Osteosynthesis errors in intertrochanteric fractures treated with the DHS system. A single center observational study

Abstract

Introduction: The use of the sliding plate/screw system for intertrochanteric fractures has proven to be a very effective fixation method, but it is still not free from failures. The objective of the study was to evaluate the causes of failure of the osteosynthesis system in patients who suffered intertrochanteric fractures who underwent surgery with the DHS sliding plate/screw system, pointing out the technical defects in its placement.

Methods: The present observational study was conducted at the Teodoro Maldonado Carbo Hospital in Guayaquil from September to December 2022. Patients with intertrochanteric fractures with surgical reduction with the DHS system were evaluated. The position of the cephalic screw in the femoral head and complications were measured. The odds ratio was used to measure risk.

Results: 73 cases were included, 45 women (61.6%), the average age of 82 years. The failure rate was 1.36% (95%CI -1.3%, 4.04%). The position of the head screw in the central – anterior zone 23 cases (31.5%) OR=0.70 (0.03-17.9) P=0.83, central – central zone 20 cases (27.39%) OR=0.85 (0.03-21.8) P=0.92, inferior – anterior zone 18 cases (24.65%) OR=0.98 (0.04-25.2) P=0.99, posterior – inferior zone 11 cases (15.06%) OR=1.78 (0.07-46.5) P=0.73, superior – posterior zone 1 case (1.36%) OR=145 (4.02-5232) P=0.007.

Conclusions: Superior-posterior positioning of the cephalic screw can increase the possibility of migration and, therefore, the system failure rate.