DHS Surgery – Instruments & Implant System

Procedure Overview

Dynamic Hip Screw (DHS) surgery is an orthopedic procedure commonly used to stabilize certain fractures of the proximal femur, particularly intertrochanteric hip fractures. The DHS implant system typically consists of a large lag screw inserted into the femoral head and neck, connected to a side plate fixed to the femoral shaft with screws. The system allows controlled sliding and compression at the fracture site during healing.

 Surgical Procedure

1. Preoperative Preparation: The patient's medical condition and fracture are assessed using appropriate imaging. The surgical team prepares the operating room and verifies the DHS implant system, instruments, and required implant sizes.
2. Anesthesia and Positioning: Anesthesia is administered, and the patient is positioned appropriately, commonly on a fracture table to facilitate fracture reduction and imaging.
3. Fracture Reduction:The surgeon aligns the fractured bone under fluoroscopic guidance and confirms the reduction.
4. Surgical Exposure:An incision is made over the lateral aspect of the proximal femur, and the underlying tissues are exposed to access the femur.
5. Guidewire Placement: A guidewire is positioned within the femoral head and neck under imaging guidance to establish the planned trajectory.
6. Bone Preparation: Compatible DHS instruments are used to prepare the femoral head and neck for the lag screw and the femoral shaft for the side plate.
7. Implant Insertion:The selected lag screw is inserted into the prepared femoral head and neck. The side plate is attached to the screw assembly and secured to the femoral shaft with appropriate cortical screws.
8. Final Assessment: Implant position, fracture alignment, and fixation are checked using intraoperative imaging.
9. Wound Closure:Hemostasis is achieved, and the surgical wound is closed in layers.
10. Postoperative Care:The patient receives pain management, wound care, thrombosis prevention when indicated, rehabilitation, and a weight-bearing plan determined by the treating orthopedic team.

 DHS Surgical Instruments

1. General Orthopedic Instruments
- Scalpel handle and surgical blades
- Mayo scissors
- Metzenbaum scissors
- Tissue forceps
- Artery forceps
- Needle holders
- Retractors
- Suction instruments

 2. Fracture Reduction Instruments
- Bone-holding forceps
- Reduction clamps
- Bone hooks, where appropriate
- Traction equipment
- Fluoroscopy-compatible positioning equipment

 3. DHS Instrument Set
- DHS angle guide
- Guidewires
- Triple reamer or system-specific reaming instruments
- Tap, where required by the implant system
- Lag screw insertion instrument
- Side-plate impactor or seating instrument
- Plate-holding forceps
- Drill guides and drill sleeves
- Compatible drill bits
- Depth gauge
- Screwdrivers
- Hexagonal or system-specific drivers
- T-handle instruments, where applicable

 4. Supporting Instruments and Equipment

- Orthopedic power drill and compatible attachments
- C-arm fluoroscopy system
- Suction apparatus
- Electrosurgical equipment
- Sterile drapes and wound-closure supplies

 DHS Implant System Components

A typical Dynamic Hip Screw implant system may include:

- Lag screws in various diameters and lengths
- DHS side plates with different barrel angles and hole configurations
- Cortical fixation screws
- Compatible guidewires
- Instrumentation for drilling, reaming, and insertion
- Plate and screw insertion instruments
- System-specific accessories

The precise implant and instrument selection depends on the fracture pattern, bone anatomy, surgeon's treatment plan, and manufacturer's specifications. Not all DHS systems use interchangeable components.

Postoperative Considerations

Postoperative management includes monitoring the surgical wound, controlling pain, preventing complications associated with immobility, and initiating rehabilitation. Weight-bearing instructions depend on fracture stability, fixation quality, and the surgeon's assessment.

 Potential Complications

Possible complications include infection, bleeding, delayed union or nonunion, implant failure, screw cut-out, loss of fracture reduction, thromboembolic events, and complications associated with anesthesia.

 Important Note

This overview is intended for educational and surgical instrument-library purposes. DHS surgery should be performed by qualified orthopedic professionals in an appropriately equipped clinical setting. Implant selection, instrumentation, and surgical technique must follow the manufacturer's instructions and established clinical protocols.