine | Hip ABD and heel slides (slide sheet can reduce friction) | Inner Range Quads | Bridges (unless NWB) |
Sitting | Knee extension | Knee flexion | Sit to stand (one balance optimised) |
Standing | Once able to maintain independent standing balance. Hip Abduction Hip Extension | Hamstring Curl and Marching on the Spot | Heel Raises and Mini squats |
Evidence[edit | edit source]
Mue D.D (2013) Outcome of Treatment of Fracture Neck of Femur using Hemiarthroplasty Vs Dynamic Hip Screw journal of West African College of Surgeons 3(2)
FAITH (2014) Fixation using alternative implants for the treatment of hip fractures (FAITH): design and rationale for a multi-centre randomized trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures BMC Musculoskeletal Discorders 15(219) doi: 10.1186/1471-2474-15-219
Precautions post surgery[edit | edit source]
- Post surgical complications
- Intra-capsular surgery may require a period of partial or protected weight bearing to ensure no displacement of the humeral head
References[edit | edit source]
- ↑ Dodds et al (2004) The Sliding Hip Screw Current Opinion in Orthopaedics Volume 15, Issue 1 pp12-17
- ↑ 2.0 2.1 Singh A.P. Dynamic Hip Screw Or Sliding Hip Screw. [online] Available at: <http://www.boneandspine.com/dynamic-hip-screw/> [Accessed 19 September 2020].
- ↑ 3.0 3.1 NICE (2017) Hip Fracture: Management National Institute for Health and Care Excellence [online] <available from: https://www.nice.org.uk/guidance/cg124/chapter/Recommendations#analgesia>