Repetitive reoperation of the DHS failure: clinical and biomechanical analysis – a case report
Authors:
M. Hrubina 1,2
Authors‘ workplace:
Ortopedické oddělení Pelhřimov, vedením oddělení pověřen: MUDr. M. Skoták
1; Katedra lékařských a humanitních oborů Kladno, Fakulta biomedicínského inženýrství ČVUT v Praze, Kladno, vedoucí katedry: Prof. MUDr. L. Navrátil, CSc.
2
Published in:
Rozhl. Chir., 2013, roč. 92, č. 7, s. 389-394.
Category:
Case Report
Overview
The author describes a rare case of repetitive reoperation of Dynamic Hip Screw failure due to the pull-out of the plate. An 86-year-old female patient suffered an injury – a pertrochanteric fracture of the left femur which was treated by DHS. After 14 weeks a new fall occurred and caused the DHS to fail – the plate pulled out and all cortical screws were broken. The first reoperation using a six-hole plate was performed. After a year and the patient’s new fall, a femoral fracture occurred in the area of the distal cortical screw underneath the plate. The DHS was removed, plate osteosynthesis of the femur was performed and the trochanteric fracture healed. No further complications were found, the patient died almost two years after the second reoperation. The biomechanical analysis of this case revealed a stress concentration close to the implant yield limit in the area of the distal cortical screw. Femoral neck screw placement was suitable with regard to the stress distribution.
Key words:
dynamic hip screw – proximal femoral fractures – osteosynthetic material breakage
Sources
1. Schumpelick W, Jantzen PM. A new principle in the operative treatment of trochanteric fracture of the femur. J Bone Jt Surg 1955;37-A:693–698.
2. Wolfgang GL, Bryant MH, OęNeil JP. Treatment of intertrochanteric fracture of the femur using sliding screw plate fixation. Clin Orthop Relat Res 1982;163:148–158.
3. Waddell JP (ed). The proximal femoral fractures. Improving outcomes. Philadelphia, Saunders-Elsevier 2011.
4. Palarčík J. Komplikace syntézy skluzným šroubem Medin. Rozhl Chir 2001;80:43–47.
5. Barton TM, Gleeson R, Topliss C, et al. A comparison of the long gama nail with the sliding hip screw for the treatment of AO/OTA 31-A2 fractures of the proximal part of the femur. J Bone Jt Surg 2010;92-A:792–798.
6. Říha D, Bartoníček J. Internal fixation of pertrochanteric fractures using DHS with a two-hole side-plate. Int Orthop 2010;34: 877–882.
7. Hrubina M, Skoták M, Krumpl O, et al. Zlomení osteosyntetického materiálu u pacientů se zlomeninou proximálního femuru ošetřenou DHS. Rozhl Chir 2012;91:146–150.
8. Jacobsen BW. Breakage of sliding hip screw. Acta Orthop Scand 1987;58:292–293.
9. Horák Z, Hrubina M, Džupa V. Biomechanical analyses of proximal femur osteosynthesis by DHS system. Bull Appl Mech 2011;7:60–65.
10. Džupa V, Džupová O, Bendová E, et al. Infekční komplikace operační léčby poranění pohybového aparátu: přehled rizikových faktorů a etiologických agens za roky 2000–2005. Klin Mikrobiol Infekc Lek 2007;13:242–247.
11. McQueen MM, Little John MA, Miles RS, et al. Antibiotic prophylaxis in proximal femoral fractures. Injury 1990;21:104–106.
12. Laohapoonrungsee A, Arpornchayanon O, Phornpuntkul C. Two-hole side-plate DHS in the treatment of intertrochanteric fracture: results and complications. Injury 2005;36:1355–1360.
13. Paker MJ, Bowers TR, Pryor GA. Sliding hip screw versus Targon PF nail in the treatment of trochanteric fractures of the hip. J Bone Jt Surg 2012;94–B:391–397.
14. Chirodian N, Arch A, Parker MJ. Sliding screw fixation of trochanteric hip fractures: outcome of 1024 procedures. Injury 2005;36:793–800.
15. Yian EH, Banerji I, Matthews LS. Optimal side plate fixation for unstable intertrochanteric hip fractures. J Orthop Trauma 1997;11: 254–259.
16. Džupa V, Bartoníček J, Příkazský V, et al. Sociálně-ekonomická studie pacientů léčených pro zlomeninu proximálního femuru. Rozhl Chir 2003;82:108–114.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2013 Issue 7
Most read in this issue
- Laparoscopic resection of the sigmoid colon for the diverticular disease
- Diverticular disease of the large bowel – surgical treatment
- Diverticular disease of the large bowel – imaging methods
- The staple line in sleeve gastrectomy