Sliding hip screw: Definition, Uses, and Clinical Overview

Sliding hip screw Introduction (What it is)

A Sliding hip screw is an orthopedic implant used to fix certain fractures near the top of the thigh bone (femur).
It combines a large screw placed into the femoral head with a side plate attached to the femur.
It is most commonly used for hip fractures outside the joint capsule, especially intertrochanteric fractures.
Its design allows controlled sliding (collapse) at the fracture site to help the bone heal.

Why Sliding hip screw used (Purpose / benefits)

The main purpose of a Sliding hip screw is to stabilize a broken bone so the fracture can heal in a more predictable alignment while allowing early movement of the patient. In many hip fractures, the challenge is balancing stability (so the bone ends do not shift excessively) with controlled compression (so the fracture surfaces can press together, which can support healing).

A key idea behind this implant is dynamic fixation. Instead of holding the bone completely rigid, the screw component can slide within the barrel of the side plate. This sliding can permit the femoral head and neck segment to settle toward the shaft in a controlled way as the patient bears weight, helping maintain contact between fracture surfaces.

Potential benefits, depending on fracture pattern and surgical goals, include:

• Internal stabilization of common extracapsular hip fractures (fractures outside the hip joint capsule).
• Load-sharing design that can allow compression at the fracture line rather than forcing all forces through the metal.
• Versatility in stable fracture patterns, where controlled collapse is desirable.
• Well-established technique in orthopedic trauma care, with instrumentation designed to guide alignment and implant placement.

Outcomes and the choice of implant vary by clinician and case, including factors such as fracture stability, bone quality, and patient health.

Indications (When orthopedic clinicians use it)

Orthopedic clinicians typically consider a Sliding hip screw for:

• Intertrochanteric femur fractures, especially relatively stable patterns
• Basicervical fractures (near the base of the femoral neck) in selected cases
• Some peritrochanteric fractures where a side-plate device is appropriate
• Situations where controlled fracture impaction is expected to be beneficial
• Cases where patient anatomy and fracture morphology suit a plate-and-screw construct

Contraindications / when it’s NOT ideal

A Sliding hip screw is not ideal for every hip fracture. Clinicians may choose another approach when the fracture is unlikely to remain controlled during sliding, or when different biomechanics are needed.

Situations where it may be less suitable include:

• Unstable intertrochanteric fracture patterns, such as those with loss of the lateral wall or patterns that tend to shorten/medialize excessively
• Reverse obliquity or fracture lines that may not be well controlled by a sliding side-plate design
• Subtrochanteric extension (fracture extends further down the femur), where intramedullary support may be preferred
• Displaced intracapsular femoral neck fractures (inside the capsule), where arthroplasty or other fixation strategies are often considered, depending on patient factors
• Severe bone quality concerns (for example, very osteoporotic bone) where fixation purchase may be less reliable; the best approach varies by clinician and case
• Active infection near the surgical site or systemic infection concerns that may delay implantation (timing and strategy vary by clinician and case)

The “not ideal” category does not automatically mean “cannot be used.” It means other implants (for example, a cephalomedullary nail or arthroplasty) may better match the fracture mechanics and patient needs.

How it works (Mechanism / physiology)

Biomechanical principle: controlled sliding and compression

A Sliding hip screw works through a dynamic compression concept. The large screw (often called a lag screw) is placed through the femoral neck into the femoral head. That lag screw connects to a barrel on a metal side plate fixed to the outer femur with smaller screws.

When the patient loads the leg, the lag screw can slide within the barrel, allowing the fractured bone segments to compress together in a controlled direction. This controlled settling can help maintain fracture contact, but too much sliding can contribute to limb shortening or altered alignment—risk that depends on fracture stability and implant position.

Anatomy involved

Understanding the nearby anatomy helps explain why this implant is used for certain fractures:

• Femoral head: the ball part of the hip joint that sits in the acetabulum (hip socket).
• Femoral neck: the narrower bridge of bone connecting head to shaft.
• Greater and lesser trochanters: bony prominences where major hip muscles attach; common sites involved in intertrochanteric fractures.
• Proximal femoral shaft: the upper part of the femur where the side plate is anchored.
• Hip capsule: a fibrous envelope around the hip joint; “extracapsular” fractures (like most intertrochanteric fractures) lie outside it.

Because many intertrochanteric fractures are extracapsular, their blood supply considerations differ from intracapsular femoral neck fractures. Still, healing depends on fracture reduction (alignment), stability, and biology.

Onset, duration, and reversibility

A Sliding hip screw provides immediate mechanical stabilization after surgery. Its “duration” is typically until the fracture heals and the bone can carry load normally. Whether the hardware is later removed varies by symptoms, implant position, healing, and clinician preference; removal is not inherently required and varies by clinician and case.

Sliding hip screw Procedure overview (How it’s applied)

A Sliding hip screw is an implant used during fracture fixation surgery, not a standalone “treatment session.” The exact steps vary by surgeon, fracture type, and operating room protocols, but the workflow is often described in broad phases:

1. Evaluation and imaging
   – Clinical assessment and review of symptoms after injury.
   – Imaging typically includes hip/femur X-rays; CT may be used in selected cases to better define fracture pattern.

2. Preoperative planning and preparation
   – Selecting an implant configuration (plate length, barrel angle, screw sizes), based on anatomy and fracture geometry.
   – Planning reduction strategy (how the fracture will be realigned).
   – Preparing for anesthesia and perioperative monitoring.

3. Fracture reduction (realignment)
   – The surgical team repositions the fracture fragments to an acceptable alignment.
   – Reduction may be achieved with traction and positioning, sometimes aided by instruments.

4. Implant placement
   – A guide system is used to place the lag screw into the femoral head along a planned path.
   – The side plate is then positioned on the femoral shaft, connecting to the lag screw via the barrel.
   – Plate screws are inserted to secure the plate to the femur.

5. Immediate checks
   – Intraoperative imaging helps confirm reduction, screw position, and overall construct alignment.
   – The surgical site is closed and dressed per standard practice.

6. Follow-up and monitoring
   – Postoperative care typically includes reassessment, pain control plans, mobility progression, and physical therapy involvement.
   – Follow-up imaging is commonly used to monitor healing and implant position over time.
   – Weight-bearing status and activity limits vary by clinician and case.

This overview is intentionally high level; individual surgical decisions are tailored to fracture stability, bone quality, and patient-specific factors.

Types / variations

The term Sliding hip screw is often used broadly, and some clinicians refer to “dynamic hip screw” (DHS) systems as a common example. Variations may include differences in geometry, materials, and fixation strategy.

Common variations include:

• Side plate length and hole count

• Plates may have fewer or more screw holes (for example, shorter plates versus longer plates) depending on the need for fixation along the femoral shaft.

• Barrel angle / plate angle options

• The angle between the plate and the lag screw path can vary to match femoral anatomy and desired screw trajectory. Options vary by material and manufacturer.

• Standard versus locking side plates

• Some systems allow locking screws in the plate, which can increase fixed-angle stability in certain bone qualities. Selection varies by clinician and case.

• Lag screw designs

• Thread shape, diameter, and instrumentation differ across systems. Some designs aim to improve purchase in weaker bone, but performance varies by implant design and clinical context.

• Adjunct fixation

• In some patterns, additional screws or devices may be used to address specific fragment instability (for example, to support the lateral wall). Use is case dependent.

Pros and cons

Pros:

• Allows controlled compression at the fracture site through sliding mechanics
• Widely used for stable intertrochanteric fracture fixation
• Can provide immediate internal stabilization after implantation
• Uses a plate-and-screw construct that many surgical teams are familiar with
• Implant position can be assessed readily on standard X-rays
• May be compatible with structured rehabilitation plans (timing varies by clinician and case)

Cons:

• Less suited to unstable fracture patterns, where excessive collapse or malalignment may occur
• Potential for hardware-related complications, including screw migration or “cut-out,” depending on reduction quality and positioning
• Can be associated with limb shortening if substantial sliding occurs
• Requires an incision and soft-tissue dissection to place the side plate
• Healing and function depend on bone quality, fracture biology, and patient comorbidities
• Some patients may later notice hardware prominence or irritation (symptoms vary widely)

Aftercare & longevity

Aftercare following Sliding hip screw fixation is typically focused on three goals: protecting the repair as the bone heals, restoring mobility and strength, and monitoring for complications. Specific instructions (especially weight-bearing) vary by clinician and case.

Factors that can influence recovery and implant “longevity” (how well the construct performs until healing) include:

• Fracture pattern and stability
  Stable fractures may tolerate controlled sliding well, while unstable patterns may be prone to excessive collapse or loss of alignment.

• Quality of reduction and implant positioning
  How well the fracture is realigned and how well the screw is placed in the femoral head can influence mechanical reliability. Clinicians often discuss concepts like screw position and “tip–apex distance” as part of placement goals, without any single rule applying to every case.

• Bone health and comorbidities
  Osteoporosis, smoking status, diabetes, nutritional status, and other systemic factors can affect bone healing and complication risk.

• Rehabilitation participation and functional demands
  Physical therapy often addresses gait, hip strength, balance, and safe transfers. The pace and intensity depend on medical status and mobility goals.

• Weight-bearing status and fall risk
  The degree of permitted weight-bearing is individualized. Avoiding reinjury is important because a new fall can disrupt healing regardless of implant type.

• Follow-up schedule and imaging
  Repeat assessments and X-rays are commonly used to confirm healing progression and that the implant remains appropriately positioned.

In many cases, the implant is intended to remain in place after healing unless it causes symptoms or there is another clinical reason to remove it. Decisions about removal vary by clinician and case.

Alternatives / comparisons

The best comparison depends on the fracture location and stability. A Sliding hip screw is one option among several, and clinicians choose based on anatomy, biomechanics, and patient needs.

Common alternatives include:

• Cephalomedullary nail (intramedullary hip nail)
  This is a rod placed inside the femoral canal with a head/neck fixation element. It may be favored in some unstable intertrochanteric or subtrochanteric patterns because the intramedullary position can change load transfer mechanics. Both approaches have trade-offs, and choice varies by clinician and case.

• Cannulated screws (percutaneous screw fixation)
  Multiple smaller screws are more commonly associated with selected femoral neck fractures rather than typical intertrochanteric fractures. They may be used when fracture characteristics and patient factors support that strategy.

• Arthroplasty (hip replacement procedures)
  For some displaced femoral neck fractures—particularly intracapsular fractures—clinicians may consider hemiarthroplasty or total hip arthroplasty, depending on patient age, activity level, and joint health. Arthroplasty replaces joint surfaces rather than relying on fracture healing alone.

• Nonoperative management (observation, protected weight-bearing, pain control)
  This may be considered in limited situations (for example, patients who are not surgical candidates). Nonoperative approaches carry their own risks and limitations, especially related to mobility and prolonged immobility, and are individualized.

• Other plate constructs
  In certain fracture extensions or unusual patterns, different plates or fixed-angle devices may be considered. Implant choice depends on anatomy and fracture mechanics.

No single option is universally “better.” The decision is typically based on fracture classification, stability features, patient physiology, and surgeon experience.

Sliding hip screw Common questions (FAQ)

Q: Is a Sliding hip screw the same as a hip replacement?
No. A Sliding hip screw is used to fix a fracture so the patient’s own bone can heal. A hip replacement replaces part or all of the hip joint surfaces, which is a different operation with different goals.

Q: Will I have pain after surgery with a Sliding hip screw?
Postoperative pain is common after fracture fixation because both the fracture and the surgical approach affect tissues. Pain experience varies widely depending on the injury, overall health, and rehabilitation course. Clinicians typically use a combination of strategies to manage pain while mobility is gradually restored.

Q: How long does the hardware stay in?
Often, the implant can remain indefinitely once the fracture has healed. Hardware removal may be considered if there are symptoms such as irritation, mechanical problems, or other clinical concerns. Whether removal is recommended varies by clinician and case.

Q: How long does it take to recover?
Recovery time varies by fracture type, patient health, and pre-injury function. Many people progress through stages: early mobility and basic walking, then strengthening and endurance work. Follow-up visits and imaging help clinicians judge healing and adjust rehabilitation plans.

Q: Will I be allowed to put weight on the leg right away?
Weight-bearing recommendations depend on fracture stability, fixation quality, and surgeon preference. Some cases allow earlier weight-bearing, while others require a period of limited weight-bearing. This is a “varies by clinician and case” decision.

Q: Is it “safe” and how common are complications?
All surgeries have risks, and fracture fixation has specific risks such as infection, blood clots, failure of fixation, or delayed healing. Complication likelihood depends on fracture pattern, bone quality, implant positioning, and patient medical factors. Your care team typically monitors for warning signs during follow-up.

Q: What is “cut-out” and why is it mentioned with Sliding hip screws?
“Cut-out” refers to the lag screw migrating within the femoral head, sometimes associated with loss of fracture alignment. It is a known hardware-related complication discussed in hip fracture fixation. Risk is influenced by reduction quality, screw position, and bone strength, among other factors.

Q: Can I drive or return to work after Sliding hip screw fixation?
Return to driving or work depends on pain control, mobility, reaction time, weight-bearing status, and the demands of the job. For driving, considerations also include which leg was injured and whether assistive devices are still needed. Timing varies by clinician and case.

Q: Will the metal set off airport detectors or prevent MRI?
Some implants may set off metal detectors, though it is not guaranteed. Many modern orthopedic implants are compatible with MRI under specific conditions, but “MRI-safe” depends on the implant materials and the scanner protocol. Imaging staff can verify compatibility based on implant documentation.

Q: How much does a Sliding hip screw procedure cost?
Costs vary widely by country, hospital system, insurance coverage, and complexity of care (including rehabilitation and follow-up). The total cost is usually more than the implant itself because it includes operating room services, anesthesia, hospitalization, imaging, and therapy. For accurate estimates, patients typically need facility- and coverage-specific information.