Dynamic Hip Screw (DHS) Procedure
A sliding lag screw and side plate system for intertrochanteric hip fractures — allowing controlled fracture collapse along the screw axis, promoting reliable union while enabling early weight-bearing.
What is Dynamic Hip Screw (DHS) Procedure?
The Dynamic Hip Screw (DHS) is a sliding lag screw and barrel-plate system that is the most widely used implant for stable and selected unstable intertrochanteric hip fractures. The large lag screw is inserted across the femoral neck into the femoral head and connected to a side plate fixed to the lateral femur. The key mechanical principle is the sliding mechanism — the screw is able to move within the barrel, allowing the fracture to impact and compress under body weight, promoting rapid and reliable union. DHS fixation allows full weight-bearing within 24–48 hours, which is critical in elderly patients to prevent the serious complications of immobility — chest infections, blood clots, pressure sores, and rapid physical deconditioning.
How the Procedure Works
Fracture Reduction
Patient positioned on a traction table; the fracture is reduced under fluoroscopic guidance without opening the fracture site.
Guidewire Placement
A guidewire is inserted percutaneously through the lateral femur, across the fracture, and into the central axis of the femoral head.
Lag Screw Insertion
The lag screw is drilled over the guidewire and positioned centrally in the femoral head — the tip-apex distance is minimised to prevent cut-out.
Side Plate Fixation
The side plate is applied to the lateral femur and secured with cortical screws, connecting the lag screw to the shaft.
Early Mobilisation
Full or partial weight-bearing commences 24–48 hours post-surgery with physiotherapy guidance.
Outcomes
Who Needs This Treatment?
- →Allows immediate or very early full weight-bearing — critical in elderly patients
- →Sliding mechanism promotes controlled fracture impaction and faster union
- →Well-established procedure with decades of reliable clinical evidence
- →Implant removal generally not required once union is confirmed
- →Low infection risk with minimally invasive technique
- →Quick procedure time minimises anaesthetic risk in frail patients
"In an elderly patient with a hip fracture, getting them weight-bearing within 24 hours is not just about comfort — it is a matter of survival. The dynamic hip screw achieves that reliably, and for appropriate fracture patterns, it remains the best tool available."
— Dr. Satish Reddy Gandavarapu, Senior Orthopaedic & Trauma Surgeon, Lux Hospitals, Hyderabad
Common Questions
Frequently Asked
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