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.

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.

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.

Background and Objectives: Intertrochanteric fracture is a prevalent condition among the elderly that affects many people annually in both health and financial status. Type A2 intertrochanteric fracture is treated with surgical internal fixation either through a cephalomedullary nail (CMN) or a Dynamic Hip Screw (DHS). This study compares radiological and clinical outcomes of CMN and DHS devices in patients with type A2 intertrochanteric fractures. Methods: In this retrospective cohort study, hospitalized patients with A2 intertrochanteric fracture who were treated with either CMN or DHS devices from 2014 to 2023 were included in the study. All participants were assessed retrospectively regarding radiological outcomes (nonunion, varus malunion, and femoral medialization percentage) clinical outcomes, and incidence of pulmonary thromboembolism and deep vein thrombosis.  Results: A total number of 194 patients were included in the study. The patients who were operated on with DHS showed a better result regarding the incidence of varus malunion compared to CMN (P=0.009), while the incidence of nonunion and union failure, and percentage of femoral medialization showed no significant difference between groups. Despite a comparable total score of modified Harris Hip score in both groups (P=0.669), DHS surgery had a better outcome in the walking distance status component (P=0.043). Conclusion: Despite better outcomes of DHS surgery regarding the incidence of varus malunion and walking distance status, other outcomes of both groups did not show a significant difference. However, more prospective studies with multiple systematic follow-ups and radiographs are needed to confirm these findings.

Background: Surgical treatment of basicervical femoral neck fractures, which are biomechanically similar to intertrochanteric fractures, is an internal fixation by Dynamic Hip Screw (DHS) and anti-rotation Screw. Since one of the remarkable complications of this surgical procedure is device failure, we aimed to make a comparison between bipolar hemiarthroplasty and the DHS plate fixation in elderly patients with basicervical femoral neck fracture. Methods: In this randomized controlled clinical trial study, 60 patients with femoral neck fractures were randomly divided into two groups of DHS fixation (control group, n = 30) and bipolar hemiarthroplasty (intervention group, n = 30). Harris Hip Score (HHS) questionnaire and the Visual Analogue Scale (VAS) for pain assessment were used for functional evaluations. Postoperative complications were evaluated at 6 months and one year postoperatively. Results: The mean age was 73. 95 ± 9. 85 years in the hemiarthroplasty group and 74. 22 ± 7. 85 years in the internal fixation group. Three patients in the internal fixation group and 6 patients in the hemiarthroplasty group were excluded. HHS in 6 months and one year after surgery in the intervention group was dramatically higher than the control group. There were no noticeable changes in VAS scores between the two groups. Two cases of device failure happened in the control group. Conclusions: It seems that bipolar hemiarthroplasty is more effective than internal fixation by DHS plate in improving the patient’ s quality of life, considering higher HHS scores, earlier patient mobilization, shorter hospital stay, lower device failure rate, and lower revision rate.

Background: Intertrochanteric (IT) fracture is one of the most common fractures in adults. Dynamic Hip Screw (DHS) surgery is a surgical procedure for IT fracture treatment. This study evaluated the mortality rate and quality of life (QOL) among these patients one year after the surgery. Methods: This cohort study was conducted on 110 patients with IT fractures treated with DHS from 2017 to 2019. A questionnaire was completed for each patient before, during, and after surgery. Preoperative information included demographics, height, weight, body mass index (BMI), smoking, diabetes, variables such as IT fracture classification, injury mechanism, lateral wall, and the American Society of Anesthesiologists (ASA) comorbidity classification. Tip-apex distance (TAD), nail position at the femoral head, and the amount of bleeding during the operation were achieved during and immediately after the surgery. The mortality rate was determined one year after the surgery, and the surviving patients were assessed by the 36-Item Short Form Survey (SF-36) questionnaire. Results: The mortality rate among patients who underwent DHS was 31. 81%. There was no significant difference between living and dead patients regarding demographic information, surgical techniques, and comorbidities. There was no association between patients regarding the average of all areas of physical, mental, and overall health and gender. There was no significant relationsHip between the mean of physical and mental health with the duration of hospital stay and the amount of bleeding during surgery. A history of diabetes, high blood pressure, and smoking in these patients was not associated with mortality and QOL. Conclusion: The patient's age is the most important risk factor for mortality after the DHS surgery.