Two-hole versus four-hole plate dynamic hip screw: a systematic review of current evidence
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ORIGINAL ARTICLE
Two-hole versus four-hole plate dynamic hip screw: a systematic review of current evidence Martin S. Davey 1,2
&
Sean O. Flynn 1,2 & Joshua Hayes 1,2 & Iain Feeley 1,2 & Marc C. Grant Freemantle 1,2 & Neil Burke 1
Received: 2 December 2019 / Accepted: 23 January 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Background The dynamic hip screw (DHS) is a common device used in the fixation of hip fractures. Traditionally, this involves the use of a four-hole side plate. Reducing the length of the side plate would theoretically reduce the amount of surgical exposure required, decrease surgery duration, and decrease perioperative morbidity and mortality. Our study aims to review the current evidence regarding the use of two-hole side plates, their use and potential complications. Methods Using PRISMA guidelines, two independent reviewers performed a search to collate the available literature from medical databases PubMed, EMBASE, Web of Science, and the Cochrane library. Only clinical and biochemical studies were included. The reference lists of articles included for full text review were searched for any additional primary or review publications. Results Four online libraries were searched, with a combined total of 5344 titles reviewed. Following title, abstract, and full text review, 8 articles were considered suitable for inclusion in qualitative analysis. There was a trend towards equal efficiency between two- and four-hole plates when used in stable fractures in terms of blood loss, failure/revision rates, operative and hospital stay durations, collapse loading testing, maximum stress, and fragment migration. Conclusion The results of this study show that DHS constructs with two- or four-hole side plates have comparable outcomes when used in patients with stable fracture patterns. However, the majority of the clinical data regarding the use of two-hole DHS plates come from retrospective case series; further prospective, randomised control trials would be of significant benefit. Level of evidence Level II; systematic review of all levels of evidence Keywords Dynamic hip screw . Four-hole . Fracture . Hip . Intertrochanteric . Two-hole
Introduction The incidence of hip fractures is steadily increasing in the global population, particularly in the osteoporotic patient, with multiple significant co-morbidities [1, 2]. The literature describes numerous anatomical variations of hip fractures, for which various fixation methods are widely practiced [2]. Orthopaedic surgeons routinely use varieties of dynamic hip screws (DHS) in the acute management of intertrochanteric or non-displaced intra-capsular femur fractures; these fracture types are reported to account for
* Martin S. Davey [email protected] 1
Department of Trauma & Orthopaedics, Beaumont Hospital, Dublin 9, Ireland
2
Royal College of Surgeons in Ireland, Dublin 2, Ireland
approximately 50% of all hip fractures [3]. The routine use of DHS as routine in managing such fractures results in a considerable reduction in 1-year po
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