Background: In intertrochanteric fractures، DYNAMIC HIP SCREW ((DHS)) is the most frequently used tool، but several studies did not give good results for this device in reverse-oblique and transverse fractures. Current study aimed to compare fixation results of reverse-oblique intertrochanteric and short-segment subtrochanteric fractures using DYNAMIC condylar SCREW (DCS) and (DHS) in patients referred to Alzahra and Kashani Hospitals in Isfahan, Iran.Methods: In a cross-sectional study، medical files of the patients referred to emergency units of the two hospitals who were diagnosed with intertrochanteric or subtrochanteric fractures and underwent (DHS) or DCS surgery more than 6 months before were assessed; they were invited for follow-up visit and examination. Written consent forms were taken from all the patients upon their entry; and they were examined in terms of complications including nonunion and failure of device and level of fracture improvement. These cases were evaluated by simple radiography ,too. Results obtained from examination of patients in addition to demographic information were recorded in the data collection form for each patient.Findings: Perfect union was observed in 14 (of 25) patients in (DHS) group and 21 (of 25) patients in DCS group (56% vs. 84%) six months after the surgery. Bone union was significantly better in DCS group (P=0.031). In addition, six months after the surgery, the devices used in 14 people in (DHS) group and 24 people in DCS group were fixed and the difference between the two groups was significant (P=0.001). 14 and 24 patients had total recovery in (DHS) and DCS groups، respectively (20% vs. 44%) with a significant difference (P=0.020).Conclusion: Considering obtained results, it can be concluded that using DCS is recommended over (DHS) due to severity of pain, bone union and fixation of the device.

Background and purpose: Femoral neck fracture is associated with a high rate of side effects, especially in young people, who are usually affected by severe energy shocks. Results after injury depend on some factors, including displacement, fragility, bleeding rate, proper placement, and stable and strong fixation. The aim of this study was to compare DYNAMIC HIP SCREW ((DHS)) or multiple cannulated SCREWs (MCS) in fractures of the femoral neck base. Materials and methods: In this cross-sectional study, 78 patients with femoral neck fracture were treated by internal fixation: MCS (n= 26) and (DHS) (n= 52) in Babol Shahid Beheshti Hospital, 2016-2018. Complications, including pain and lameness, infection, avascular necrosis (AVN), and nonunion were investigated in both groups. The visual analog scale (VAS) score and Harris HIP Score (HHS) were also compared between the two groups. Results: Mean ages of the patients in MCS group and (DHS) group were 54. 19 ± 23. 35 and 58. 50 ± 21. 06 years, respectively. In patients treated by MCS, infection, AVN, no welding, and pain and lameness were seen in 3, 2, 3, and 6 patients, respectively, while these complication were observed in 1, 1, 1, and 4 patients in the (DHS) group, respectively. The rate of complications were not found to be significantly different between the two group (P>0. 05). The mean VAS score was significantly lower in the (DHS) group compared to that in the MCS group (P<0. 05). The HHS scores were not significantly different between the two groups (P<0. 05). Conclusion: According to this study, MCS is more appropriate in the treatment of femoral neck fractures due to less bleeding and shorter operation time.

Background and Objectives: Intertrochanteric fractures are the most common fractures that needs surgical fixation. There are some instruments applying to fix the intertrochanteric fractures. The aim of this study was to assess the positive predict value of Tip-Apex Distance (TAD) on intertrochanteric fractures treated by ((DHS), DYNAMIC HIP SCREW).Materials and Methods: In a single center descriptive prospective study 100 Patients with intertrochanteric fractures who were treated by (DHS) were evaluated. These patients assessed for their Tip-Apex Distance and rate of fixation failure.Results: 53 male and 47 female with mean age of 76.71±11.17 were included. 43% of subjects were in grade IV of osteoporosis, 21% in grade V and 29% in grade III. In 57% the SCREW was located at posterior-inferior side in 40% it was placed in central and in 3% superiorly mean of TDA was 23.5±1.83 mm. The most common complication was failure of SCREW.Conclusion: Based on the findings, an intertrochanteric fracture is higher in men than woman. Most patients with intertrochanteric fractures suffered from osteoporosis. The distance between the SCREW head to the apex has a significant possitive association with fixation failure.

Introduction: Intertrochantric fracture treatment is one of the orthopedic problems in the elderly. Especially in unstable fractures and patients with osteoporosis the outcome of treatment is not satisfactory. This study introduces criterion which might be effective in the prognosis of the treatment.Methods: Between 2002-2007, 128 patients with unstable intertrochantric fracture who had a severe osteoporosis in terms of sigh’s criterion (grade 1-3) and were treated with (DHS) and had a Tip Apex Distance (TAD) below 25mm were followed up. In this patient Y/B (diameter of femoral neck/diameter of body of nail) and X/A (great diameter of femoral head/ diameter of pitch of nail) were calculated and failure of treatment was evaluated in different groups.Results: The total amount of treatment failure was 33 (26%). the average age of patients was 74.4 years old. 86 patients were female and 42 of them were male. The greatest failure rate was seen in B1 group (21 cases) with Y/B³3.6mm and in B2 group (23 cases) with X/A ³3mm. The mean of Y/B and X/A were 3.64 and 3.08 millimeters, respectively. Conclusion: Noting the high incidence of treatment failure especially in B1 and B2 groups which shows great incidence of the treatment failure in patients with large femoral neck and head diameter, new treatment measures should be taken to improve the treatment prognosis of unstable intertrochantric fractures especially in patients with large femoral neck and head diameter.

We report a 71 year-old patient with intertrochanteric fracture who had been managed with (DHS) and her healed fracture complicated by a subcapital femoral neck fracture.A subcapital femoral neck fracture complicating a healed intertrochanteric fracture is rare but catastrophic event. Such cases are managed in a hetereogenous manner, i.e. there exists a mixture of cases treated by either fixed angle devices or DYNAMIC compression HIP SCREWs ((DHS)). We report on a patient who developed subcapital femoral neck fractures after open reduction and internal fixation of an intertrochanteric HIP fracture with a DYNAMIC HIP SCREW. We found 5 cases in literature with similar complication.

Background & aim: Treatment of sub trochanteric fractures is very challenging for bone and joint surgeons. The techniques used to treat these fractures are fracture reduction and the use of condylar DYNAMIC SCREWs and HIP DYNAMIC SCREWs. The aim of this study was to compare the treatment of sub trochanteric fractures of type A femur with condylar DYNAMIC SCREW and HIP DYNAMIC SCREW in hospitalized patients at Shahid Beheshti Hospital, Yasuj, Iran from 2007-2017. Methods: The present study was conducted by reviewing the existed data files of 50 patients with sub trochanteric fracture type A hospitalized at Shahid Beheshti Hospital, Yasuj, Iran from 2007-2017. These patients were randomly divided into two equal groups of 25 in terms of treatment with condylar DYNAMIC SCREW(DCS) and HIP DYNAMIC SCREW ((DHS)). In these two groups, the variables of treatment failure, pain, and range of motion of the HIP in three-month and six-month periods were compared. The collected data were analyzed using Chi-square and Mann-Whitney tests. Results: From the 50 patients, 11(22%) failed treatment, of which four (16%) were treated with (DHS) and seven (28%) with DCS. No statistically significant relationsHIP was seen between age (p=0. 1), sex (p=0. 3) and type of intervention (p=0. 9) with treatment failure. Treatment failure (approximately 90%) occurred in the first four months and all within six months. Both treatments (using DCS and (DHS)) were optimally effective in the treatment of subtrocentric fractures of type one and no statistically significant difference was observed between them (p <0. 001). Conclusion: Both treatments (using DCS and (DHS)) were optimally effective in the treatment of sub trochanteric fractures of type A and no statistically significant differences were observed between them.

Background: This study aimed to present a rare case of a failed DYNAMIC HIP SCREW ((DHS)) used for fixation of intertrochanteric fracture sliding into the pelvis and to review the most common causes of (DHS) failure in order to prevent this from happening in the future. Case Report: A 68-year-old woman was referred to the orthopedics clinic with left HIP pain and limping from 6 months ago. In our evaluation, she had (DHS) failure and intrapelvic protrusion. Conclusion: There have been several aspects of the previously described (DHS) failure. We performed a two-stage total HIP arthroplasty (THA) for the patient with a good one-year follow-up in the present case.

Background: Pelvic fracture is one of the most common fractures in the elderly, especially in the intertrochanteric region. Therefore, in the present study, an external fixator was designed specifically for intertrochanteric fractures. The present study aimed to compare the operating time, amount of bleeding, and mortality rate between the patients who received either DYNAMIC HIP external fixators (DHEF) or DYNAMIC HIP SCREW ((DHS)). Methods: In 2018, 46 patients with intertrochanteric fracture due to trauma and high anesthesia risk were included in the study and randomly assigned to two groups of control (n=24, patients treated with (DHS)) and intervention group (n=22, patients treated with the DHEF). Treatment was carried out using the DHEF which was newly designed and placed outside the patient's body under short and light anesthesia. After 3 and 12 months of follow-up, the two groups were compared for some variables, including mortality rate, pain intensity, Harris HIP score (HHS), cut-off rate of the device, femoral neck angles before and after the operation, hemoglobin changes, hematocrit levels before and after the operation, the number of injected blood units, and the number of hospitalization days. Results: Mortality rate was higher in open surgery with (DHS). The assessment of variables in both intervention and control groups demonstrated that duration of operation (P<0. 001), hospitalization length, time to union (P=0. 001), pain intensity five days after the operation, as well as changes in Hb and HCT, were significantly higher in the control group than the intervention group. The mean HHS scores of 83. 5± 14. 3 and 78. 2± 11. 5 were gained for the DHEF and (DHS) groups, respectively (P=0. 22). conclusion Considering the superior results of treatment with the external fixator in comparison with the (DHS), such as lower mortality rate and fewer complications, a DYNAMIC HIP external fixator can be prescribed in patients with intertrochanteric fractures and high anesthesia risk.