10. Vikram.cdr

Per-trochanteric (4 Part) fractures of femur are commonest in elderly people. The incidence is expected to increase in the coming years, with an ageing population resulting in a greater number of traumatic injuries in patients with osteoporotic bone. DHS fixation is gold standard modality for treatment of such fractures. Various implants used for such fractures are 1) DHS Sliding compression screw and plate devices 2) Intra-medullary devices such as TFN and PFN 3) Enders Nail, 4) Bi-axial plate, 5) External fixator 6) Jewett nail and SP nail. Various Complications of DHS implant are as follows: 1) Implant Failure: a) Cut out of screw b) Proximal or distal migration of screw c) Breaking of plate and screws, 2) Uncontrolled medialisation of distal fragment and collapse at fracture site, 3) AVN with collapse of head , 4) Infection: Superficial or Deep infection [1]. However, Hip Instability: Subluxation and Dislocation is very rare [2]. We report, six cases of Hip instability following 480 cases of DHS fixation surgeries for unstable four part Intertrochanteric fracture. Materials and Methods This is a prospective study conducted at our hospital since 1997. We reviewed patients with inter-trochanteric fracture femur treated with various implants. We performed 510 surgeries for Pertrochanteric fracture femur with different modalities DHS (n=480), TFN (n=13), Biaxial Plate (n=15), SP nail (n=1), and Enders Nail (n=1). We found six cases who developed hip instability only after DHS fixation. All available clinical notes and X-rays of these patients were studied to get the relevant information. Of the six cases three were male and two female patients, four had right sided fracture and one had left sided fracture, 4 had infection and 2 had mechanical problems, 1 patient refused further investigations & treatment, 3 other died in due course of time due to unrelated disease complications. 1 lost to follow –up and 1 patient with deep infection underwent excision arthroplasty. Radiological findings of these patients are shown in table 1 and 2.