A double-blind, prospective, randomised, controlled clinical trial of minimally invasive dynamic hip screw fixation of intertrochanteric fractures

Wong, T. C.; Chiu, Y.; Tsang, W L; Leung, W. Y.; Yeung, S. H.

doi:10.1016/j.injury.2008.09.029

Cited by 38 publications

(49 citation statements)

References 32 publications

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“…It provides controlled compression at the fracture which further enhances the union rate. Also, the functional status of our patient according to Harris Hip Score system at 6 th and 12 th postoperative month was found to be "Good" which is almost similar to various other studies [33][34][35] .…”

Section: Discussionsupporting

confidence: 88%

Minimal Invasive Dynamic Hip Screw Fixation for Intertrochanteric Fractures of Femur

Kandel

Pathak

Singh

et al. 2016

International Journal of Orthopaedics

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nonunion, implant cut out, joint infection, delayed union and varus deformity was not observed in any of these patients. Moreover, Harris Hip Score showed good functional outcome. CONCLUSION: Fixation of DHS with minimal invasive technique for stable hip fracture has good functional outcome in cost effective way with fewer incidences of complications resulting in great advantage over the conventional method of fixation. INTRODUCTIONHip fractures are leading cause of death and disability among the elderly. Proximal femoral fracture accounts 30% of all hospital admissions with mortality of 15-20% worldwide. Among these, trochanteric fractures are around four times more with female predominance. Treatment goals for these populations include early rehabilitation, restoration of the anatomic alignment of the proximal part of femur and maintenance of fracture reduction [1][2][3][4] . Though resistance augmented Baixauli plates, Medroff plates, trochanteric stabilizing plates, percutaneous compression plates and intra medullary devices are focused on unstable inter-trochantric fracture, it is now almost universally accepted that internal fixation is the best method in which fixation with Dynamic Hip Screw (DHS) is considered as the standard one [5][6][7][8][9] . In the last decade, minimal invasive DHS (MIDHS) technique offered a better outcome compared to conventional approach, while maintaining equal fixation stability. The experimental basis of minimal invasive surgery is based on the fact that nutrient artery gives 2/3 rd of the blood supply to the bone, and 1/3 rd comes from the periosteum inflow [3] . So, this study which was conducted to ascertain the short term

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Section: Discussionsupporting

confidence: 88%

Minimal Invasive Dynamic Hip Screw Fixation for Intertrochanteric Fractures of Femur

Kandel

Pathak

Singh

et al. 2016

International Journal of Orthopaedics

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“…13 Hospital stay was lower in MIDHS but not statistically significant, though it was significantly lower in our study (p<0.0001). HHS at 3 days was statistically higher in MIDHS but not at 3 months.…”

Section: Discussioncontrasting

confidence: 70%

“…12,13 Our study shows that the difference between the two groups in terms of HHS at 10 days was statistically significant (p=0.047), favourable for MIDHS group due to less pain and better wound healing of smaller incisions leading to better mobilization and range of motion. This difference was not statistically significant (p =0.084) at 6 weeks as expected as by this time soft tissue healing is more or less complete also for the conventional group.…”

Section: Discussionmentioning

confidence: 68%

Minimally invasive dynamic hip screw for intertrochanteric fractures: comparison with conventional method and surgical tips

Vidyarthi¹,

Paluvadi

Sinha

2017

Int J Res Orthop

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Background: 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.Methods: 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.Results: Blood loss, duration of surgery and average pain score were significantly lower (p <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. Conclusions: 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.

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“…Existen varios estudios prospectivos aleatorizados comparando ambas técnicas 13,[16][17][18][19][20][21] . Alobaid 13 fue uno de los pioneros en la técnica MIDHS.…”

Section: Discussionunclassified

Técnica DHS mínimamente invasiva: menor tiempo quirúrgico con similares resultados en el postoperatorio inmediato respecto al DHS convencional. Estudio retrospectivo de cohortes

Méndez-Gil

Fernández-Valencia

Plaza-García

et al. 2014

Revista Española de Cirugía Ortopédica y Traumatología

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Cómo citar este artículo: Méndez-Gil A, et al. Técnica DHS mínimamente invasiva: menor tiempo quirúrgico con similares resultados en el postoperatorio inmediato respecto al DHS convencional. ResumenObjetivos: El tratamiento de fracturas pertrocantéreas con clavo DHS (Dynamic Hip Screw) mediante técnica mínimamente invasiva (MIDHS) ha mostrado resultados superiores a la técnica convencional (CDHS) en estudios previos. El presente estudio pretende determinar si existen diferencias en requerimientos transfusionales, morbilidad, estancia hospitalaria y en el coste asociado, a partir de un análisis retrospectivo de 2 cohortes. Material y método: Estudio de cohortes en 80 pacientes con fracturas intertrocantéreas de fémur (31-A1 y 31-A2.1) tratados con implante DHS entre julio de 2005 y septiembre de 2007: 40 de ellos con la técnica convencional y 40 de ellos con técnica MIDHS. Resultados: No se observaron diferencias estadísticamente significativas ni en la pérdida sanguínea, ni en requerimientos transfusionales, ni en morbilidad. La estancia hospitalaria en el grupo MIDHS fue 1,3 días menor, con un coste directo de 306,3 D por caso, inferior al grupo CDHS, aunque sin significación estadística (p = 0,3). La duración de la intervención fue menor en el grupo MIDHS: 49,3 versus 78,8 min (p = 0,0001). Discusión: Contrariamente a lo publicado en estudios previos, en el presente estudio la técnica MIDHS no ha mostrado ventajas excepto por requerir un menor tiempo para realizar la técnica. Consideramos que la técnica MIDHS podría ayudar en mejorar la productividad y eficiencia en el uso de quirófanos. © 2013 SECOT. Publicado por Elsevier España, S.L. Todos los derechos reservados. * Autor para correspondencia.

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A double-blind, prospective, randomised, controlled clinical trial of minimally invasive dynamic hip screw fixation of intertrochanteric fractures

Cited by 38 publications

References 32 publications

Minimal Invasive Dynamic Hip Screw Fixation for Intertrochanteric Fractures of Femur

Minimal Invasive Dynamic Hip Screw Fixation for Intertrochanteric Fractures of Femur

Minimally invasive dynamic hip screw for intertrochanteric fractures: comparison with conventional method and surgical tips

Técnica DHS mínimamente invasiva: menor tiempo quirúrgico con similares resultados en el postoperatorio inmediato respecto al DHS convencional. Estudio retrospectivo de cohortes

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