Complications of Dynamic Hip Screw- DHS

What are the complications of Dynamic Hip Screw Fixation for hip fractures?

Complications of a Dynamic Hip Screw or DHS fixation, are common to any hip fracture, and listed as

1. Blood clots in the leg’s or lungs (called as DVT – Deep Vein Thrombosis or P.E- Pulmonary Embolism). These happen due to prolonged immobilization, stress of surgery and dehydration. These conditions tend to produce reduced blood flow causing it to clot where it gets pooled within the vein.

2. Infection: Each time there is a cut made to the surface of the skin there is a chance of infection. The surgery is usually done in clean sterile environment, but still infection can happen. In case of infection treatment lies in intravenous antibiotics for a few days to a few weeks and in extreme cases by removal of the prosthesis.

3. Anaesthetic problems.  The stress of surgery can cause problems like heart attacks, chest pains, irregular heartbeat, stroke or mini stroke.

4. Excessive blood loss: Some patients tend to lose more blood doing hip surgery than normally tolerated by the body. They may need blood transfusions to make up for the loss.

5. Lag screw cut out: Occasionally the lag screw may start cutting out of the bone and move into either the hip joint intra articular surface or near the skin surface. It depends on the bone quality, operative technique and placement of the screw (it is commoner if the screw is placed in the superior part of the femoral head than centrally).

Related Topics:-

* Total Hip Replacement

* Precautions after a Total Hip Replacement

* Dynamic Hip Screw

* Complications of Total Hip Replacement

* Complications of Dynamic Hip Screw – DHS

* How to do a DHS or Dynamic Hip Screw

* How to do a Total Hip Replacement

How to do a Dynamic Hip Screw Fixation

What are the steps of a dynamic hip screw insertion for a hip fracture?

Dynamic Hip Screw

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.

Dynamic Hip Screw – DHS

Dynamic Hip Screw

Dynamic Hip Screw (also called DHS or CHS- Compression Hip Screw) is a type of implant used to treat Hip Fracture. Specifically, it is used to treat an Inter-Trochanteric Hip Fracture or an Undisplaced Intra-Capsular Hip Fracture. The treating Orthopaedic Surgeon will make the decision as when to use Dynamic Hip Screw.

What are the steps of a dynamic hip screw insertion for a hip fracture?

In this procedure, the patient is placed on his back and appropriate anaesthetic given. The fracture is reduced by longitudinal traction applied using a special traction operating table.  The other leg is moved out of the way. 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 the reduced fracture is visualized prior to making the incision to confirm proper reduction of the fracture. Then, 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. 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 battery operated power drill. A suitably sized screw is fixed into the head. This is connected to a mechanical plate with three to five holes along its length and held in place by screws. Images confirming proper placement of the screw and plate are obtained. The wound is closed in layers using stitches and a dressing is applied prior to the patient leaving the theatre.

What is Dynamic Hip Screw fixation for a hip fracture?

Dynamic Hip Screws are fixed for extra-capsular fractures of the hip joint (fractures which lie outside the capsule of the hip joint). The prosthesis consists of a large screw which is inserted into the head of femur using continuous x-ray observations in operating theatres and held in place by a metallic plate resting onto the side of the femur bone.

What is Dynamic Hip Screw fixation for a hip fracture?

Dynamic Hip Screws are fixed for extra-capsular fractures of the hip joint (fractures which lie outside the capsule of the hip joint). The prosthesis consists of a large screw which is inserted into the head of femur using continuous x-ray observations in operating theatres and held in place by a metallic plate resting onto the side of the femur bone.

What are the steps of a dynamic hip screw insertion for a hip fracture?

In this procedure, the patient is placed on his back and appropriate anaesthetic given. The fracture is reduced by longitudinal traction applied using a special traction operating table.  The other leg is moved out of the way. 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 the reduced fracture is visualized prior to making the incision to confirm proper reduction of the fracture. Then, 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. 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 battery operated power drill. A suitably sized screw is fixed into the head. This is connected to a mechanical plate with three to five holes along its length and held in place by screws. Images confirming proper placement of the screw and plate are obtained. The wound is closed in layers using stitches and a dressing is applied prior to the patient leaving the theatre.

What are the complications of Dynamic Hip Screw Fixation for hip fractures?

Complications, are common to any hip fracture, and listed as

1. Blood clots in the leg’s or lungs (called as DVT or P.E). These happen due to prolonged immobilization, stress of surgery and dehydration. These conditions tend to produce reduced blood flow causing it to clot where it gets pooled within the vein.

2. Infection: Each time there is a cut made to the surface of the skin there is a chance of infection. The surgery is usually done in clean sterile environment, but still infection can happen. In case of infection treatment lies in intravenous antibiotics for a few days to a few weeks and in extreme cases by removal of the prosthesis.

3. Anaesthetic problems.  The stress of surgery can cause problems like heart attacks, chest pains, irregular heartbeat, stroke or mini stroke.

4. Excessive blood loss: Some patients tend to lose more blood doing hip surgery than normally tolerated by the body. They may need blood transfusions to make up for the loss.

5. Lag screw cut out: Occasionally the lag screw may start cutting out of the bone and move into either the hip joint intra articular surface or near the skin surface. It depends on the bone quality, operative technique and placement of the screw (it is commoner if the screw is placed in the superior part of the femoral head than centrally).

Related Topics:-

* Total Hip Replacement

* Precautions after a Total Hip Replacement

* Dynamic Hip Screw

* Complications of Total Hip Replacement

* Complications of Dynamic Hip Screw – DHS

* How to do a DHS or Dynamic Hip Screw

* How to do a Total Hip Replacement