DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20172090

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

Kandarp Vidyarthi, Siddhartha Venkata Paluvadi, Abhinav Sinha

Abstract


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.

 


Keywords


Intertrochanteric fracture, DHS, MIDHS, Stable fracture, BMI

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References


Sterling R. Gender and Race/Ethnicity Differences in Hip Fracture Incidence, Morbidity, Mortality, and Function. Clin Orthop Related Res. 2010;469(7):1913-8.

Riggs B, Melton L. The worldwide problem of osteoporosis: Insights afforded by epidemiology. Bone. 1995;17(5):505-11.

Kannus P, Parkkari J, Sievänen H, Heinonen A, Vuori I, Järvinen M. Epidemiology of hip fractures. Bone. 1996;18(1):57-63.

Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hipfractures in adults. Cochrane Database Syst Rev. 2008;16:CD000093.

Saudan M, Lübbeke A, Sadowski C, Riand N, Stern R, Hoffmeyer P. Pertrochanteric Fractures: Is There an Advantage to an Intramedullary Nail? J Orthop Trauma. 2002;16(6):386-93.

Bolhofner B, Russo P, Carmen B. Results of Intertrochanteric Femur Fractures Treated With a 135-Degree Sliding Screw With a Two-Hole Side Plate. J Orthop Trauma. 1999;13(1):5-8.

Shah M, Aharonoff G, Wolinsky P, Zuckerman J, Koval K. Outcome After Hip Fracture in Individuals Ninety Years of Age and Older. J Orthop Trauma. 2003;17(8):6-11.

Lee Y, Huang H, Lo T, Huang C. Dynamic hip screw in the treatment of intertrochanteric fractures: a comparison of two fixation methods. Int Orthop. 2006;31(5):683-8.

McLoughlin S, Wheeler D, Rider J, Bolhofner B. Biomechanical Evaluation of the Dynamic Hip Screw With Two- and Four-Hole Side Plates. J Orthop Trauma. 2000;14(5):318-23.

Laohapoonrungsee A, Arpornchayanon O, Phornputkul C. Two-hole side-plate DHS in the treatment of intertrochanteric fracture: Results and complications. Injury. 2005;36(11):1355-60.

Verhofstad M, Werken C. DHS osteosynthesis for stable pertrochanteric femur fractures with a two-hole side plate. Injury. 2004;35(10):999-1002.

Ho M, Garau G, Walley G, Oliva F, Panni A, Longo U et al. Minimally invasive dynamic hip screw for fixation of hip fractures. Int Orthop. 2008;33(2):555-60.

Wong T, Chiu Y, Tsang W, Leung W, Yeung S. A double-blind, prospective, randomised, controlled clinical trial of minimally invasive dynamic hip screw fixation of intertrochanteric fractures. Injury. 2009;40(4):422-7.

Alobaid A, Harvey E, Elder G, Lander P, Guy P, Reindl R. Minimally Invasive Dynamic Hip Screw. J Orthop Trauma. 2004;18(4):207-12.

DiPaola M, Rozbruch SR, Helfet DL. Minimal incision technique using a two hole plate for fixation of stable intertrochanteric hip fractures. Orthopedics. 2004;27:270–4.

Gotfried Y. Percutaneous Compression Plating of Intertrochanteric Hip Fractures. Journal of Orthopaedic Trauma. 2000;14(7):490-495.

Pajarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo E. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. A randomised study comparing post-operative rehabilitation. J Bone Joint Surg Br. 2005;87:76–81.

Ekstrom W, Karlsson-Thur C, Larsson S, Ragnarsson B, Alberts K. Functional Outcome in Treatment of Unstable Trochanteric and Subtrochanteric Fractures With the Proximal Femoral Nail and the Medoff Sliding Plate. J Orthop Trauma. 2007;21(1):18-25.

Gadegone W, Salphale Y. Proximal femoral nail – an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year. Int Orthop. 2006;31(3):403-8.

Menezes D, Gamulin A, Noesberger B. Is the Proximal Femoral Nail a Suitable Implant for Treatment of All Trochanteric Fractures? Clin Orthop Related Res. 2005;439:221-7.

Simmermacher R, Bosch A, Van der Werken C. The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures. Injury. 1999;30(5):327-32.

Song W, Chen Y, Shen H, Yuan T, Zhang C, Zeng B. Biochemical Markers Comparison of Dynamic Hip Screw and Gamma Nail Implants in the Treatment of Stable Intertrochanteric Fracture: A Prospective Study of 60 Patients. J Int Med Res. 2011;39(3):822-9.