Evaluation of peri-trochanteric fractures treated with cement-augmented dynamic hip screw in elderly patients

  • Hesham H. Refae
  • El Sayed A. Ahmed
  • Hamdy H. Tammam
  • Alaa M. El Senbsy
Keywords: Dynamic hip screw Osteoporosis , Screw cut out, Polymethylmethacrylate (PMMA) Salvati and Wilson score.


Background: Dynamic hip screw (DHS) has been the standard treatment for stable
trochanteric fracture patterns. However, primary stabilization with dynamic/sliding hip
screw is not always successful, especially in osteoporotic fractures. Internal fixation in
such a situation may achieve a satisfactory initial fracture site reduction, but late
fracture collapse into varus during weight bearing, can lead to a high failure rate. Since
1975, polymethylmethacrylate (PMMA) cement-augmented DHS have been used as a
solution by adding an anchoring ability to the lag screw.
Methods: A series of 20 osteoporotic intertrochanteric fractures were operated with
cement augmented dynamic hip screw. One patient lost to follow up. All patients
were then allowed partial weight bearing walker aided ambulation under the
guidance of physiotherapist on the second postoperative week . The patients were
followed radio logically and clinically at regular intervals (1.5 month, then at 3rd
month and then at 6th month interval after surgery). Results were graded as excellent
(score >31), good (score 24-31), fair (score 16-23), and poor (score <16). Clinical
result was given according to Salvati and Wilson scoring.
Results: All 20 patients were taken for the study they were followed for minimum 6
months and at 6 months the clinical outcome was rated as per the Salvati and Wilson
scoring system. One patient lost to follow-up. Final clinical results as evaluated by
Salvati and Wilson scoring were; excellent in 8 cases (42.1%), good in 8 cases
(42.1%), fair in 2 case (10.5%) and poor in 1cases (5.2%). There were no non-union,
AVN, implant failure and screw cut-out in our study.
Conclusions: The surgical management of intertrochanteric fractures with PMMA
augmented DHS provide a stable fixation with moderate pain free early mobilisation
and better outcome in osteoporotic patients without the complications of superior screw
cut-out, sliding collapse, and with the appropriate placement of bone cement along with
proper amount (7-9 ml) of cement we can also reduce the cement related complications
such as delayed healing, nonunion, heat necrosis and avascular necrosis