COMPARATIVE STUDY OF TREATMENT OF UNSTABLE INTERTROCHANTERIC FRACTURE WITH SIMPLE DYNAMIC HIP SCREW AND LOCKING DYNAMIC HIP SCREW IN ELDERLY PATIENTS

Aim: Is to evaluate the outcome of locking dynamic hip screw in comparison to standard dynamic hip screw in terms of fracture union, implant failure, range of movement of hip joint in unstable intertrochanteric fractures in elderly patients (age > 65 years), and to assess the hip function using modified Harris hip score. Methodology: This is a prospective randomized comparative study comprises of unstable intertrochanteric fracture of femur treated with dynamic hip screw and locking dynamic hip screw. The cases were selected randomly for fixation with Dynamic Hip Screw (DHS) and Locking Dynamic Hip Screw. The series consist of 50 cases divided in 2 groups. The group 1 consist of 25 cases treated by DHS and group 2 consist of another 25 cases treated by Locking DHS. The cases were followed up for minimum of 6 month duration Result and Observations: Most common mode of trauma in both groups of patients was slip (60%).Mean of Singh Index in group 1st cases was 3.64 ± 0.68 while mean of Singh Index in group 2nd was 3.56 ± 0.57.There were 5 cases (22.73%) of varus deformity in group 1st patients and 4 cases (19.05%) of varus deformity in group 2nd patients, although there were no significant varus deformity > 10o in both groups.2 cases of nonunion was seen in group 1st patients. In DHS group there was one case each of side plate pull out and screw cut out. No implant failure was seen in locking DHS. This study showed that functional outcome deteriorated when patients were more osteoporotic. Final outcome assessed using Modified Harris Hip Score. In group 1st there were 4.76% excellent, 86.37% good to fair and 9.09 % poor results, whereas in group 2nd cases 9.52% excellent, 85.71% good to fair and 4.77% was poor. Mean of Modified Harris Hip Score in group 1st was 68.33 ± 8.66 while 70.83 ± 8.35 in group 2nd cases. Conclusion: Keeping in mind of osteoporosis in geriatric population Locking DHS have some advantage in term of less chance of implant failure and functional outcome of the cases based on Harris hip score were slightly better, however they not statistically significant.