Sliding hip screw fixation: Definition, Uses, and Clinical Overview

Sliding hip screw fixation Introduction (What it is)

Sliding hip screw fixation is a common orthopedic method for stabilizing certain hip-area fractures.
It uses a large screw in the femoral head connected to a side plate on the femur.
The design allows controlled sliding as the fracture heals and compresses.
It is most often used for specific “trochanteric” (upper femur) fractures, especially in older adults after a fall.

Why Sliding hip screw fixation used (Purpose / benefits)

Sliding hip screw fixation is used to hold broken bone fragments in the upper femur in a stable alignment while the body heals the fracture. The main clinical goal is fracture stabilization—keeping the bone ends appropriately positioned so they can unite—while also allowing a degree of controlled compression across the fracture as the patient moves.

In many hip fractures around the trochanteric region (the bony prominences just below the femoral neck), the fracture pattern can benefit from a device that permits impaction (the bone ends settling together) rather than rigidly resisting all motion. The “sliding” feature is designed to let the screw telescope within the plate barrel, which can encourage fracture contact during healing under physiologic loading. Clinicians often describe this as a dynamic construct (it changes slightly under load) as opposed to a fully fixed-angle construct.

Potential benefits, depending on the fracture pattern and patient factors, may include:

• Mechanical stability for common upper-femur fracture patterns.
• Controlled collapse/settling at the fracture site, which may improve bone-to-bone contact in suitable fractures.
• A well-established technique with widely available implants and standardized surgical workflows.
• Compatibility with postoperative rehabilitation, where mobilization plans are coordinated with fixation stability and patient health.

The overall purpose is not pain treatment by itself; pain reduction typically occurs indirectly as the fracture is stabilized and healing progresses. Outcomes and protocols vary by clinician and case.

Indications (When orthopedic clinicians use it)

Common scenarios where Sliding hip screw fixation may be selected include:

• Intertrochanteric femur fractures (fractures between the greater and lesser trochanter) that are considered suitable for a sliding construct
• Stable or minimally unstable trochanteric fracture patterns, where controlled impaction is acceptable
• Certain basicervical or peritrochanteric fractures when the surgeon judges a sliding hip screw construct appropriate
• Patients where preserving the native hip joint is preferred (fixation rather than joint replacement), depending on fracture type
• Situations where a side-plate device is favored based on anatomy, fracture geometry, or implant availability

Exact indications depend on imaging, bone quality, and surgeon preference.

Contraindications / when it’s NOT ideal

Sliding hip screw constructs are not a universal solution for all hip fractures. Situations where Sliding hip screw fixation may be less suitable, or where another approach may be preferred, can include:

• Fracture patterns with significant instability, such as those with characteristics that tend to drive excessive shortening or loss of alignment (selection varies by clinician and case)
• Reverse obliquity or subtrochanteric extension patterns, where intramedullary fixation is often considered (decision varies)
• Certain femoral neck fractures (intracapsular fractures), which may be treated with different fixation strategies or arthroplasty depending on displacement and patient factors
• Pathologic fractures from tumor or severe bone disease, where specialized implants or reconstruction may be needed
• Active infection near the surgical site or systemic infection concerns that change timing or approach
• Severe medical instability where anesthesia or surgery risk is judged too high (management planning varies)
• Anatomy or prior hardware that limits safe implant placement

Contraindications are individualized and depend on fracture classification, radiographic findings, and overall patient health.

How it works (Mechanism / physiology)

Biomechanical principle

Sliding hip screw constructs typically include:

• A large lag screw placed through the femoral neck into the femoral head
• A side plate fixed to the lateral femoral shaft with screws
• A barrel (sleeve) in the plate that allows the lag screw to slide (telescope) along its axis

The central concept is dynamic compression: as the patient’s hip is loaded during movement, the lag screw can slide within the barrel, allowing the fracture fragments to settle together. This can increase contact between fracture surfaces in patterns where impaction is beneficial and expected.

This “sliding” is not the same as instability. The plate and screws resist rotation and translation while permitting limited axial telescoping along the screw. How much sliding occurs depends on fracture pattern, reduction quality, bone density, implant design, and postoperative loading.

Relevant hip anatomy

Sliding hip screw fixation primarily involves the proximal femur:

• Femoral head: the ball that articulates with the acetabulum (hip socket)
• Femoral neck: the narrowed segment connecting head to shaft
• Greater and lesser trochanters: bony prominences where muscles attach; common fracture zone in intertrochanteric injuries
• Lateral femoral cortex: the outer side of the femur where the plate is anchored

Although the hip is a joint, the fixation generally stabilizes bone rather than cartilage or ligaments. Surrounding muscles (gluteals, iliopsoas, abductors) influence forces across the fracture and can affect reduction and stability.

Onset, duration, and reversibility

• Onset: Mechanical stabilization is immediate after implantation, but bone healing occurs over weeks to months.
• Duration: The implant is designed to maintain stability throughout healing; longevity depends on fracture healing and patient factors.
• Reversibility: Hardware can sometimes be removed later, but removal is not automatically required and is case-dependent. Decisions vary by clinician and case.

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

Sliding hip screw fixation is a surgical treatment performed in an operating room setting. Specific steps and tools vary by surgeon, hospital protocols, and implant system, but a typical workflow is:

1. Evaluation / exam – History and physical exam focused on injury mechanism, baseline mobility, and medical status
   – Imaging, usually including hip and femur X-rays; additional imaging may be used if needed
   – Fracture classification to guide whether a sliding construct is appropriate

2. Preparation – Preoperative planning for implant sizing, plate configuration, and approach
   – Medical optimization as appropriate (for example, assessing blood counts, hydration, or anticoagulant considerations)
   – Anesthesia planning (regional or general options may be considered depending on patient and setting)

3. Intervention (surgical fixation) – Patient positioning on a fracture or radiolucent table to allow imaging during surgery
   – Fracture reduction, meaning the surgeon aligns the broken bone pieces to restore anatomy as closely as possible
   – Placement of a guide wire and preparation of the channel for the lag screw
   – Insertion of the lag screw into the femoral head in a planned position
   – Attachment of the side plate to the femoral shaft with screws
   – In some constructs, an anti-rotation element or supplemental fixation may be added (varies by clinician and case)

4. Immediate checks – Intraoperative imaging to confirm alignment, implant position, and fracture stability
   – Assessment for limb length and rotation (as feasible in the surgical setting)
   – Wound closure and postoperative imaging per local protocol

5. Follow-up – Monitoring for healing and hardware position on repeat imaging at clinician-directed intervals
   – Rehabilitation planning, including gait training and strengthening, tailored to patient health and fixation stability
   – Ongoing assessment for complications (for example, wound issues, fixation failure, or nonunion), recognizing risk varies by patient and fracture type

This overview is intentionally general and does not replace clinician-specific protocols.

Types / variations

“Sliding hip screw” is often used broadly to describe a family of dynamic hip screw-type constructs. Common variations include:

• Different plate lengths and screw counts

• Plates may have varying numbers of holes to accept different numbers of shaft screws. Selection depends on bone quality, fracture characteristics, and surgeon preference.

• Different barrel angles

• Plates come in different built-in angles to match patient anatomy and desired screw trajectory. Exact options vary by material and manufacturer.

• Lag screw design differences

• Variations in thread design, core diameter, and instrumentation exist across systems. These differences can affect handling and purchase in bone.

• Add-on anti-rotation options

• Some constructs include an additional screw or component intended to reduce rotational movement of the femoral head/neck fragment, especially in certain fracture patterns.

• Trochanteric stabilization adjuncts

• Some systems allow an extra plate or extension to support the lateral wall or trochanteric region when stability is a concern. Use varies by clinician and case.

• Materials

• Common implant materials include stainless steel or titanium alloys. MRI compatibility and artifact depend on material and manufacturer.

In modern practice, Sliding hip screw fixation is often discussed alongside intramedullary (cephalomedullary) nails, which are not “sliding hip screws” but can address overlapping fracture indications.

Pros and cons

Pros:

• Allows controlled fracture impaction in patterns where sliding is desirable
• Widely used and familiar to many orthopedic teams
• Provides stable fixation for many trochanteric fracture types
• Implant position can be checked and adjusted using intraoperative imaging
• Can be combined with adjuncts (anti-rotation, stabilization plates) in select cases
• Generally compatible with structured rehabilitation planning (details vary)

Cons:

• Not ideal for all unstable fracture patterns, where other fixation may better control forces
• Hardware complications can occur (for example, loss of fixation, screw migration, or breakage), with risk influenced by bone quality and fracture type
• Requires surgical exposure along the lateral femur, with typical surgical risks (bleeding, infection, wound problems)
• Outcomes can be affected by reduction quality and implant positioning
• Some patients may experience irritation from hardware or soft-tissue discomfort
• May not address injuries that involve the femoral head blood supply concerns in the same way as other strategies (relevance depends on fracture location)

Aftercare & longevity

Aftercare following Sliding hip screw fixation is typically coordinated among orthopedics, nursing, and rehabilitation clinicians. The specifics vary by clinician and case, but general themes include:

• Weight-bearing and activity progression

• The amount of weight allowed on the operated leg depends on fracture stability, fixation quality, bone health, and overall medical status. Plans differ between patients.

• Rehabilitation and function

• Physical therapy often focuses on safe transfers, walking mechanics, hip and core strength, balance, and fall-risk reduction. The pace of progression depends on pain, confidence, and medical comorbidities.

• Follow-up imaging

• Repeat X-rays are commonly used to track fracture alignment, sliding/impaction behavior, and healing progression. Timing is clinician-directed.

• Healing and implant “longevity”

• The implant is intended to maintain stability until the bone heals. Once healing occurs, hardware may remain in place indefinitely unless symptoms, complications, or future surgeries make removal or revision relevant. Removal decisions vary by clinician and case.

• Factors that can influence outcomes

• Fracture pattern and severity
• Bone density and quality
• Accuracy of fracture reduction and implant positioning
• Smoking status, nutrition, and metabolic health
• Diabetes, vascular disease, kidney disease, and other systemic conditions
• Medications that affect bone metabolism or bleeding risk
• Adherence to follow-up and rehabilitation participation

Because patient circumstances differ widely, recovery experiences can be quite variable.

Alternatives / comparisons

Sliding hip screw constructs are one option among several for managing proximal femur fractures. Comparisons are best made based on fracture classification, patient age, bone quality, and functional goals.

• Nonoperative management (observation/supportive care)

• In select situations, nonoperative care may be considered (for example, patients who cannot tolerate surgery). This approach typically prioritizes comfort and medical stability, and may involve higher risks of prolonged immobility. Decisions are highly individualized.

• Intramedullary fixation (cephalomedullary nail)

• A nail placed inside the femoral canal can provide a different mechanical profile, often favored for certain unstable patterns or those with subtrochanteric extension. Like Sliding hip screw fixation, it relies on correct reduction and implant placement, and each has trade-offs.

• Cannulated screw fixation

• Multiple smaller screws are more commonly associated with certain femoral neck fracture patterns rather than classic intertrochanteric fractures. Suitability depends on fracture location and displacement.

• Arthroplasty (partial or total hip replacement)

• For some fracture types—especially certain displaced femoral neck fractures in older adults—replacement may be considered to address healing risks and allow earlier functional recovery in selected patients. This is a different operation with different complication profiles.

• Plate-and-screw fixed-angle devices

• Some fractures may be treated with fixed-angle plates that do not rely on sliding. These may be chosen when a surgeon wants more rigid control of alignment, depending on the fracture pattern and bone quality.

In practice, the choice is guided by imaging, stability goals, surgeon experience, and patient health status rather than a one-size-fits-all hierarchy.

Sliding hip screw fixation Common questions (FAQ)

Q: Is Sliding hip screw fixation the same as a “dynamic hip screw (DHS)”?
In many settings, yes—“dynamic hip screw” is a commonly used name for a sliding hip screw and side-plate construct. Terminology can vary by region, hospital, and implant manufacturer. Clinicians may use these terms interchangeably, but specific components can differ across systems.

Q: Will I have pain after the surgery?
Postoperative pain is common after any fracture fixation and typically comes from the fracture, soft-tissue healing, and surgical incision. Pain experience varies widely among individuals. Clinicians usually manage pain with a combination of medications and rehabilitation strategies, tailored to the patient.

Q: How long does the hardware last?
The implant is designed to stabilize the bone during healing and can remain in place long-term. Some people never need hardware removal, while others may require additional procedures if complications occur or if another hip surgery becomes necessary. Longevity depends on healing, bone quality, and mechanical demands.

Q: Is Sliding hip screw fixation considered safe?
It is a widely performed orthopedic technique with well-known risks and benefits. As with any surgery, potential complications include infection, blood clots, bleeding, anesthesia-related issues, and fixation failure, among others. Individual risk depends on overall health, fracture type, and perioperative factors.

Q: When can someone walk or put weight on the leg after surgery?
Weight-bearing plans vary by clinician and case, influenced by fracture stability, fixation quality, and patient health. Some patients may be allowed earlier weight-bearing than others, while some may need restrictions. The treating team typically aligns rehabilitation goals with the stability of the repair.

Q: When can someone drive or return to work after Sliding hip screw fixation?
Timing depends on pain control, reaction time, mobility, the operated side, medication use, and job demands. Clinicians often consider whether a person can safely perform emergency braking and basic functional tasks. Return-to-work expectations range widely between desk work and physically demanding roles.

Q: How much does Sliding hip screw fixation cost?
Costs vary substantially by country, hospital system, insurance coverage, implant choice, and whether rehabilitation or additional services are required. Hospital billing often includes surgeon, anesthesia, facility, imaging, and therapy components. For any individual case, accurate estimates typically come from the treating facility and insurer.

Q: Will the metal set off airport detectors?
It may, depending on the sensitivity of the detector and the amount and type of metal. Many people with orthopedic implants travel without major issues, but experiences differ. Documentation policies vary by airport and country.

Q: Can I get an MRI with a sliding hip screw?
Many modern orthopedic implants are MRI-conditional, but the answer depends on the specific material and manufacturer guidance. Even when MRI is allowed, metal can create image artifact near the hip that reduces detail in that area. Imaging teams typically verify implant information before scanning.

Q: Does the screw “sliding” mean the fracture is moving and not healing?
Not necessarily. The sliding mechanism is designed to allow controlled settling that can increase bone contact in certain fracture patterns. However, too much collapse or loss of alignment can be a concern, which is why follow-up imaging is commonly used. Interpretation depends on the fracture type and clinical context.