MIPO technique provides good, though slightly delayed bone healing and decreases incidence of nonunion and need for bone grafting. This technique should be used in distal tibia fractures where locked nailing cannot be done like fractures with small distal metaphyseal fragments, vertical splits, markedly comminuted fractures and in fractures with intra-articular extension.

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Intertrochantric fractures of the proximal femur are one of the most common injuries of the elderly. Prolonged duration and peroperative blood loss in this elderly frail population is one of the major problems in using the DHS. We performed minimally invasive DHS (MIDHS) implantation for such patients and compared results with conventional technique, hypothesising better perioperative outcomes.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">We operated upon 30 cases as the case group from June 2013 to August 2016 with this technique. Patients older than 60 years of age with BMI less than 25 with stable AO type fractures which were easily reducible without sag of the distal fragment were included. In a control group 30 patients who had their hip fracture fixed with a DHS placed through the conventional approach were included. These groups were matched for sex, age, ASA grade and fracture type according to the AO classification. All surgeries were performed within 3 weeks of injury. We studied the patients in terms of time taken for surgery, peroperative blood loss, postoperative pain scores, need for analgesics and improvement in postoperative mobilization and rehabilitation by HHS</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Blood loss, duration of surgery and average pain score were significantly lower (p &lt;0.0001) for MIDHS group due to a smaller incision and less muscle dissection. The HHS was also significantly better at 10 days in the MIDHS group. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Minimally invasive DHS is a simple and effective technique for fixation of intertrochantric fractures, especially in elderly, with reduced operative time, blood loss and postoperative pain scores leading to a more effective postoperative rehabilitation.</span></p><p align="left"> </p>

It was concluded in this study that cyclical loading is a better method of pretensioning in ACL reconstruction than tensioner on tendon board with 15 pounds of tension for 10 minutes.

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