Background. Intertrochanteric fractures of the proximal femur are one of the most common fractures encountered, and dynamic hip screw with a side plate is the standard treatment. We compared a minimally invasive surgical technique with the conventional surgical technique used in the fixation of intertrochanteric fractures with the dynamic hip screw (DHS) device. Methods. Thirty patients with such fractures were treated with the conventional open technique and 30 with a new minimally invasive technique. Patients in both groups were followed up for 1 year. Results. There was less blood loss, minimal soft tissue destruction, shorter hospital stay, and early mobilization with the minimally invasive technique. Conclusion. The present study finds minimally invasive technique superior to conventional (open) DHS. 1. Introduction Hip fractures are among the most common fractures encountered in orthopaedic trauma. Now they need more attention because as the average life expectancy, elderly population, and subsequent resulting osteoporosis continue to increase, orthopaedic surgeons will get more such cases [1–4]. Intertrochanteric fractures in the elderly are associated with high rates of mortality, ranging from 15 to 20%, as they are at a high risk for deep vein thrombosis (DVT), urinary tract infections, and pulmonary embolism if they fail to mobilize or ambulate early [5]. Surgical stabilization fulfills the aim of early mobilization and facilitates union in an anatomical position. Due to this, operative stabilization of these fractures is now the gold standard treatment. Although other options are available, the standard approach is to use a dynamic hip screw (DHS) with a 4-holed side plate in stable fractures in most centers [6–8]. DHS was historically introduced in 1950s to replace the standard fixed nail plate [4]. Traditionally a wide surgical exposure is necessary for this procedure which comes with its drawbacks like a large skin incision, considerable soft tissue trauma, significant blood loss, and pain. To avoid these problems minimally invasive surgery has been advocated recently [3, 4, 7, 9]. It has theoretical advantages of decreased blood loss, better cosmesis, less pain, and rapid rehabilitation. We conducted a prospective comparative study of conventional (open) DHS and minimally invasive DHS at our center to test the utility of this new approach. 2. Methods This study was carried out in the Department of Orthopaedic Surgery, Sohar Hospital, Oman, between 2008 and 2011. A total of 60 patients with intertrochanteric femoral fractures were selected
References
[1]
A. K. Mishra, “Management of intertrochantric fracture by using dynamic hip screw/dynamic martin screw,” Journal of Orthopaedics, vol. 4, no. 2, article e40, 2007.
[2]
D. G. LaVelle, “Fractures of hip,” in Campbell's Operative Orthopaedics, vol. 1, pp. 28–75, Mosby, 2003.
[3]
A. Alobaid, E. J. Harvey, G. M. Elder, P. Lander, P. Guy, and R. Reindl, “Minimally invasive dynamic hip screw. Prospective randomized trial of two techniques of insertion of a standard dynamic fixation device,” Journal of Orthopaedic Trauma, vol. 18, no. 4, pp. 207–212, 2004.
[4]
T.-C. Wong, Y. Chiu, W.-L. Tsang, W.-Y. Leung, and S.-H. Yeung, “A double-blind, prospective, randomised, controlled clinical trial of minimally invasive dynamic hip screw fixation of intertrochanteric fractures,” Injury, vol. 40, no. 4, pp. 422–427, 2009.
[5]
R. Watson-Jones, Fracture Treatment, vol. 29, 7th edition, 2009.
[6]
B. R. Bolhofner, P. R. Russo, and B. Carmen, “Results of intertrochanteric femur fractures treated with a 135-degree sliding screw with a two-hole side plate,” Journal of Orthopaedic Trauma, vol. 13, no. 1, pp. 5–8, 1999.
[7]
Y.-S. Lee, H.-L. Huang, T.-Y. Lo, and C.-R. Huang, “Dynamic hip screw in the treatment of intertrochanteric fractures: a comparison of two fixation methods,” International Orthopaedics, vol. 31, no. 5, pp. 683–688, 2007.
[8]
A. R. Lyons, “Clinical outcomes and treatment of hip fractures,” American Journal of Medicine, vol. 103, no. 2A, pp. 51S–63S, 1997.
[9]
J.-P. Wang, T.-F. Yang, Q.-Q. Kong et al., “Minimally invasive technique versus conventional technique of dynamic hip screws for intertrochanteric femoral fractures,” Archives of Orthopaedic and Trauma Surgery, vol. 130, no. 5, pp. 613–620, 2010.
[10]
H. W. Jones, P. Johnston, and M. Parker, “Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures,” International Orthopaedics, vol. 30, no. 2, pp. 69–78, 2006.
[11]
M. R. Shah, G. B. Aharonoff, P. Wolinsky, J. D. Zuckerman, and K. J. Koval, “Outcome after hip fracture in individuals ninety years of age and older,” Journal of Orthopaedic Trauma, vol. 15, no. 1, pp. 34–39, 2001.
[12]
M. Ho, G. Garau, G. Walley et al., “Minimally invasive dynamic hip screw for fixation of hip fractures,” International Orthopaedics, vol. 33, no. 2, pp. 555–560, 2009.
[13]
Z. Zhou, X. Zhang, S. Tian, and Y. Wu, “Minimally invasive versus conventional dynamic hip screw for the treatment of intertrochanteric fractures in older patients,” Orthopedics, vol. 35, no. 2, pp. e244–e249, 2012.
[14]
F. D. Prete, T. Nizegorodcew, and P. Regazzoni, “Quantification of surgical trauma: comparison of conventional and minimally invasive surgical techniques for pertrochanteric fracture surgery based on markers of inflammation (interleukins),” Journal of Orthopaedics and Traumatology, vol. 13, no. 3, pp. 125–130, 2012.
[15]
A. Laohapoonrungsee, O. Arpornchayanon, and C. Phornputkul, “Two-hole side-plate DHS in the treatment of intertrochanteric fracture: results and complications,” Injury, vol. 36, no. 11, pp. 1355–1360, 2005.
[16]
M. H. Verhofstad and C. Werken, “DHS osteosynthesis for stable pertrochanteric femur fractures with a two-hole side plate,” Injury, vol. 35, no. 10, pp. 999–1002, 2004.
[17]
S. W. McLoughlin, D. L. Wheeler, J. Rider, and B. Bolhofner, “Biomechanical evaluation of the dynamic hip screw with two- and four-hole side plates,” Journal of Orthopaedic Trauma, vol. 14, no. 5, pp. 318–323, 2000.
