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

Abstract

<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 <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>

Outcomes of minimally invasive osteosynthesis of intertrochanteric fractures with dynamic hip screw: A prospective case series

“…Still, it is associated with considerable blood loss due to greater soft tissue and muscle dissection in addition to the exposure of the fracture site. 23,30,31 This study evaluated the results of minimally invasive DHS fixation in elderly patients with intertrochanteric fractures and assessed the factors that can affect the functional outcomes. Satisfactory results were obtained in 82.9% of patients.…”

Fraturas intertrocantéricas fixadas com parafuso dinâmico de quadril: Ensaio clínico randomizado comparando a via lateral de Hardinge e o acesso minimamente invasivo

“…The main benefit of the minimally-invasive technique in relation to the traditional surgery is the reduction in opera-tive time and the lower rate of bleeding, but there is no consensus on the superiority of the technique in terms of the the postoperative recovery of the patients. [8][9][10] The main objective of the present study is to analyze intertrochanteric fractures fixed with the DHS system by comparing minimally-invasive plate ostheosynthesis (MIPO) and the traditional Hardinge access route regarding the postoperative pain index. The secondary goal is to assess whether there is a superiority of the former approach in terms of operative time, blood loss indexes, and the degree of active mobility in the immediate postoperative period (IPOP).…”

“…The main benefit of the minimally-invasive technique in relation to the traditional surgery is the reduction in operative time and the lower rate of bleeding, but there is no consensus on the superiority of the technique in terms of the the postoperative recovery of the patients. 8 9 10 …”

“…O principal benefício que a técnica minimamente invasiva traz em relação à cirurgia tradicional é a diminuição do tempo cirúrgico e a menor taxa de sangramento, mas não há um consenso quanto à superioridade dessa técnica em termos da recuperação pós-operatória dos pacientes 8 9 10 …”

Outcomes between Conventional versus Minimal Invasive Dynamic Hip Screw in Fixation of Intertrochanteric Fracture of Femur

“…11,12 A study reported mean surgical duration (53.6±13.6 v/s 77.6±16.19) min, Intra operative blood loss (47.58±23.07 v/s 142.67±57.77) ml and duration of hospital stay (3.2±0.43 v/s 7.7±1.2) days in minimally invasive DHS v/s conventional DHS treated patients respectively. 13 Recently several studies have reported on their application of MIS in DHS fixation for intertrochanteric femoral fracture, but actually there are not well organized, local data of prospective randomized, controlled trials of this combination of techniques. The goal of this study is to provide an efficient and pragmatic surgical technique for surgical decision making to reduce the complications.…”