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Chapter 03 Video 1: Intertrochanteric fracture; Open Reduction Internal Fixation with Dynamic Hip Screw

December 16, 2016

Contributors: Kenneth A Egol, MD; Daniel B Bazylewicz, MD; Abiola Atanda, MD; Mathew Hamula, BA, BS

This video is a demonstration of the repair of an intertrochanteric fracture with open reduction internal fixation with a dynamic hip screw in an 82 year old male. The patient is positioned on a standard fracture table and prepped and draped. The operative limb is confirmed radiographically and landmarks include the greater trochanter, vastus ridge, and the femoral shaft. Dissection is carried out, taking care to cauterize perforating blood vessels, and the vastus lateralis is elevated. 130-135° with 2-4 holes is the most commonly used side plate. A threaded guide pin is inserted into the femoral head and neck, and placement should be as central as possible and confirmed radiographically. The head and neck are reamed, taking care not to advance into the acetabulum. The bone is tapped in this case, and the lag screw is inserted and confirmed radiographically. A 4 hole plate is temporarily fixed with a clamp, and screws are placed depending on bone quality, fracture pattern, and surgeon preference. Traction is released and the plate is impacted manually. The lag screw end should be visualized within the plate. The wound is thoroughly irrigated, a drain is placed, and standard closure performed.

Results for "Let's Discuss: Hip Fractures—Including Osteoporosis"