Dynamic hip screw fixation for inter-trochanteric fractures: determinants of outcomes.

OBJECTIVE To evaluate factors associated with revision of dynamic hip screw implant in patients undergoing the procedure for the fixation of intertrochanteric fractures. METHODS The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients who had undergone dynamic hip screw fixation surgery between 2008 and 2012. Medical records and data for all patients were obtained from the medical records office. For all patients, the record files were systematically reviewed using a structured, pre-defined data extraction sheet. SPSS 20 was used statistical analysis. RESULTS Out of 317 patients who had undergone the procedure, 8(2.5%) were excluded due to missing records. The study sample as such stood at 309(97.5%). Of them, 6(1.9%) required revision of the dynamic hip screw placed initially. High tip apex distance was found to be associated with the revision (p<0.0001).Demographic parameters and co-morbid conditions were not associated with a need for revision surgery (p>0.05). CONCLUSIONS Patients requiring dynamic hip screw implant revision had higher tip apex distance than the rest. A lower value is advisable during placement of the screw to reduce the need for subsequent revision.