1	DHS method in treatment of the fracture of proximal end of femur
2	Introduction Fractures of the proximal femur a serious medical and social problem. Most fractures occur in elderly patients, usually in association with osteoporosis and as a result of only minimal or moderate trauma. Reported mortality with these fractures ranges from 15-20% Hip fractures account for 30%of all hospitalized patients in the USA.
3	Classification All fractures from the extra capsular part of the neck to a point 5 cm distal to the lesser trochanter There are numerous classifications: Boyd and Griffin, Evans, ASIF classification. From practical point those fractures are divided in trochanteric and subtrochnteric fractures. According to the ASIF classification three groups of trochanteric fractures can be distinguished, depending on whether the medial cortex shows an intact lesser trochanter-single or several fractures or fractures of both cortices. Stable and unstable trochanteric fractures.
4	Material and Methods We have analyzed 195 patients, treated in our hospital. 72% where female, 28 male. Average age of 65 years. Treatment: closed (skeletal traction) and open (internal fixation) Disadvantages of closed reduction: relatively high mortality, the function of the extremity, particularly motion in the knee regained slowly.
5	Internal Fixation The goal of surgical treatment is strong stable fixation of the fractured fragment. Kaufer,Mattheus and Sonstegard have listed the following variables that determine the strength of the fracture fragment assembly:
6	Kaufer,Mattheus and Sonstegard. Bone quality, fragment geometry, reduction, implant design implant placement. The surgeon has in his control only the quality of reduction implant choice and placement. Stable fractures-treatment successful with any type of implant. Unstable fractures-frequent complications with a fixed-angle implant (non sliding) combined with a valgus osteotomy. DHS sliding implant-method of choice in unstable fractures.
7
8
9
10
11
12
13
14
15
16
17	Conclusion DHS allows not only stable fixation of anatomically reduced trochanteric fractures but also a guided collapse and impaction of the fragments in the unstable fracture. The implant will therefore slide distally and laterally until a new area of bony support is reached. The fracture will usually unite in spite of some shortening of leg but significant functional disabilities due to this are rare.