Femoral nailing is an attractive option for the treatment of hip fractures. This is a minimally invasive technique only...
Sliding Hip Screw
Evolution of Sliding Hip Screw
The technology used to repair or fix the hip has evolved significantly. Initial repair methods used basic plate and screw constructs that required prolonged periods of nonweightbearing on the injured leg. However, as our understanding of hip fractures has evolved it has become apparent that any method we use to fix the hip needs to allow for immediate ability to put full weight on the leg, especially in elderly patients.
Due to this understanding the technology surrounding hip fracture fixation has evolved significantly and there are now several highly specialized tools to fix the hip. Which method is used depends on the “stability” of the fracture. Simply, a fracture is considered stable if the outside, or lateral, surface of the bone is intact. Stable fractures can be fixed using a special plate and screw called a sliding hip screw, while unstable fractures are fixed using a nail down the middle of the bone.
The sliding hip screw aids in healing of the hip fracture by allowing the large screw in the bone to piston through the plate on the side of the bone. This transfers downward “shear” force into “compressive” force through the site of the fracture, which allows for more efficient healing. These constructs also allow for immediate weightbearing after surgery, allowing for patients to participate in physical therapy and start their recovery sooner.
The Synthes Dynamic Hip Screw (DHS) is one of several options for sliding hip screw constructs. The large screw in the bone, called the lag screw, is made of stainless steel and has threads at the tip of the screw only to allow for more effective compression. The femur side plate is also made of stainless steel and is lower profile than other competing options, which leads to less irritation to the surrounding muscle and tissue after placement.
Both the plate and screw come in several size options to allow for customization to each patients’ anatomy. The DHS system is particularly unique because of the number of options in each component of the construct: plate length, barrel length, barrel angle, and lag screw length.