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

Abstract

As the elderly population increases, the incidence of fragility hip fracture also increases. By 2050, the incidence is predicted to be around 4.5 million.1 Treatment of intracapsular hip fractures depends on many factors including patient age, fracture pattern, degree of fracture displacement and comorbidities. For younger patients (<65 years of age), the femoral head should be preserved using an internal xation method, either multiple screw xation or dynamic hip screw (DHS), to avoid any long-term complication of arthroplasty.2 For elderly patients, both internal xation methods are suitable for non- displaced intracapsular hip fractures. Nonetheless, arthroplasty is preferable for displaced intracapsular hip fractures because of a lower reoperation rate and better functional outcome.3 In this issue, Jettoo et al.4 compared DHS xation with multiple screw xation for intracapsular hip REFERENCES fractures in terms of complications and conversion to hemiarthroplasty or total hip arthroplasty. DHS xation resulted in more medical complications than multiple screw xation, whereas multiple screw xation was associated with a higher conversion rate to arthroplasty. DHS xation has more disadvantages related to soft-tissue stripping and blood loss.5,6 It is important to emphasise that the reasons for revision surgery are multifactorial and not due to the implant/ xation method alone.7,8 Accurate fracture reduction is a prerequisite to satisfactory bone union.9 It is worth noting that the study by Jettoo et al.3 was a retrospective review based on hospital data. The fracture classi cation, degree of fracture displacement, and bone quality were not clearly documented. The evidence was not suf cient to support the superiority of DHS xation over multiple screw xation in treating intracapsular hip fractures.