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

– Basilar neck fractures 31-B

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 intramedullary 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

With the DHS Blade, rotational stability is achieved without

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).

• Trochanteric pseudarthrosis after

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.

Surgical Technique

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

The hooks of the implant should be

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.

Abduction position of the leg for two

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