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

Posted on February 27, 2026 | by drhip

Dynamic hip screw fixation Introduction (What it is)

Dynamic hip screw fixation is a surgical method used to stabilize certain hip and upper femur (thigh bone) fractures.
It uses a large screw placed into the femoral head connected to a side plate on the femur.
It is commonly used for many intertrochanteric hip fractures (breaks just below the femoral neck).

Why Dynamic hip screw fixation used (Purpose / benefits)

Dynamic hip screw fixation is designed to hold broken bone segments in a stable position while the body heals the fracture. In plain terms, it “splints” the broken upper femur from the inside using metal hardware.

A key goal is to allow controlled compression at the fracture site. As a person begins rehabilitation and the fracture settles, the screw can slide slightly within the plate barrel. This controlled “sliding” can help the bone ends stay in contact, which is generally favorable for healing in many fracture patterns.

Clinicians may choose this construct because it can:

Provide strong fixation in appropriate fracture types.
Maintain alignment while allowing limited, controlled fracture impaction (collapse) that can promote stability.
Support earlier mobilization compared with prolonged immobilization in selected cases (timing and weight-bearing vary by clinician and case).
Use widely available implants with well-established surgical principles (exact design varies by material and manufacturer).

The problem it aims to solve is mechanical instability after a fracture—painful movement at the break and the risk that the bone heals in a poor position or does not heal as intended.

Indications (When orthopedic clinicians use it)

Dynamic hip screw fixation is typically considered in scenarios such as:

Intertrochanteric femur fractures that are judged suitable for a sliding hip screw construct
Stable fracture patterns where controlled collapse is acceptable and expected
Fractures where a side plate and lag screw can achieve reliable purchase in the femoral head
Some basicervical fracture patterns (near the base of the femoral neck), depending on stability and surgeon preference
Situations where imaging and intraoperative assessment suggest the fracture can be reduced (realigned) and held with this device

Specific indications vary by clinician and case, including fracture geometry, bone quality, and patient factors.

Contraindications / when it’s NOT ideal

Dynamic hip screw fixation may be less suitable, or another approach may be preferred, in situations such as:

Certain unstable intertrochanteric patterns, where the fracture line configuration may not be well controlled by a sliding side-plate construct
Reverse obliquity or fracture patterns with a tendency for the femoral shaft to shift medially (often considered for intramedullary fixation instead)
Subtrochanteric fractures (below the lesser trochanter), which commonly require different fixation strategies
Displaced intracapsular femoral neck fractures, where arthroplasty (hip replacement) or different fixation methods are often considered (choice varies by clinician and case)
Severe comminution (multiple fragments) or compromised lateral cortical support, which can affect stability
Active infection near the surgical site or systemic infection not controlled (timing and approach vary by case)
Medical or functional situations where a patient may not be able to tolerate surgery or anesthesia (management varies by clinician and case)

How it works (Mechanism / physiology)

Biomechanical principle: controlled sliding and compression

Dynamic hip screw fixation is commonly described as a sliding hip screw system. The central concept is that the large screw in the femoral head (often called a lag screw) can slide within a barrel attached to a side plate fixed on the femoral shaft. Under load during rehabilitation, the construct can allow limited telescoping. This can create compression across the fracture, helping stabilize the bone ends against each other.

This “dynamic” behavior is the defining feature: the implant is designed to permit controlled movement at the implant interface rather than rigidly locking the fracture length in all cases. How much sliding occurs depends on fracture pattern, reduction quality, and patient loading, and it varies by clinician and case.

Relevant hip and femur anatomy

Understanding the location helps make sense of why this implant is used:

The femoral head is the “ball” of the hip joint.
The femoral neck connects the head to the shaft.
The greater and lesser trochanters are bony prominences where muscles attach.
The intertrochanteric region is between the trochanters—this is a common fracture zone in older adults after a fall, but it can occur in other settings as well.

Dynamic hip screw fixation primarily stabilizes fractures in the upper femur outside the hip joint capsule (commonly intertrochanteric). That matters because blood supply concerns and healing behavior differ between intracapsular (femoral neck) and extracapsular (intertrochanteric) fractures.

Onset, duration, and reversibility

Onset: Mechanical stabilization begins immediately after the implant is placed and confirmed.
Duration: The hardware is intended to remain in place long term, though removal may be considered in select situations (for example, symptomatic hardware), and this varies by clinician and case.
Reversibility: The fixation is not “reversible” in the way a medication is; it is a structural implant. Revision, removal, or conversion to another procedure may be considered if complications occur.

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

Below is a high-level, typical workflow. Exact steps and instruments vary by surgeon, hospital, and implant system.

Evaluation / exam – History of the injury, pain location, and function – Physical exam focusing on leg position, swelling, and neurovascular status – Imaging, commonly X-rays; CT or other studies may be used in selected cases (varies by clinician and case)
Preparation – Preoperative planning using imaging to understand fracture pattern – Medical optimization and anesthesia planning – Positioning to allow fracture reduction and imaging during surgery
Intervention – Fracture reduction: the surgeon realigns the fracture (often using traction and positioning) – Placement of a guidewire into the femoral head under imaging guidance – Preparation of the bone channel and insertion of the lag screw – Attachment of the side plate to the femoral shaft with multiple screws – In some cases, an additional anti-rotation (derotation) screw may be used depending on the system and fracture characteristics
Immediate checks – Intraoperative imaging to confirm implant position, alignment, and screw placement – Wound closure and sterile dressing
Follow-up – Postoperative imaging at intervals to assess healing and implant position – Rehabilitation planning (mobility aids, strengthening, gait training), tailored to the individual and surgeon’s protocol – Monitoring for pain control, wound healing, and complications

This overview is informational; details like incision size, specific measurements, and weight-bearing instructions are individualized.

Types / variations

Dynamic hip screw fixation is a concept implemented through different implant configurations and surgical preferences. Common variations include:

Barrel/plate angle options: Plates come in different angles to match femoral anatomy and fracture requirements (varies by manufacturer).
Plate length: Shorter or longer side plates may be chosen based on fracture extension and bone quality.
Lag screw design differences: Thread geometry, materials, and instrumentation differ by system (varies by material and manufacturer).
With or without an anti-rotation screw: Some surgeons add a second screw to reduce rotation of the femoral head/neck fragment in selected patterns.
Standard DHS vs alternative sliding devices: Some systems use a helical blade concept rather than a traditional lag screw (more commonly associated with certain intramedullary devices, but design families vary).
Augmentation options: In specific situations, surgeons may consider adjuncts to improve purchase in bone (use and type vary by clinician, case, and local practice).

Clinicians choose among these options based on fracture stability, patient anatomy, bone quality, and experience with specific systems.

Pros and cons

Pros:

Allows controlled fracture compression through sliding mechanics in appropriate patterns
Generally familiar technique in orthopedic trauma practice (training and local preference vary)
Can provide stable fixation for many extracapsular proximal femur fractures
Uses modular components (plate, barrel, lag screw) with multiple sizing options
Enables radiographic verification of alignment and implant position during placement
Can be compatible with structured rehabilitation plans (details vary by clinician and case)

Cons:

Not ideal for certain unstable fracture patterns, where different fixation may better control deformation
Implant position is critical; suboptimal placement can affect stability and outcomes
The “dynamic” sliding can lead to shortening/impaction, which may affect leg mechanics depending on degree and case
Risks common to orthopedic implants and fracture surgery (infection, blood clots, anesthesia risks) still apply
Hardware-related issues can occur, such as screw cut-out, breakage, or irritation (risk varies by case)
May require reoperation in some situations (rates vary widely by fracture type, patient factors, and surgical technique)

Aftercare & longevity

Aftercare following Dynamic hip screw fixation usually focuses on protecting the healing fracture while restoring mobility and function. What “aftercare” looks like can differ substantially based on fracture stability, bone quality, and surgeon preference.

Factors that commonly influence outcomes and longevity include:

Fracture pattern and stability: Stable intertrochanteric fractures often behave differently than unstable or highly comminuted fractures.
Quality of reduction (realignment): Better alignment can improve how loads pass through bone and implant.
Implant placement: Position of the lag screw within the femoral head and overall construct alignment are commonly emphasized in orthopedic practice.
Bone quality: Osteoporosis or poor bone stock can affect screw purchase and the risk of fixation failure.
Rehabilitation participation: Physical therapy, gait training, and progressive strengthening may influence function and confidence; exact timelines vary by clinician and case.
Weight-bearing status: Some patients are allowed earlier weight-bearing, while others require restrictions. This decision is individualized.
Comorbidities: Diabetes, smoking status, nutrition, kidney disease, and other health factors can influence healing capacity and complication risk.
Follow-up schedule and imaging: Periodic assessment helps monitor healing and detect problems early.

In many cases, the hardware is intended to remain in place. If the fracture heals and the implant is not causing symptoms, it may never need to be removed. When pain, prominence, or complications occur, next steps vary by clinician and case.

Alternatives / comparisons

Dynamic hip screw fixation is one of several ways to manage proximal femur fractures. The most appropriate choice depends on fracture type, patient factors, and surgeon judgment.

Common alternatives include:

Nonoperative management (observation/monitoring): Sometimes considered when surgery is not feasible due to medical risk or patient goals of care. This approach may involve pain control, positioning, and supportive care, but it can carry its own risks related to immobility.
Intramedullary nailing (cephalomedullary nail): A rod placed inside the femoral canal with a screw/blade into the femoral head. It is often considered for certain unstable intertrochanteric patterns or subtrochanteric extension, but selection varies by clinician and case.
Cannulated screws (multiple screws): More commonly used for selected femoral neck fractures rather than typical intertrochanteric fractures. Stability needs and blood supply considerations differ across these fracture types.
Arthroplasty (partial or total hip replacement): Often considered for displaced femoral neck fractures in older adults, or when fixation is less likely to succeed. It replaces part or all of the joint rather than fixing the fracture with plates/screws.
Other plate constructs: Some fractures may be treated with alternative plating systems depending on anatomy and fracture characteristics.

High-level comparison: Dynamic hip screw fixation is commonly chosen when a sliding compression construct fits the fracture mechanics. Intramedullary nails may be favored when internal leverage and control of unstable patterns is a priority. Arthroplasty is a different category—focused on replacing the joint—used when fixation is less suitable or when joint-related issues dominate decision-making.

Dynamic hip screw fixation Common questions (FAQ)

Q: Is Dynamic hip screw fixation the same as a “hip replacement”?
No. Dynamic hip screw fixation is a fracture fixation method that stabilizes the patient’s own bone so it can heal. A hip replacement (arthroplasty) removes and replaces part or all of the joint surfaces. Which approach is used depends largely on fracture type and patient factors.

Q: Will the surgery be painful?
Pain is expected after any fracture and operation, especially in the early period. Hospitals use multimodal pain strategies that may include medications and physical therapy approaches, tailored to the individual. Pain experience varies widely by person and by fracture severity.

Q: How long does the hardware last?
The implant is generally designed to remain in place long term. If healing occurs and the hardware is not causing symptoms, it may stay indefinitely. Removal or revision is considered only in selected situations and varies by clinician and case.

Q: When can someone walk or put weight on the leg?
Weight-bearing and walking timelines depend on fracture stability, implant fixation, bone quality, and the surgeon’s protocol. Some patients are allowed earlier weight-bearing with support, while others need restrictions. This decision is individualized and reassessed during follow-up.

Q: How long does recovery take after Dynamic hip screw fixation?
Recovery is usually described in phases: early mobility and wound healing, then progressive strengthening and function. Many people improve over weeks to months, but the trajectory varies by age, baseline function, complications, and rehabilitation access. Follow-up imaging is commonly used to confirm healing progress.

Q: What are the main risks or complications?
Risks include general surgical risks (infection, bleeding, blood clots, anesthesia-related issues) and fixation-specific issues (loss of fixation, screw cut-out, malalignment, limb shortening from impaction, or need for reoperation). Not everyone experiences complications, and risk varies by clinician and case. Patients are typically monitored for warning signs during follow-up.

Q: Will I set off metal detectors or need an implant card?
Some people report triggering detectors, while many do not. Implant cards and documentation practices vary by hospital and manufacturer. If documentation is needed, it is often available through surgical records rather than required for daily life.

Q: How much does Dynamic hip screw fixation cost?
Costs vary widely based on country, hospital setting, insurance coverage, implant system, length of stay, and rehabilitation needs. It is usually more helpful to think in terms of categories (hospital fees, surgeon/anesthesia fees, implant costs, imaging, therapy) than a single number. A billing office can typically explain how estimates are structured.

Q: When can someone drive or return to work?
Driving and work timelines depend on pain control, mobility, ability to safely operate a vehicle, side of surgery, job demands, and local regulations. Sedating pain medications can also affect safety. Clinicians typically individualize guidance based on function and healing progress.

Q: Does the “dynamic” sliding mean the bone is not fixed tightly?
The construct is intended to be stable while allowing controlled compression across the fracture as healing progresses. That sliding is a designed feature, not necessarily a sign of failure. The amount and direction of collapse that is acceptable depends on the fracture pattern and clinical context, which varies by clinician and case.