Functional Outcome of Intertrochanteric Fracture (Kyle’s Type 1 and 2) Treated with Dynamic Hip Screw

Abstract

Background: Intertrochanteric fractures are common in elderly and surgical treatment like Dynamic Hip Screw (DHS) fixation is often used for early mobilization and to reduce the risks associated with prolonged immobilization. However, the outcomes may vary based on the different fracture patterns and conditions of the bone. Aim of the study: To evaluate the functional outcome and radiological evaluation of intertrochanteric fracture (Kyle’s type 1 and 2) treated with Dynamic Hip Screw (DHS). Methods: This quasi-experimental study was conducted in the Department of Orthopedic Surgery, BSMMU, Dhaka, from Sept 2022 to Sept 2024. Within this period, 26 patients were selected after fulfilling the selection criteria, and they had undergone DHS fixation. Assessment was done preoperatively and postoperatively on the 1st, 3rd, 6th, and 9th months. Pain status was assessed using the Visual Analog Scale (VAS) Score. Functional outcomes were measured by the Harris Hip Score, perioperative events, and the radiological union was noted postoperatively. Standard statistical analysis was used to process and analyze the data using the software ‘Statistical Package for Social Science’ (SPSS) version 25, IBM®, Armonk, USA. For all analyses, a p-value <0.05 was considered statistically significant. Result: The average age of patients was 67.73±10.26 years, with 77% of the study population > 60 years. Females accounted for 61.5% of cases. 76.9% of the patients had at least one major comorbidity. 50% were osteoporotic. 84.6% of cases occurred due to simple falls. 53.8% of cases had type 1 and 46.2% were type 2 fracture patterns. 57.7% had involvement of the left limb. The mean operative time was 66.81 ± 8.11 minutes. 80.8% of patients had a Tip Apex Distance (TAD) of <25mm. The fracture union was achieved at an average of 16.62 ± 2.38 weeks. The VAS and HHS scores improved significantly from 7.8±0.95 to 1.04±0.92 and 87.12±5.92, respectively. 42.3% had excellent, 42.3% had good, and 15.4% had fair outcomes. Improved HHS scores were observed more in male patients, Kyle’s type 1, and with a <25mm. Conclusion: Dynamic Hip Screw fixation for intertrochanteric fracture is an effective and safe procedure with significantly improved functional outcomes. Kyle’s type 1 showed relatively better functional outcomes with a lower rate of postoperative complications than Kyle’s type 2. Also, Better outcomes were observed in male patients and TAD <25mm.