Influence of Perioperative and Patient-Related Factors on Clinical Outcomes in Intertrochanteric Femoral Fractures Managed with Dynamic Hip Screw

Open Access

Abstract

Background: Intertrochanteric femoral fractures are common in the elderly and contribute to significant morbidity. Dynamic Hip Screw (DHS) fixation remains a widely used and cost-effective treatment, though outcomes depend on both patient factors and perioperative parameters. Aim: To assess how perioperative factors and patient characteristics influence clinical and functional outcomes after DHS fixation. Methods & Materials: This quasi-experimental observational study included 26 patients (aged 31–80 years) treated with DHS between September 2022 and September 2024. Demographics, comorbidities, injury mechanism, bone density (Singh Index), perioperative variables, and postoperative complications were analyzed. Pain was assessed using the Visual Analogue Scale (VAS), and functional recovery was evaluated by the Harris Hip Score (HHS) at nine months. Results: Mean age was 67.7 ± 10.3 years, with females comprising 61.5%. Falls from standing height caused most injuries (84.6%). The mean injury-to-surgery interval was 4.96 ± 1.76 days, operative time 66.8 ± 8.1 minutes, and blood loss 200 ± 50 mL. Mean union time was 16.6 ± 2.4 weeks. VAS improved significantly from 7.9 ± 0.95 to 1.0 ± 0.92. Independent ambulation was regained by 53.9% of patients. Complications were low (7.7% superficial infection; 7.7% screw cut-out). HHS was significantly associated with bone density (p = 0.04) and tip–apex distance (p = 0.003). Conclusion: DHS fixation provides predictable union, favorable functional outcomes, and low complication rates. Better bone quality and optimal screw positioning (TAD ≤25 mm) were key predictors of improved recovery.