Dynamic Hip Screw Fixation

An orthopedic implant known as a dynamic hip screw (DHS) or sliding screw fixation is used to fixate specific kinds of hip fractures and permits controlled dynamic sliding of the femoral head component along the construct. The concept behind dynamic compression is that by allowing the femoral head component to move in a single plane, which is how bone reacts to dynamic stresses, the native femur can go through proper fracture healing and remodeling.

Internal fixation of femoral neck and intertrochanteric fractures is accomplished using dynamic hip fasteners. It’s a sizable cancellous lag screw that moves easily inside a metal sleeve. The side plate that is screwed to the lateral femoral cortex is where the sleeve is connected. The fracture is dynamically compressed as a result of the femoral head becoming impacted on the femoral neck during weight bearing. As compression happens, the lag screw’s shaft slides down the sleeve, keeping the fracture reduced.

The side plate’s sleeve contains the lag fastener for the femoral head. The fixation fasteners that are inserted into the femoral diaphysis are visible on the side plate. The lowest four screws are cortical screws, while the two upper screws are cancellous screws.

In order to improve compression and regulate femoral head movement, a cannulated cancellous screw that functions as a lag screw has also been inserted. Keep in mind that the lesser trochanter has separated from the tibia and has moved medially.

Intra Medullary Nailing Of Long Bones And Hip Fractures

An upper quadrant of the femur (thigh bone) injury is referred to as a hip fracture. The factors at play determine how much of a break there is. The level of the fracture or the affected bones and soft tissues will largely determine the type of surgery used to address a hip fracture.

Open/Closed Reduction And Internal Fixation/Plating Of Long And Small Bone Fractures

An orthopedic procedure known as internal fixation involves the surgical placement of implants for the purpose of repairing a broken bone. This idea goes back to the middle of the 19th century, but it wasn’t used as a standard of care until the middle of the 20th century. Stainless steel or titanium can be used to make interior fixators.

Bone fasteners, metal plates, pins, rods, Kirschner wires, and intramedullary devices like the Kuntscher nail and interlocking are examples of internal fixators.

Open Reduction Internal Fixation (ORIF)

Open Reduction Internal Fixation (ORIF) entails both the open reduction, or setting, of the bone itself and the use of implants to direct the mending process of a bone. When a fracture requires open surgery to fix bones, the term “open reduction” is used. In order to allow or aid healing, internal fixation refers to the fixation of screws and/or plates intramedullary bone nails (femur, tibia, and humerus). In order to promote healing and avoid infection, rigid fixation prevents micro-motion across fracture lines, which occurs when implants like plates (such as the dynamic compression plate) are used. When there is a serious fracture, such as a comminute or displaced fracture, or when casting or splinting alone would not cause the bone to heal properly, Open Reduction Internal Fixation methods are frequently used.

Risks and complications can include bacterial colonization of the bone, infection, stiffness and loss of range of motion, non-union, mal-union, damage to the muscles, nerve damage and palsy, arthritis, tendonitis, chronic pain associated with plates, screws, and pins compartment syndrome, deformity, audible popping and snapping, and possible future surgeons to remove the hardware.

Internal Fixation For Fractures

The creation of internal fixation, which was high on the list of treatment advancements, is the most important development to occur during the 20th century. 

Internal fixation reduces the likelihood of nonunion (inadequate healing) and malunion (healing in improper position), shortens hospital stays, and permits patients to return to work sooner. 

Until a broken bone is strong enough to support weight, it must be meticulously fixed in place. Prior to the 20th century, doctors used casts and splints to hold the bone from the outside of the body. (external fixation). However, the development of sterile surgery significantly decreased the risk of infection, allowing medical professionals to work directly with bone and transplant materials in the body.

New materials, like titanium, cobalt, and stainless steel, were not only strong but also had the flexibility and power needed to support the bone. Additionally, these substances rarely result in an allergic response or implant failure and are compatible with the body. The most popular internal fixation methods involve supporting the bone immediately inside the body with wires, plates, rods, pins, nails, and screws.

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