What are the steps of a dynamic hip screw insertion for a hip fracture?
Please read about a Dynamic Hip Screw, before you read this. This article is suitable for Orthopaedic trainees.
In this procedure, the patient is placed on his back and appropriate anaesthetic given.Either Spinal or a General Anaesthetic, depending on patient factors.
* Fracture Reduction: The hip fracture is reduced by longitudinal traction applied using a special traction operating table. The other leg is moved out of the way. Depending on the fracture configuration, rotation and shortening of the leg is corrected appropriately.
* The surgery is performed with the surgeon standing on to the side of the affected hip joint.
* Using continuous, x-ray emissions from an image intensifier (or C-arm) the reduced fracture is visualized prior to making the incision to confirm proper reduction of the fracture.
* Incision:- A 6cm to 8 cm long incision is made along the top outerside of the femur bone. This exposes the subcutaneous fat. Further dissection of the muscular layer is carried out by using a blunt instrument. The femur bone is exposed. I find it easier to go below the curve of the Greater Trochanter when making an incision.
* Under the x-ray guidance of the image intensifier the procedure is visualized on television screens. A guide wire is inserted into the head of femur using a power drill. A suitably sized screw is fixed into the head.This has to be generally in the centre of the head in 2 views, the AP (antero-posterior) and latreal view.
* This is connected to a mechanical plate (called DHS plate) with four to six holes along its length and held in place by screws.
* Images confirming proper placement of the screw and plate are obtained.
* Wound Closure:- The wound is closed in layers using stitches and a dressing is applied prior to the patient leaving the theatre.