Dynamic Hip Screw - DHS

Original Editor - User Name
Top Contributors - Rhiannon Clement, Lucinda hampton and Kim Jackson

Purpose

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. 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

Click here to see operation details.

History of the DHS

Prior to the use of DHS sliding screws, angled blade plates were used. 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. Therefore, the DHS, with sliding barrel, was created to allow controlled compression across the fracture site. This is important for bone healing.

NICE Guidelines recommends: Use extramedullary implants such as a sliding hip screw in preference to an intramedullary nail in patients with trochanteric fractures above and including the lesser trochanter (AO classification types A1 and A2).

Physiotherapy Interventions

Considerations post surgery:

• Post op instructions and weight bearing status
• Infections
• Neurovascular complications
• Pain
• Self-efficacy and motivation
• Fear of falling

Any transfer or mobility aids will be determined by the weight bearing status (usually highlighted in the op note). If the surgeon feels the hip needs protecting post surgery, they may advise partial or non-weight bearing for the patient.

Physiotherapy interventions:

• Transfers (bed, chair, toiletting).
• Mobility (+/- appropriate aid).
• Goal setting
• Advising patient and team on pain management and expectations post-surgery
• Advice on swelling management
• Exercises
• Balance retraining and confidence building
• Gait retraining
• Considering home environment.
• Interactions with family and carer

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). NICE guidelines advise, unless contraindicated, for patient's to mobilise the day after surgery.

Physiotherapy exercises post hip surgery:

Illustrations by: https://myhealth.alberta.ca/Alberta/Pages/hip-fracture-hip-exercises.aspx

	After surgery		After 6 weeks
Supine	Hip ABD and heel slides (slide sheet can reduce friction)	Inner Range Quads	Bridges (unless NWB)
Sitting	Knee extension	Knee flexion	Sit to stand (one balance optimised)
Standing	Once able to maintain independent standing balance. Hip Abduction Hip Extension	Hamstring Curl Marching on spot	Heel Raises Marching on the Spot

Evidence

Provide the evidence for this technique here

Resources

Youtube - DHS surgery