Dynamic hip screw

Last revised by Mohammadtaghi Niknejad on 27 Feb 2024

Dynamic hip screws (DHS) are a femoral head-sparing orthopedic device used to treat femoral neck fractures. It is sometimes referred to as a pin and plate.

Femoral neck fractures that are undisplaced and hence have a low risk of avascular necrosis (Garden I and II fractures) can be treated with head-preserving surgery and internal fixation. If there is a high risk of femoral head avascular necrosis (Garden III and VI fractures), femoral head resection and hip hemiarthroplasty are preferred 4.

Following reduction, the fracture is internally fixed by applying a large lag screw through the neck, which is held laterally by a lateral femoral plate. The lag screw can slide in the plate along the longitudinal axis of the femoral neck, allowing compression of the fracture, which aids healing. If sliding has taken place, the lateral end of the lag screw may protrude laterally from the plate.

Some surgeons will also insert a derotation screw into the neck (usually superior to the lag screw) to limit rotation and prevent non-union/avascular necrosis.

It is important to be aware that the Dynamic Hip Screw is a trade name for the Synthes company and is one example of a sliding hip screw. There are various types of sliding hip screws produced by various implant companies. 

Complications

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Cases and figures

  • Figure 1: dynamic hip screw plate (image)
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  • Case 1: normal with cerclage wire
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  • Case 2: DHS with lag screw sliding
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  • Case 3: fractured screws
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  • Case 4: fractured plate
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  • Case 5: fractured
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