Dynamic hip screw: does side make a difference? Effects of clockwise torque on right and left DHS.

A study was performed to assess the effect of clockwise rotational torque onto the fracture configuration in unstable intertrochanteric fractures. The premise is that rotational torque in the sagittal plane imparted during screw insertion can lead to a potentially unstable construct in LEFT-sided DHS fixations when compared to the RIGHT-sided ones. This unstable fixation construct manifests as an anterior spike of the proximal fragment in left-sided fixations due to clockwise torque. Eleven out of 30 unstable left-sided fractures showed an anterior spike compared with none in 26 right-sided fractures (p<0.001). The study concludes that appropriate corrective measures of reducing the torque imparted is probably indicated in unstable left-sided fractures treated with a DHS.