Decision Making in the Management of Extracapsular Fractures of the Proximal Femur – is the Dynamic Hip Screw the Prevailing Gold Standard?

Joshua Jacob1, Ankit Desai1, *, Alex Trompeter2
1 Orthopaedic Specialty Registrars, Ashford and St. Peter’s Hospital NHS Foundation Trust, Chertsey, UK
2 Consultant Orthopaedic Trauma Surgeon, St. George’s Healthcare NHS Trust, London, UK

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Creative Commons License
© 2017 Jacob et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Orthopaedic Specialty Registrars, Ashford and St. Peter’s Hospital NHS Foundation Trust, Chertsey, UK; Tel: 0779516808; E-mail:


Currently, approximately half of all hip fractures are extracapsular, with an incidence as high as 50 in 100,000 in some countries. The common classification systems fail to explain the logistics of fracture classification and whether they all behave in the same manner. The Muller AO classification system is a useful platform to delineate stable and unstable fractures. The Dynamic hip screw (DHS) however, has remained the ‘gold standard’ implant of choice for application in all extracapsular fractures. The DHS relies on the integrity and strength of the lateral femoral wall as well as the postero-medial fragment. An analysis of several studies indicates significant improvements in design and techniques to ensure a better outcome with intramedullary nails. This article reviews the historical trends that helped to evolve the DHS implant as well as discussing if the surgeon should remain content with this implant. We suggest that the gold standard surgical management of extracapsular fractures can, and should, evolve.

Keywords: Extracapsular, Fracture neck of femur, Management, Dynamic hip screw.