Surgical Fixation of Hip Fractures – A Novel Technique for Pre-Operative Planning

Purpose : Use of the dynamic hip screw (DHS) is considered the gold standard for hip fracture stabilisation, but conventional DHS (CHDS) fixations may be limited by longer surgical duration and delayed recovery compared to minimally invasive DHS (MIDHS) fixations. We describe a novel low-cost surgical method grounded in trigonometry that reduces intra-operative time, peri-operative complications, and improves overall patient outcomes. Methods : A prospective double-blinded study included 15 patients who underwent surgical fixation of IT hip fractures using a 4-hole DHS system. All surgeries were performed at a tertiary referral hospital between January 2019 and April 2023 by surgeons with similar levels of experience. Main outcome measurements included tip-apex distance (TAD), surgery duration, haemoglobin loss, and hospital stay duration. Two independent assessors measured TAD using the post-operative anteroposterior and lateral radiographs. Kyle's classification was used to categorize the IT fractures. IBM SPSS Statistics 26.0 for Mac (SPSS, Chicago, IL, USA) was used for the statistical analysis. Statistically significant difference was defined as p-value < 0.05. Results : Both groups had similar baseline characteristics (p > 0.05), except for Kyle's classification (p = 0.04). The MIDHS group had more complex fractures (40% MIDHS Kyle 3/4 vs 10% CDHS Kyle 3/4) but the mean surgical duration was significantly shorter (p = 0.019) (43.8 ± 12.3 minutes) compared to the CDHS group (73.4 ± 18.2 minutes). Postoperatively, there was no significant difference (p>0.05) in hospital stay duration, haemoglobin (Hb) loss, or TAD. Conclusions : Despite having more complex fractures, MIDHS group had even shorter surgical duration compared to CDHS group, with no significant difference in TAD, haemoglobin loss and hospital stay duration.