Intertrochanteric fractures in the elderly by dynamic helical hip system (DHHS) & the conventional dynamic hip screw: A comparative study

Background: Intertrochanteric fractures are one of the fragility fractures occurring mostly in patients older than 70 years of age. The most common mechanism of failure of fixation devices like dynamic hip screw (DHS) is the head and neck fragment cutting off the hip screw, due to severely osteoporotic bone in the elderly. Overcoming this problem remains a big challenge in current orthopaedics practice. The Dynamic Helical Hip System (DHHS) has been designed to overcome these very shortcomings of the conventional DHS. Aim: To compare the clinical and radiological outcomes of osteoporotic intertrochanteric fractures managed with two different designs of implants and to verify the advantage, if any, of the Dynamic Helical Hip System (DHHS) over DHS, specially cut-out of the implant from femoral head-neck with subsequent varus collapse. Methods: 60 geriatric patients with osteoporotic intertrochanteric fractures were treated with either the conventional DHS or DHHS. All the patients were randomly distributed in one of the two groups. The present study is a prospective randomised clinical trial. Results: There were 04 cases of failure of DHS in our series compared with only 01 case of failure in DHHS series. Conclusion: In the management of osteoporotic intertrochanteric fractures DHHS was found to be the superior implant in performance compared to the conventional DHS in terms of screw cut out.