Practical: DHS

The patient should be supine on the operating table on traction.

The patient’s leg should be internally rotated by around 10 degrees.

I would perform a direct lateral incision.

I would make a 10-15cm incision starting two finger-widths distal to the greater trochanter.

I would dissect through skin, subcutaneous tissue, the fascia lata and split the vastas lateralis.

The guidewire should be placed with a tip-apex distance of <25mm

Posterior inferior positions are superior to anterior superior positions.

The theatre assistant hands you the triple reamer. The triple reamer is pictured below.


Reaming for the screw

Reaming for the barrel

Reaming for the plate barrel junction




Insert the DHS screw

Tap the DHS plate down to the bone

Fix the DHS plate using cortex screws