gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

24.10. - 27.10.2017, Berlin

Comparison of the Outcome Between Conventional Open Technique and Minimally Invasive Technique Using Dynamic Hip Screw Fixation for Inter-Trochanteric Fracture of Femur

Meeting Abstract

  • presenting/speaker Rajiv Maharjan - BP Koirala Institute of Health Sciences, Dharan, Nepal
  • Bikram Prasad Shrestha - BP Koirala Institute of Health Sciences, Dharan, Nepal
  • Guru Prasad Khanal - BP Koirala Institute of Health Sciences, Dharan, Nepal
  • Pashupati Chaudhary - BP Koirala Institute of Health Sciences, Dharan, Nepal
  • Raju Rijal - BP Koirala Institute of Health Sciences, Dharan, Nepal

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocIN36-1462

doi: 10.3205/17dkou095, urn:nbn:de:0183-17dkou0954

Veröffentlicht: 23. Oktober 2017

© 2017 Maharjan et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Rigid fixation and early mobilization using standard dynamic hip screw (DHS) should be considered as the standard treatment for intertrochanteric fractures. The potential drawbacks of conventional technique of DHS are large skin incision with considerable soft-tissue dissection, blood loss, pain and delayed rehabilitation. Minimally invasive surgery (MIS) has the theoretical advantages of decreased blood loss, better cosmetic results, less pain and faster rehabilitation. We conducted this randomized trial to compare the safety profile and functional outcome of a mini-incision technique versus conventional open technique for fixation of intertrochanteric fractures using a DHS device.

Methods: 60 prospective patients (skeletally mature) with closed traumatic isolated intertrochanteric femur fractures (AO/OTA 31-A1, A2) which had acceptable reduction before fixation by closed manipulation under image intensifier were randomized into conventional DHS group (n=30, fixed by conventional open technique) or minimal invasive DHS group (n=30, fixed by minimal incision technique) using same standard dynamic hip screw (DHS) device, approach with similar type and regime of standard prophylactic antibiotics. Patients with previous ipsilateral hip fracture or surgery, congenitally deformed or abnormally bowed femur were excluded. Ethical approval was obtained from Institutional Review Committee (IRC).Peri-operative parameters were noted as per pro-forma and similar protocol of physiotherapy was started for each patient. The patients were assessed at immediate post-operative period then at 2, 6, 12, 24 and 52 weeks post operative period.

Results and Conclusion: Mean age, gender distribution, mode of injury, fracture classification, side involved and injury-surgery interval were symmetrically distributed among the two groups (p>0.05) and hence randomization was successful. The duration of surgery, blood loss/transfusion requirement and post-operative pain (VAS score), surgical site infection were lesser for minimal incision group (p>0.05). The hospital stay, ambulatory status and time to union were comparable for both the groups. At the final follow up, complications like loss of reduction, malunion and implant failure were not significantly different among the groups (p>0.05). The functional status was assessed by modified Harris Hip score and the average score was greater for mini DHS group but not significant (p>0.05).

Min-incision DHS fixation for inter-trochanteric femur fracture has advantages like shorter duration of surgery, less blood loss and less post-operative pain in comparison to conventional open technique but the long term functional outcome is not significantly different from conventional open technique.