Abstract
Background: Traditional bone setters (TBS) offer quicker and cheaper treatment and are believed to use faster healing methods. Fall and fractures of hip are common in elderly. Among them trochanteric fractures account for approximately half of the hip fractures in elderly; out of this, more than 50% fractures are unstable. If proper precautions are not taken fractures unite in malposition resulting in shortening, limp and restricted. We evaluated the surgical and functional outcomes of extra capsular femur fractures of femur treated with Dynamic Hip Screw (DHS) in patients who underwent treatment with traditional bone setting. Methods: The present study was undertaken at a Tertiary care hospital, Andhra Pradesh between the years 1998-2001. All the 34 patients with sustained extra capsular femur fractures treated by traditional bone setters for 6-8 weeks were included. Patients underwent DHS for trochanteric and sub trochanteric fractures. Patients were followed at 6 weeks, 3 months and 6 months. On each visit Fracture union, complications, limb shortening were observed. Functional outcome was assessed by using Harris hip score at baseline and at 6 months. Results: At the time of presentation to the hospital, all patients had pain and unable to walk. 70% (24) of the patients had shortening of limb, 90% of the patients had limitation for range of motion. In 98.67% of patients, fracture was found to be united at the 6th month follow up. Patients who had stable reduction before fixation also showed early radiological union. 10 patients developed 1 cm shortening, 4 patients had 2 cm shortening and 1 patient developed 3 cm shortening. At the end of six months there was an increase from 11.7% to 47.0% in excellent and from 29.4% to 47% in good scores on Harris hip score as compared to baseline. This was substantiated by a fall in fair and poor scores 47.0% to 5.8% and 11.7 % to 5.8% respectively. Two patients developed respiratory infection and two patients developed catheter related urinary tract infection. Two patients developed mal union. Conclusion: This study showed DHS to be a versatile, stable, acceptable implant fixation in trochanteric and subtrochanteric fractures treated previously by Traditional Bone setters. However, the results would have been superior if they would have operated earlier.