Dhs principles

principles concerning decision to use DHS and its complications - done during basic fracture fixation course

1. AND BIOMECHANICS? DHS - PRINCIPLES

2. Inter trochanteric fractures

3. What signifies instability? Posteromedial comminution ( calcar ) Subtrochanteric extension / reverse oblique Involvement of lateral cortex

4. Implant of choice Dynamic hip screw (DHS) Cephalomedullary device Fixed angle device

5. Dynamic hip screw

6. Only for STABLE fractures

7. Why only stable? CONTROLLED COLLAPSE

8. IF NOT….

9. Biomechanically Shorter lever arm in CMD – reduce bending forces

10. Some tips on implant insertion

11. Pre-scrub reduction Pre-op planning to determine best way to reduce the fracture Traction Internal rotation Occasionally need to lift the posterior displacement

12. Guide wire placement

13. TAD should be <25mm

14. Conclusion Correct indication Pre-op planning Reduce before scrub Slightly inferior - centre Achieve TAD <25mm