Dynamic hip screw fixation versus multiple screw fixation for intracapsular hip fracture

Abstract

Purpose: To compare dynamic hip screw (DHS) fixation with multiple screw fixation for intracapsular hip fractures in terms of complications and conversion to hemiarthroplasty or total hip arthroplasty (THA).

Methods: Records of 52 884 patients aged ≥50 years who underwent internal fixation using a dynamic hip screw (n=18 014, 34.1%) or multiple screws (n=34 870, 65.9%) for intracapsular femoral neck fracture from September 2007 to September 2013 were extracted from the hospital admission database that covers all admissions to the National Health Service hospitals in England using the ICD-10 and OPCS-4 codes. Gender, age, and Charlson comorbidity score of each patient were recorded, as were complications at specific time intervals and revision to hemiarthroplasty or THA at one and 4 years.

Results: Compared with DHS fixation, multiple screw fixation resulted in shorter hospital stay (15 vs. 13 days, p<0.001) and lower rates of 30-day myocardial infarction (2% vs. 1.5%, p=0.022), 30-day lower respiratory tract infection (12.4% vs. 10.6%, p=0.001), 90-day mortality (10.4% vs. 8.6%, p=0.001), and avascular necrosis (0.1% vs. 0.06%, p=0.032), but a higher rate of conversion to hemiarthroplasty or THA at one or 4 years (all p<0.001).

Conclusion: Multiple screw fixation for intracapsular hip fracture was associated with a higher conversion rate to hemiarthroplasty or THA at one and 4 years, compared with DHS fixation.

Keywords: hip fractures; postoperative complications.