Dinamic Hips Srew BLADE
Locking mechanism
During insertion: DHS Blade is unlocked
The shaft part and the blade part can rotate against each other.
Mekanisme penguncian selama : dephankam insersi belikat adalah terkunci poros bagian dan pisau bagian dapat berputar terhadap satu sama lain .
After implantation: DHS Blade is locked
When the bolt in the DHS Blade is screwed forward, the rotation between blade part and shaft part gets locked. The shaft part and the blade part cannot rotate against each other anymore.
Setelah implantasi: DHS Blade terkunci ketika baut di pisau DHS screwed maju, rotasi antara bagian pisau dan poros bagian terkunci. Bagian poros dan bagian pisau tidak bisa memutar terhadap satu sama lain lagi.
Indications and Contraindications
– Pertrochanteric fractures of type 31-A1 and 31-A2 – Intertrochanteric fractures of type 31-A3
Contraindications
– Subtrochanteric fractures: for this type of fracture, a 95º DCS plate or the intramedullary nail PFNA Long is recommended.
- Fraktur subtrokanter= untuk tipe fraktur 950 DCS plate – The DHS is not to be used in cases where there is a
high incidence of:
- DHS TIAK I GUNAKAN UNTUK KASUS KASUS DIMANA ADA RESIKO TINGGI = 1. SEPSIS
- 2. PRIMER MALIGNAN ATAU TUMOR METASTASIS - 3. SENSITIF
- 4. VASCULAR COMPROMISE
-Recommendation
Di sarankan : gunakan blade DHS untuk pasien osteoporosis dan DHS skrew untuk pasien dengan kualitas baik tulang.
Use the DHS Blade for osteoporotic patients and the DHS Screw for patients with good bone quality.
Menggunakan pisau untuk dhs osteoporotic pasien dan berkat survey kesehatan penduduk sekrup untuk pasien dengan tulang yang baik kualitas .
Clinical Cases
Pertrochanteric fractures Special surgical considerations:
Implant of choice
Recent metanalysis has shown that the DHS tends to be sta-tistically superior to intramedullary devices for trochanteric fractures.3,4 Further studies are required to determine
whether different types of intramedullary nails produce simi-lar results, or whether intramedulsimi-lary nails are advantageous for certain fracture types (e.g. subtrochanteric fractures).4 Prevention of cut-out: correct placement of the screw
The correct placement of the DHS Screw or Blade has shown to be one of the main success factors to prevent implant cut-out. The device should ideally be positioned in a center-center position in the femoral head and within 5 mm of subchondral bone.5, 6 See surgical technique page 8.
Femoral neck fractures
Special surgical considerations: Implant of choice
For unstable basicervial fractures, the DHS seems biomechan-ically superior to three cannulated screws.7 Nevertheless, operations of cervical hip fractures with a dynamic hip screw or three parallel screws seem to give similar clinical results. 8 Emergency treatment
A femoral neck fracture should be treated surgically within 6 hours of admission whenever possible. Elderly patients who had surgery within 12 hours 9 or even within 24 hours 10 have a significantly lower mortality rate.
Antirotation screw
an antirotation screw.
Multiple options for screw placement and the angular freedom of the lateral and proximal screws enable the plate to be combined with an intramedullary system.
Beberapa pilihan untuk sekrup dan sudut penempatan kebebasan itu dan
proksimal lateralis sekrup memungkinkan pelat yang akan dikombinasikan dengan sebuah intramedullary sistem .
Notches along the plate and the addi-tional cerclage screw facilitate the positioning of cerclage systems to im-prove plate fixation.
Premium material: titanium (grade 1). Trofix is offered in a sterile package. It is the ideal solution for several indi-cations (e.g. as an emergency plate for trochanteric refixation during hip arthroplasty).
Takik sepanjang piring dan addi-tional cerclage sekrup memfasilitasi posisi cerclage sistem untuk im - membuktikan fiksasi piring. Premium bahan: titanium (grade 1). Trofix ditawarkan dalam paket steril. Ini adalah solusi ideal untuk beberapa indi-kation (misalnya sebagai darurat piring untuk trochanteric refixation selama pinggul artroplasti).
osteotomy or fracture
• Trochanteric osteotomies (primary fix-ation)
• Multifragmentary trochanteric fractures
• Per-/subtrochanteric fractures with trochanteric fragments. In this case the plate must be combined with an intramedullary system.
• Periprosthetic fractures with trochanter tear off. In this case the plate is com-bined with a stem implant.
trochanteric pseudarthrosis setelah osteotomy satu atau patah tulang ?
trochanteric osteotomies ( fix- utama ation ) ? multifragmentary trochanteric patah tulang ? per- / subtrochanteric patah tulang dengan trochanteric fragmen . Dalam hal ini harus dikombinasikan dengan sebuah piring intramedullary sistem . ? periprosthetic patah tulang dengan merobek . trokanter Dalam hal ini piring com- bined dengan batang implan
• Pathological fractures/metastases in the proximal area of the Femur (fixation or augmentation of the trochanter) Indications
To achieve a good outcome, trochanteric fixation surgery is based on five equally important steps.
? patologis / retakan-retakan metastasis di kawasan proksimal femur ( fiksasi atau augmentasi dari trokanter tersebut ) indikasi untuk mencapai suatu hasil , baik trochanteric operasi fiksasi ini didasarkan pada lima sama pentingnya langkah .
1. Preoperative Planning
Preoperative planning with adequate X rays and X ray templates (REF 06.0136x.000) is strongly recommended.
This allows determination of the dimen-sions of plate length, head size and the appropriate position of screws, par-tic-ularly in presence of a hip prosthesis to prevent any interference with the hip stem.
The surgical procedure is defined at this stage.
2. Incision
A long lateral approach is recommended. The length and orientation of the
incision is determined by the preoperative planning.
Note: the length of the incision should include the additional length needed for the application of the tension device. 3. Mobilization of the
Trochanteric Fragment(s)
Mobilize the trochanteric fragment(s) together with the abductor muscle tendon unit.
The trochanteric fragment(s) with the abductor muscle tendon should be
released from all the adhering scar tissue between the capsula and acetabular rim.
Reduce the freed trochanteric fragment to the appropriate anatomic position under an image intensifier.
Avoid damage of the fragment and tendon unit.
Note: the reduction of the trochanteric fragment can be facilitated by using a cerclage wire placed through the muscle above the trochanter tip, to pull the fragment down into its original position. Debride the areas of bony contact prior to reducing the fracture.
4. Plate Positioning and Reduction
placed over the proximal edge of the trochanteric fragment.
Atraumatic splitting of the tendon and muscle fibers longitudinally with scissors facilitates the insertion of the hooks. Note: avoid the gluteus superior nerve. Once the hooks are positioned over the top of the fragment(s), reduce the fracture.
Note: do not bend the hooks in order to avoid damages on the plate.
5. Plate Fixation
Secure the plate both distally and proximally.
5a. Shaft Fixation
Two types of screws are available for shaft fixation.
4.5 mm titanium screws are used in the absence of prosthesis in the central holes of the plate. In presence of a stem they also may be placed unicorti-cally.
weeks.
No adduction and active abduction for six weeks.
No active flexion > 60° for six weeks. A wedge-shaped pillow is recommended for sitting.
Ambulation with crutches is allowed after the first postoperative day. The amount of weight bearing relies on the outcome of the reduction and trochanteric fixation. It should be decided by the surgeon for each case. Postoperative Care
