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Online ISSN 1827-1707
104° SPLLOT CONGRESS
Proximal femur fractures in the elderly: New “Fast and up” strategies
Hip arthroplasty: state of the art
Genoa, November 30 - December 1, 2007
Lazzara D., Petrini A.
UO Ortopedia e Traumatologia Nuovo Ospedale S.Giovanni di Dio Azienda Sanitaria Firenze, Firenze, Italia
The Dynamic Hip Screw (DHS, Synthes, USA) is one of the most widely used and experimented screw-plate systems for treating proximal femor fractures in both elderly and young patients. In our clinic, about 150 cases are treated with this system on average every year. This study presents the epidemiology of trochanteric fractures, a review of the literature on the outcome after various treatment options (sliding screw plate, first and second generation intramedullary nail) and on the evolution of techniques and materials reported in clinical trials. The review is followed by a description of a recent Synthes product which, compared with external-internal fixation systems, locking compression plate (LCP) and less invasive stabilization system plate (LISS) employing the principle of angular stable plate-screw fixation, the company has extended for use with the DHS based on concepts developed with these systems (for the diaphyseal plate) and intramedullary trochanteric nails (for the proximal head screw). A new LCP-DHS system with a spiral blade (DHS blade) has been developed in which the new LCP-DHS plate has Combi-Holes for conventional or angular stable fixation, while the design of the proximal jacket and the ability to have angles 130-150° remain unchanged. The conventional head screw may be replaced with a spiral blade that is inserted and definitively placed by compression. The new coupling (unless one uses a conventional plate with the DHS blade or a conventional screw with the LCP-DHS) has the advantage that it blocks rotation of the head on the screw and that the screws can be used for angular fixation (particularly useful in osteoporotic bone). As far as we know, we are the first to use the new system starting in 2007, as indicated, for elective treatment of fractures of highly porotic bone.