Fixation of subtrochanteric fractures : Does a technical optimization of the dynamic hip screw application improve the results?

The subtrochanteric region has certain anatomical and biomechanical features that can make fractures in this region difficult for the treating surgeon. The preferred type of device is a matter of debate. Increased understanding of mechanical characteristics of the dynamic hip screw (DHS) has reduced the incidence of complications. Our hypothesis is based on the technical optimization of the DHS application. We prospectively studied 37 patients with subtrochanteric fractures with a mean age of 42.9 years. We utilized a two-stage protocol: initially, conversion of the comminuted fractures into two part fractures; then application of the implant with a technique that allowed dynamization of the DHS. Clinical and radiographic data were used to assess the outcome at 12 months. Fracture healing was obtained for all cases in a mean time of 11.64 weeks. One patient had 1.5 cm shortening of the injured limb. No implant failure was reported. All patients resumed pre-injury activities of daily living. It was concluded that the patients who were treated with the technical optimization of the DHS application achieved a close-to-normal anatomy following surgery and maintained this state throughout the follow-up period.