Treatment of Inter-trochanteric Fractures in Adults with Dynamic Hip Screws without Radiological Control - an Operational Dilemma

Abstract

Objective: The objective was to assess the early (immediate post-operative) and final outcome
of fracture union, mal-union, non-union, avascular necrosis, implant failure and infection.
Material & Methods: A prospective study of fifty five patients of intertrochanteric fractures
treated with dynamic hip screws (DHS) without radiological control (C-arm and X-rays) was
conducted at Orthopaedic Department, Services Hospital Lahore. AO classification of
intertrochanteric fractures was used and fractures were classified as A1, A2 and A3 fractures.
Results: There were 20 (40%) A1, 25 (50%) A2 and 5 (10%) A3 fractures. All fractures were
reduced and fixed with DHS. 19 patients (38%) had ideally placed implants, 18 patients (36%)
had less ideally placed implants and 13 patients (26%) had implants in non-ideal (unsatisfactory)
position that required immediate re-do surgery. Overall complication rate was 88% in A2
fractures and 80% in A3 fractures.
Conclusion: DHS osteosynthesis in intertrochanteric fractures without radiological control
should be discouraged. It is always better to refer the cases where radiological facilities are
available in order to avoid morbidity, increased hospital stay and financial burden on the already
financially constrained individuals.