Clinical outcome following treatment of stable and unstable intertrochanteric fractures with dynamic hip screw

Abstract

Introduction: Intertrochanteric (IT) fractures are associated with significant morbidity and mortality in the elderly population. We aim to compare the clinical outcome of unstable with stable IT fractures after treatment with dynamic hip screw (DHS).

Materials and methods: Patients with IT fractures treated with DHS at National University Hospital between 2003 and 2005 were included in the study. Patients were divided into 2 groups: stable and unstable IT fractures. Clinical outcome parameters include perioperative complications, functional outcomes, and incidence of morbidity and mortality.

Results: One hundred and thirty-six patients were analysed. Mean age was 77 years. There were 61 stable and 78 unstable fractures. Average length of follow-up was 30 months. The rates of local complications were not significantly different between the 2 groups. The incidence of malunion and excessive impaction were significantly higher in the unstable group. The ambulatory status at one year post-surgery was not significantly different between the 2 groups. In terms of general postoperative complications and one year mortality rate, there was no significant difference between the 2 groups. The need for blood transfusion was significantly higher in the unstable group.

Conclusion: In summary, DHS fixation provides comparable postoperative outcomes in unstable IT fractures with relatively low rates of complications. Although it was associated with a higher incidence of malunion and excessive impaction in the unstable fracture group, there was no difference in functional status at one-year compared to the stable group.