title: [Trochanteric fractures of the femur. A retrospective study of 223 patients treated with the Dynamic Hip Screw].
abstract: The incidence of trochanteric fractures is currently increasing. The introduction of new devices aims to secure the position of the reduction, and allow patients to mobilize early.
  
  
  METHODS
  227 fractures in 223 patients were treated in our hospital with DHS between 1991 and 1993, and were followed up to fracture union. There were 87 men and 136 women; the average age was 77,4 years (21-101 years). Using Ender's classification 68,58 % of these fractures were type 1 or type 2.
  
  
  RESULTS
  The average operative time was 48 min; open reduction was only required for 54 fractures. The mean rate of blood loss was 187 cc. Radiological examination showed anatomical reduction for 176 fractures, poor reduction (displacement between 5 and 10(o)) in 33 cases and varus displacement in 16 cases. One reoperation was rapidly required because of valgus displacement more than 20(o). Quality of fixation was assessed by the screw position in the femoral head : 72% were correct. All patients walking before the fracture restarted walking with a frame on the second postoperative day and the average time of weight bearing was 18 days.
  
  
  RESULTS
  Superficial sepsis (3 cases) or haematoma (17 cases) were not significant. 3 patients required further treatment : in one case, because of a refracture under the plate, in one other case, because of a displacement of the screw and in the last case because of a bad reduction. A pathologic fracture occured in one case. These cases were considered to be errors of surgical technique. Deep vein thrombosis occured in 5 patients. The death rate was 22% : 11 patients died within the first month after the fracture, 35 died between the first and third months.
  
  
  RESULTS
  177 surviving patients were reviewed 3 months after surgery. All fractures achieved union. The mean rate of healing was 2,6 months. Functional results were good : 31 patients walked independantly, 66 needed a cane, 42 two canes, 20 a frame. 77% of these patients walked without pain. 5 patients were not able to walk. Joint movements were reduced: hip flexion was more than 100(o) for 116 patients. Radiological examination showed anatomical union in 141 cases; 22 fractures healed with a valgus displacement and 7 with a varus displacement.
  
  
  CONCLUSIONS
  These results are analyzed and compared with several other published studies.
authors.affiliation: Service d'Orthopédie-Traumatologie, Hôpital Nord, C.H.U. Amiens, Place Victor Pauchet, F-80054, Amiens Cedex 1, France.
authors.forename: P
authors.initials: P
authors.lastname: Mertl
authors.forename: S
authors.initials: S
authors.lastname: Mauger
authors.forename: O
authors.initials: O
authors.lastname: Jarde
authors.forename: P
authors.initials: P
authors.lastname: Vives