DHS: Definition, Uses, and Clinical Overview

DHS Introduction (What it is)

DHS most commonly refers to a Dynamic Hip Screw.
It is an orthopedic implant used to stabilize certain proximal femur (upper thigh bone) fractures.
It combines a large screw in the femoral head with a side plate along the femur.
It is commonly used in hip fracture surgery, especially around the trochanteric region.

Why DHS used (Purpose / benefits)

A DHS is designed to hold broken bone segments in a stable alignment while the fracture heals. In hip fracture care, the goal is typically to restore mechanical stability so a patient can begin rehabilitation and regain function under a clinician-directed plan.

The “dynamic” feature is central to the concept. Rather than rigidly locking the fracture with no motion at the fracture site, a DHS is built to allow controlled sliding (impaction) along the axis of the screw as the patient loads the limb. This can help the fracture surfaces compress together, which is one of the biomechanical conditions that often supports bone healing.

Common benefits clinicians aim for when selecting a DHS include:

• Stable fixation for certain fracture patterns of the upper femur
• Controlled compression across the fracture as healing progresses
• A widely used implant concept with predictable instrumentation in many operating rooms
• Flexibility in plate length and configuration to match bone anatomy and fracture pattern (varies by system)

The problem it addresses is not “hip pain” in general, but structural failure of bone—most often a fracture near the hip—where internal fixation is used to support healing and restore function.

Indications (When orthopedic clinicians use it)

Typical scenarios where clinicians may use a DHS include:

• Intertrochanteric femur fractures (fractures between the greater and lesser trochanters), especially stable patterns
• Some basicervical fractures (near the base of the femoral neck), depending on fracture stability and surgeon preference
• Selected pertrochanteric fracture patterns where a sliding hip screw construct is appropriate
• Certain fracture situations where controlled collapse/impaction is desirable
• Cases where the clinician’s assessment supports a plate-and-screw construct over an intramedullary device (varies by clinician and case)

Exact indications depend on fracture classification, stability, bone quality, and local practice patterns.

Contraindications / when it’s NOT ideal

A DHS may be less suitable—or another approach may be preferred—in situations such as:

• Unstable intertrochanteric fractures (for example, certain reverse obliquity patterns), where intramedullary fixation is often considered (varies by clinician and case)
• Fractures with significant subtrochanteric extension (extending below the lesser trochanter), where alternative constructs may provide more appropriate load-sharing
• Severe comminution (multiple fragments) in patterns that do not reliably resist collapse or rotation with a sliding screw construct
• Displaced intracapsular femoral neck fractures, where arthroplasty or other fixation strategies may be chosen based on patient factors and fracture characteristics
• Situations where bone quality is extremely poor and fixation purchase is a concern (approach varies by clinician and case)
• Active infection at or near the surgical site, where implant placement may be deferred or altered (managed case-by-case)

These are general considerations; real-world decisions are individualized.

How it works (Mechanism / physiology)

Biomechanical principle

A DHS functions as a sliding hip screw construct. The core elements are:

• A large lag screw placed through the femoral neck into the femoral head
• A side plate attached to the lateral femoral shaft
• A barrel/slot mechanism that allows the lag screw to slide relative to the plate

When load is applied through the hip (for example, during standing or walking as permitted), the lag screw can slide within the barrel. This can permit controlled fracture impaction, bringing bone surfaces into contact and helping share forces across the healing fracture.

Relevant anatomy

Understanding DHS use is easier with a brief map of the area:

• Femoral head: the “ball” that sits in the hip socket (acetabulum)
• Femoral neck: the narrowed segment connecting head to shaft
• Greater and lesser trochanters: bony prominences where muscles attach; many hip fractures occur in this region
• Proximal femur: the upper portion of the thigh bone, encompassing the above structures

Many DHS applications involve fractures around the intertrochanteric region, which is extracapsular (outside the hip joint capsule). This matters because blood supply patterns and healing behavior differ between extracapsular and intracapsular fractures.

Onset, duration, and “reversibility”

A DHS provides immediate mechanical stabilization after implantation. Its purpose is to support healing over weeks to months, depending on fracture pattern and patient factors (varies by clinician and case).

A DHS is not a medication and has no pharmacologic onset or duration. Its functional “duration” is the time it remains in the body and continues to provide support. In many cases, the implant is left in place long term unless there is a clinical reason to remove it. Removal is possible but is a separate decision that depends on symptoms, healing, and risk-benefit considerations (varies by clinician and case).

DHS Procedure overview (How it’s applied)

DHS is not a diagnostic test; it is an implant used during fracture fixation surgery. The workflow below is a high-level overview and intentionally avoids step-by-step operative instruction.

1. Evaluation / exam – Clinical assessment of pain, function, and overall health status – Imaging to define fracture type and plan fixation (commonly X-ray; CT may be used in selected cases) – Review of comorbidities and medications that may affect surgery and healing (varies by clinician and case)

2. Preparation – Preoperative planning for implant angle, plate length, and screw size (varies by system) – Anesthesia planning and operating room positioning – Sterile preparation and antibiotic protocols per institutional standards

3. Intervention (implant placement) – Fracture alignment (“reduction”) is achieved by positioning and/or surgical technique – A guide pathway is created to place the lag screw into the femoral head – The side plate is secured to the femoral shaft with multiple screws – Final construct is checked for alignment and hardware position

4. Immediate checks – Intraoperative imaging is typically used to confirm implant placement and fracture alignment – Wound closure and postoperative pain-control planning per care team protocols

5. Follow-up – Scheduled clinical follow-ups and imaging to assess healing and implant position – Rehabilitation progression is individualized; weight-bearing status and activity progression vary by clinician and case

Types / variations

“DHS” is often used as an umbrella term, but there are meaningful variations among systems and configurations. Common dimensions of variation include:

• Plate length and hole count

• Side plates may have different numbers of screw holes (for example, shorter vs longer plates), chosen based on fracture pattern and bone quality.

• Neck-shaft angle options

• DHS systems commonly offer different fixed angles (often around the 130–150° range; exact options vary by manufacturer).

• The selected angle aims to match patient anatomy and planned reduction.

• Barrel length

• Some systems offer short vs long barrel designs to accommodate screw length and anatomy (varies by manufacturer).

• Lag screw design

• The lag screw may be cannulated (placed over a guidewire) in many modern systems.

• Thread design, diameter, and metallurgy vary by manufacturer.

• Material

• Common implant materials include stainless steel or titanium alloys. Properties such as stiffness, imaging artifact, and corrosion behavior vary by material and manufacturer.

• Rotational control add-ons

• In selected cases, surgeons may add an anti-rotation screw or supplementary fixation to reduce risk of femoral head/neck rotation (usage varies by clinician and case).

• Related constructs (often discussed alongside DHS)

• Clinicians may compare DHS to cephalomedullary nails (intramedullary devices) or other plate-screw systems depending on fracture stability and patient factors.

Pros and cons

Pros:

• Provides stable internal fixation for many extracapsular proximal femur fractures
• Allows controlled sliding/compression at the fracture site as healing progresses
• Uses a familiar implant concept with standardized instruments in many settings
• Can be configured with different plate lengths and angles (varies by system)
• Typically permits a structured rehabilitation plan once fixation is achieved (details vary by clinician and case)
• Implant is entirely internal, avoiding external frames and pin-site care

Cons:

• Not ideal for certain unstable fracture patterns, where other constructs may better resist deformation (varies by clinician and case)
• Requires accurate implant positioning; suboptimal position can increase risk of fixation failure (risk varies by case)
• Hardware-related symptoms can occur (for example, irritation), sometimes prompting discussion of implant removal after healing (varies by clinician and case)
• As with any surgery, there are general risks such as infection, bleeding, anesthesia-related complications, and blood clots (risk varies by patient and setting)
• Healing and functional recovery depend on factors beyond the implant, including bone quality and overall health
• May not address situations where joint replacement is the more appropriate strategy (for example, certain intracapsular fractures), depending on patient and fracture features

Aftercare & longevity

Aftercare following DHS fixation generally focuses on protecting the repair while restoring mobility and function. Specific protocols differ across surgeons, institutions, fracture patterns, and patient factors.

Key factors that can influence outcomes and the “longevity” of the construct include:

• Fracture pattern and stability

• Stable patterns often behave differently than unstable or highly comminuted patterns.

• Bone quality

• Osteoporosis or other metabolic bone conditions can reduce fixation purchase and affect healing behavior.

• Implant positioning and construct choice

• The relationship of the lag screw to the femoral head and the overall alignment of the fracture reduction can influence mechanical performance (assessed on imaging).

• Weight-bearing status and rehabilitation progression

• Clinicians may recommend different levels of loading at different phases. The appropriate plan varies by clinician and case.

• Follow-up attendance and imaging

• Follow-up visits and X-rays are commonly used to monitor fracture healing and detect changes in alignment or implant position.

• General health factors

• Smoking status, nutrition, diabetes, vascular disease, and certain medications can influence bone healing and surgical recovery (effects vary across individuals).

In many patients, the DHS hardware can remain in place long term. When hardware is removed, it is usually because of a specific clinical indication (for example, persistent symptoms after confirmed healing), and the decision is individualized.

Alternatives / comparisons

The “right” approach depends heavily on fracture type (intertrochanteric vs femoral neck), stability, patient age/health, and surgeon experience. Common alternatives or comparators include:

• Nonoperative management (observation/supportive care)

• In selected patients who are not surgical candidates, care may focus on pain control and function. This is generally reserved for specific circumstances and carries its own trade-offs (varies by clinician and case).

• Cephalomedullary nailing (intramedullary hip nail)

• Often considered for unstable intertrochanteric fractures or patterns where an intramedullary device offers favorable mechanics.

• Compared with DHS, nails are placed inside the femoral canal and may better resist certain bending forces, but have different technical considerations and potential complications (varies by case).

• Arthroplasty (hemiarthroplasty or total hip arthroplasty)

• More commonly discussed for displaced intracapsular femoral neck fractures, where blood supply concerns and nonunion risk influence decision-making.

• Unlike DHS, arthroplasty replaces part or all of the joint rather than fixing the fracture.

• Other plate-and-screw constructs

• Depending on anatomy and fracture extension, other fixed-angle plates or specialty devices may be used.

• Rehabilitation-only approaches for non-fracture hip pain

• It is important not to confuse DHS with treatments for arthritis, tendinopathy, bursitis, or labral injury. Those conditions may be managed with physical therapy, medication, injections, or arthroscopy, which are not substitutes for fracture fixation when a fracture is present.

DHS Common questions (FAQ)

Q: What does DHS stand for in hip surgery?
DHS most commonly stands for Dynamic Hip Screw. It is an internal fixation device used to stabilize certain fractures near the hip, especially in the upper femur around the trochanters. The term may be used differently in other medical contexts, but in orthopedics it typically refers to this implant.

Q: Is a DHS the same as a hip replacement?
No. A DHS is used to fix a fracture by stabilizing the patient’s own bone so it can heal. A hip replacement (arthroplasty) replaces part or all of the hip joint with artificial components.

Q: Will I feel the DHS hardware in my hip?
Some people notice stiffness, awareness, or localized irritation, while others do not feel the implant at all. Sensations can depend on body habitus, soft tissue coverage, healing, and activity level. If symptoms occur, clinicians typically evaluate them with an exam and imaging.

Q: How long does a DHS last once implanted?
A DHS is designed to provide stability during fracture healing and can remain in place long term. Whether it is left in permanently or removed later depends on symptoms, fracture healing, and risk considerations. Decisions about removal vary by clinician and case.

Q: How painful is recovery after DHS surgery?
Pain is common after fracture fixation surgery, particularly in the early period, and it typically changes over time as tissues heal. Pain levels vary widely based on fracture severity, surgical approach, and individual factors. Clinicians generally use a multimodal pain-management plan tailored to the patient and setting.

Q: When can someone walk or put weight on the leg after a DHS?
Weight-bearing status is individualized and depends on fracture pattern, fixation stability, bone quality, and surgeon preference. Some patients may be allowed earlier weight bearing than others, while some may need restrictions for a period. The appropriate progression varies by clinician and case.

Q: When can someone drive or return to work after DHS fixation?
Timing depends on pain control, mobility, reaction time, medication use, and whether the operated side affects driving tasks. Return-to-work timing also depends on job demands (sedentary vs physical). Clinicians commonly base these decisions on function and safety considerations rather than a single universal timeline.

Q: Is DHS surgery “safe”?
DHS fixation is a commonly performed procedure for appropriate fractures, but no surgery is risk-free. Risks can include infection, bleeding, blood clots, implant failure, and anesthesia-related complications, among others. Overall risk varies by patient health, fracture complexity, and care setting.

Q: What does DHS cost?
Costs vary by region, hospital or surgical center, implant system, surgeon fees, rehabilitation needs, and insurance coverage. Patients often see separate charges for the facility, surgeon, anesthesia, imaging, and physical therapy. A billing department can usually provide an estimate based on the planned procedure and coverage.

Q: Can I get an MRI if I have a DHS?
Many modern orthopedic implants are MRI-compatible under specific conditions, but compatibility depends on the implant material, manufacturer specifications, and the MRI system. Clinicians and radiology teams typically verify implant details before scanning. Imaging artifacts near the implant can still affect image quality in the immediate area.