Dynamic hip screw

If you are considering a dynamic hip screw operation to treat a fractured neck of femur, or have an operation planned, it is important to know all you can about it. This includes:

• why you need this operation

• what it will be like

• how it will affect you

• what risks are involved

• any alternatives.

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your choice of treatment to correct a fractured neck of femur with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is the problem?

You have broken the upper end of your thighbone close to your hip joint. This part of your thighbone is called your neck of femur. A break is also called a fracture; these are exactly the same thing. There is no difference in severity between a fractured bone and a broken bone. Therefore your injury may be called a fractured neck of femur. The upper end of your thighbone forms part of your hip joint. Your break is close to, but just outside your hip joint.

What is the neck of femur?

The hip joint is a ball and socket joint. The socket part is formed by a cup in the pelvis, called the acetabulum. The ball part of the joint is the head of the thighbone, called the head of femur. The top part of the thighbone, just below the head, is called the neck of the femur.

What has gone wrong?

Your thighbone has broken close to the hip, probably due to a fall. Most patients who suffer this fracture have osteoporosis (thinning of the bones). The bone was probably very weak due to osteoporosis. A fall can lead to the bone breaking. Alternatively the bone can break, resulting in the fall.

The aim

The aim is to put the bones back into a better position. They will be held in place with a metal screw and plate.

The benefits

The operation will stop your leg hurting. If you were able to walk prior to the fracture, you should be able to walk again after your operation. You will be able to put weight on your leg immediately. You do not need to wait for your fracture to heal first. You will not have to stay in bed until your fracture heals.

Are there any alternatives?

If you are not fit enough for surgery, we can treat you without surgery. This would be with bed rest and a splint that pulls on the thighbone until the fracture has healed. This is called traction. You will have to stay in bed for two months or more while your hip heals.

What if you do nothing?  

If you do not have an operation you may suffer one of the serious complications that results from staying in bed for a long time. These complications include pressure sores, pneumonia and deep vein thrombosis (blood clots in the legs). These complications can be fatal.

Who should have it done?

If your thighbone is broken and you are fit enough for surgery, you ought to have the fracture fixed.

Who should not have it done?

If you suffer from major medical problems, these should be sorted out before you have the operation. These problems include irregular heart rhythms and breathing problems.

Author: Mr Boyd Goldie MBBS FRCS BSC DHMSA. Consultant in orthopaedics & trauma.

© Dumas Ltd 2006

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