Dynamic Hip Screw - DHS: Difference between revisions
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Considerations post surgery: | Considerations post surgery: | ||
* Infections | * Infections | ||
* Neurovascular complications | |||
* Weight bearing status | * Weight bearing status | ||
* Pain | * Pain | ||
* Self-efficacy and motivation | * Self-efficacy and motivation | ||
* Fear of falling | |||
Physiotherapy interventions: | |||
* Transfers (bed, chair, toiletting). | |||
* Mobility (+/- appropriate aid). | |||
* Goal setting | |||
* Advising patient and team on pain management and expectations post-surgery | |||
* Exercises | |||
* Balance retraining and confidence building | |||
* Gait retraining | |||
* Considering home environment. | |||
* Interactions with family and carers. | |||
== Evidence == | == Evidence == | ||
Revision as of 10:13, 19 September 2020
Purpose[edit | edit source]
The Dynamic Hip Screw (DHS) or Sliding Hip Screw can be used as a fixation for neck of femur fractures. This would usually be considered for fractures that occur outside the hip capsule (extracapsular), often stable intertrochaneric fractures[1]. This is because there is a reduced chance of interrupting the blood supply to the head of the femur, and so it may be possible to preserve the joint. However, it may also be appropriate for younger patients with fractures within the hip capsule (intracapsular) if there is a good chance that the blood supply is preserved, reducing the risk of avasular necrosis.
Technique[edit | edit source]
History of the DHS[edit | edit source]
Prior to the use of DHS sliding screws, angled blade plates were used[2]. These fixed plates matched the angle of the femural head. These plates had a number of complications, including failure to purchase, requiring frequent osteotomies. They also did not allow any compression across the fracture site, leading to stress failures and frequent non-union[2]. Therefore, the DHS, with sliding barrel, was created to allow controlled compression across the fracture site.
Physiotherapy Interventions[edit | edit source]
Any transfer or mobility aids will be determined by the weight bearing status of the patient. This is decided by the surgeon and highlighted in the post-op notes. If the surgeon feels the hip needs protecting post surgery, they may advise partial or non-weight bearing for the patient.
It is important that the patient is transferred out of bed, within these limitations, as early as possible to avoid complications of bed rest (e.g. chest infections, DVT, muscle atrophy).
Considerations post surgery:
- Infections
- Neurovascular complications
- Weight bearing status
- Pain
- Self-efficacy and motivation
- Fear of falling
Physiotherapy interventions:
- Transfers (bed, chair, toiletting).
- Mobility (+/- appropriate aid).
- Goal setting
- Advising patient and team on pain management and expectations post-surgery
- Exercises
- Balance retraining and confidence building
- Gait retraining
- Considering home environment.
- Interactions with family and carers.
Evidence[edit | edit source]
Provide the evidence for this technique here
Resources[edit | edit source]
add any relevant resources here
