A dynamic hip screw (DHS) is an operation to fix a broken hip (extracapsular hip fracture) using a large screw and metal plate. It is one of the most commonly performed trauma operations and allows the fracture to heal in a stable position while the patient mobilises.
An incision is made on the outer side of the upper thigh. A large screw is inserted across the fracture into the head of the femur (thighbone), guided by X-ray. This screw slides within a metal barrel attached to a plate, which is fixed to the outer shaft of the femur with screws. The 'dynamic' design allows controlled compression of the fracture as the patient walks, promoting healing. The operation typically takes 45–90 minutes.
The DHS is the standard fixation for intertrochanteric (extracapsular) hip fractures — fractures that occur in the region just below the neck of the femur. These fractures are common in elderly patients following a fall.
Non-operative management of these fractures is rarely appropriate as it leads to prolonged immobility, pain, and high rates of complications including blood clots, chest infections, and pressure sores.
Surgery is usually performed within 36 hours of admission. Rapid pre-assessment is performed. Blood tests, heart tracing, and chest X-ray. Medication review and optimisation of medical conditions.
The aim is to stabilise the fracture, relieve pain, and allow early weight-bearing and mobilisation. Most patients can put full weight on the leg from the day after surgery. The fracture typically heals over six to twelve weeks.
Many elderly patients experience some decline in mobility after a hip fracture. Rehabilitation aims to restore as much function as possible.
DVT risk despite preventive measures.
Confusion is common in elderly patients post-operatively.
Expected around the hip and thigh.
The screw may cut through the femoral head, particularly in osteoporotic bone. This may require further surgery.
The fracture may not heal or may heal in a poor position.
Loss of blood supply to the femoral head. Less common with extracapsular fractures than intracapsular ones.
Wound or deep infection.
Chest infection, heart problems, kidney injury are more common in frail elderly patients.
Usually performed under spinal anaesthesia, which is generally preferred in elderly patients. General anaesthesia is used when spinal is not suitable.
Mobilisation begins on the day of or day after surgery with physiotherapy support. Full weight-bearing is usually permitted immediately. Rehabilitation continues in hospital or in a community setting. Recovery time varies depending on overall health and pre-fracture mobility. The metalwork is usually left in place permanently.
Wound check at two weeks. X-ray and clinic review at six weeks. Further follow-up as needed.
Usually not. The plate and screw are left in place permanently. Removal is only considered if they cause problems.
Yes, most patients are encouraged to put full weight on the leg from the day after surgery.
Typically six to twelve weeks. Full recovery of mobility may take longer.