Use of Tranexamic Acid in Dynamic Hip Screw Plate Fixation for Trochanteric Fractures

Purpose To evaluate perioperative blood loss and blood transfusion requirement in patients who underwent dynamic hip screw plate fixation for a stable trochanteric fracture with or without preoperative intravenous tranexamic acid (TXA). Methods 49 men and 11 women (mean age, 56.5 years) who underwent open reduction and internal fixation with a dynamic hip screw plate for a stable trochanteric fracture by a single surgeon were equally randomised to receive either a single dose of intravenous TXA (15 mg/kg) 15 minutes prior to surgery or an equal volume of normal saline by slow infusion. Intra- and post-operative blood loss and the need for blood transfusion were assessed, as was any thromboembolic adverse event. Results The TXA and control groups were comparable in terms of age, gender, body mass index, blood pressure, pulse rate, time from injury to surgery, operating time, and preoperative haematological data. Blood loss was lower in the TXA than control group intraoperatively (320.3 vs. 403.33 ml, p<0.001), during 0 to 24 hours (61.67 vs. 186.67 ml, p<0.001), and during 24 to 48 hours (27 vs. 86.67 ml, p<0.001), as well as the total volume (408.97 vs. 676.67 ml, p<0.001). Respectively for the TXA and control groups, 27 and 30 required 28 and 41 units of blood intra-operatively (p<0.001), and 6 and 15 required 6 and 15 units of blood postoperatively (p=0.014). No patient had any thromboembolic adverse event. Conclusion TXA is safe and effective in reducing blood loss in dynamic hip screw plate fixation for stable trochanteric fractures.

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Design and biomechanical study of slide-poking external fixator for hip fracture

Journal of International Medical Research ◽

10.1177/0300060520950934 ◽

2020 ◽

Vol 48 (12) ◽

pp. 030006052095093

Author(s):

Hua-Biao Chen ◽

Hong-Bo Wu ◽

Min Chen ◽

Yu-Liang Huang

Keyword(s):

Hip Fracture ◽

Femoral Head ◽

Hip Fractures ◽

External Fixator ◽

Dynamic Hip Screw ◽

Control Groups ◽

Vertical Loading ◽

Hip Screw ◽

The Mean ◽

And Control

Background Femoral head collapse and coxa vara lead to internal fixator failure in elderly patients with hip fracture. External fixator application is an optimal choice; however, the existing methods have many disadvantages. Methods Type 31-A1.3 hip fracture models were developed in nine pairs of 1-year-old fresh bovine corpse femur specimens. Each left femur specimen was fixed by a dynamic hip screw (control group), and each right femur specimen was fixed by the slide-poking external fixator (experimental group). Vertical loading and torsion tests were then performed in both groups. Results In the vertical loading experiment, a 1000-N load was implemented. The mean vertical downward displacement of the femoral head in the experimental and control groups was 1.49322 ± 0.116280 and 2.13656 ± 0.166374 mm, respectively. In the torsion experiment, when the torsion was increased to 10.0 Nm, the mean torsion angle in the experimental and control groups was 7.9733° ± 1.65704° and 15.4889° ± 0.73228°, respectively. The slide-poking external fixator was significantly more resistant to compression and rotation than the dynamic hip screw. Conclusion The slide-poking external fixator for hip fractures that was designed and developed in this study can provide sufficient stability to resist compression and rotation in hip fractures.

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

Journal of BP Koirala Institute of Health Sciences ◽

10.3126/jbpkihs.v1i2.22073 ◽

2018 ◽

Vol 1 (2) ◽

pp. 7-20

Author(s):

Rajiv Maharjan ◽

S.R. Paneru ◽

R. Rijal ◽

P. Chaudhary ◽

G.P. Khanal

Keyword(s):

Blood Loss ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Invasive Technique ◽

Open Technique ◽

Minimal Incision ◽

Hip Screw ◽

Incision Technique ◽

Operative Recovery

Background: Inter-trochanteric fracture of femur causes significant morbidity and mortality in elderly. Dynamic Hip Screw (DHS) fixation is the most effective and safe method of treatment. Conventional open technique (CDHS) is the popular and familiar one; however, minimal incision technique (MIDHS) has many advantages like: smaller incision, lesser dissection/blood loss, less requirement of transfusion, less painful, faster recovery etc. Objectives: To Compare CDHS and MIDHS technique of DHS fixation for inter-trochanteric fracture femur in terms of functional outcome, safety and associated complications (if any). Methods: Eligible patients presenting within study period were randomized into CDHS group (n= 33) and MIDHS group (n= 32). Success of randomization was tested by analyzing demographics, injury characteristics and pre-op. clinical data (p> 0.05). They were followed up at 2, 6, 12, 24 and 52 weeks post-op. for clinico-radiological and functional assessment. Results: The duration of surgery, lag screw positioning, post-operative hospital stay and surgical site infection were not significantly different between the groups. However, need for blood transfusion, length of incision and post-operative VAS score for pain were significantly lesser for MIDHS group than CDHS group (p< 0.05). Patients in MIDHS group started walking with aids significantly earlier in post-operative recovery period. The Harris Hip Score at final follow-up and grading of the results and surgical complications were not significantly different between the groups. Conclusion: The minimal incision technique had various immediate / short term advantages over conventional technique; like: minimal scar, minimal soft tissue dissection / less blood loss requiring less transfusion, lesser pain in post-operative period and ability to ambulate early.

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Blood loss in trochanteric fractures: multivariate analysis comparing dynamic hip screw and Gamma nail

Injury ◽

10.1016/s0020-1383(17)30657-5 ◽

2017 ◽

Vol 48 ◽

pp. S44-S47 ◽

Cited By ~ 5

Author(s):

Mario Ronga ◽

Daniele Bonzini ◽

Marco Valoroso ◽

Giuseppe La Barbera ◽

Jacopo Tamini ◽

...

Keyword(s):

Multivariate Analysis ◽

Blood Loss ◽

Gamma Nail ◽

Dynamic Hip Screw ◽

Trochanteric Fractures ◽

Hip Screw

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A Novel Method of Management of Unstable Trochanteric Fractures - A Retrospective Study in a Tertiary Care Hospital, Mysore

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/242 ◽

2021 ◽

Vol 8 (18) ◽

pp. 1264-1269

Author(s):

Praveen Duraisamy ◽

Vivekanandan Andavar ◽

Balachanderc Rajendran ◽

Girish Chandra Rangaswamy

Keyword(s):

Fracture Healing ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Implant Failure ◽

Care Hospital ◽

Trochanteric Fractures ◽

Case Record ◽

Implant Migration ◽

Hip Screw

BACKGROUND Trochanteric fractures are commonly encountered in elderly patients, and the outcome may be bad, if not intervened early. Dynamic hip screw (DHS) fixation is the most common treatment in stable trochanteric fracture. In unstable trochanteric fractures, there is high incidence of failure in view of excessive collapse seen with dynamic hip screw. In order to limit the collapse, we have done a modification on dynamic hip screw implant. Here we have assessed fracture healing, collapse and implant failure, in unstable trochanteric fractures (Evan’s unstable fractures) treated by modified dynamic hip screw fixation. METHODS The present retrospective case record analysis was conducted among 31 patients with unstable trochanteric fracture classified according to Evan’s classification who were operated with modified DHS in a tertiary care hospital. The details about fracture healing, collapse of fracture fragments, implant failure were assessed in a structured checklist through the case record analysis. RESULTS Out of 31 patients in this study, 29 patients showed fracture healing (93.5 %) with or without minimal collapse and 2 patients had non-union (6.5 %) at the end of 5 months follow up. Ultimately, all fractures united at the end of 1-year follow-up. Out of 31 patients in this study, at first month follow-up, 26 patients showed no implant failure (83.9 %), 5 patient had implant migration not breaching cortex (16.1 %), at third month follow-up, out of 5 patients who had implant migration, two patients had implant migration not breaching cortex (6.4 %), 3 patients had implant migration breaching cortex (11.0 %), at fifth month follow-up, two patients had implant migration not breaching cortex (6.4 %), 3 patients who had implant migration breaching cortex underwent revision surgery (11.0 %). CONCLUSIONS Modified dynamic hip screw has shown improved results as compared to normal dynamic hip screw in treating unstable trochanteric fracture, which limits the collapse at fracture site. KEYWORDS Unstable Trochanteric Fractures, Collapse, Modified Dynamic Hip Screw

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Randomized comparative study to evaluate the role of proximal femoral nail and dynamic hip screw in unstable trochanteric fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20162618 ◽

2016 ◽

Vol 2 (3) ◽

pp. 75

Author(s):

Shivanand C Mayi ◽

Sachin Shah ◽

Sadashiv R Jidgekar ◽

Arunkumar Kulkarni

Keyword(s):

Comparative Study ◽

Functional Outcome ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Trochanteric Fractures ◽

Stable Fixation ◽

Femoral Nail ◽

Duration Of Surgery ◽

Hip Screw

Background: Treatment of unstable trochanteric fracture is much more challenging than stable fracture. These fractures require stable fixation to minimize the fracture and implant related complications. Need of this study is to assess the suitable implant for stable fixation of unstable trochanteric fracture with less intra and postoperative complications and good functional outcome.Methods: In this prospective randomized comparative study, 64 patients were distributed into two groups. Group A consisted of patients treated by proximal femoral nail (PFN) (n=32) and group B treated by dynamic hip screw (DHS) (n=32). All the patients were evaluated preoperatively and surgery was done according to the group they were allotted. Post-operative follow up was done at 6 weeks, 3, 6 and 12 months.Results: Average age of the patients in this study was 51.26±10.24 year. In this study patients were followed up for an average of 10.87±2.61 month. The duration of surgery was shorter in PFN group. Weight bearing was earlier in PFN group than DHS group. Mean functional ability score was better in PFN group with significant gain in function earlier as compared to DHS group.Conclusions: PFN is a better implant for internal fixation of unstable trochanteric fractures which allows early mobilization and has got better functional outcome score in early postoperative period than DHS

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A comparative study between dynamic hip screw and intramedullary nail fixation in trochanteric fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20212424 ◽

2021 ◽

Vol 7 (4) ◽

pp. 794

Author(s):

Krishan Kumar ◽

Anurag Chhabra ◽

Ashok Kumar ◽

Sourabh Jain ◽

Ankush Berwal

Keyword(s):

Blood Loss ◽

Traffic Accidents ◽

Road Traffic ◽

Common Type ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Trochanteric Fractures ◽

Surgical Time ◽

Significant Difference ◽

Hip Screw

Background: The trochanteric fractures are one of the commonest fractures in elderly population. Incidence of these fractures is increasing due to better life expectancy, growing number of population, industrialization and the road traffic accidents. Variety of implants are available but still there is no consensus for single implant.Methods: A prospective randomized control study was conducted on total 60 patients of intertrochanteric fractures which were randomized into 2 groups of 30 each, treated with dynamic hip screw (DHS) and proximal femoral nail (PFN). All the patients were followed up for a maximum of 6 months. Outcomes were reviewed and compared such as mode of injury, complications, functional and radiological outcomes.Results: There was no significant difference between two groups of patients as regards to mean age and sex. The mode of injury by slip and fall was main cause. The most common type of fracture as per AO-orthopaedic trauma association (OTA) classification was 31-A2 (65%) and 31-A3 (5%) being the least common type. Mean surgical time of DHS group and PFN group was 125.17 minutes and 89.93 minutes respectively. Mean blood loss in DHS group and PFN group was 251.67 ml and 158.67 ml respectively. Mean radiological union time of fracture in DHS group and PFN group was 12.3 and 9.5weeks respectively. Mean Harris hip score at six month in DHS group and PFN group was 80.77 and 85.47 respectively.Conclusions: We conclude that though both the implants can achieve comparable union rates but PFN are better than DHS as of better Harris hip score, shorter surgical time and less intra operative blood loss.

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A comparative study of 70 cases of inter-trochanteric fracture femur treated with dynamic hip screw and proximal femoral nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170788 ◽

2017 ◽

Vol 3 (2) ◽

pp. 293

Author(s):

Gaurav Singla

Keyword(s):

Hip Fractures ◽

Standard Procedure ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Trochanteric Fractures ◽

Fracture Femur ◽

Femoral Nailing ◽

Significant Difference ◽

Hip Screw ◽

Proximal Femoral Nailing

Background: Inter-trochanteric fracture femur is a common and grievous injury, mostly suffered in elderly people. It accounts for approximately half of hip fractures in elderly and out of this, more than 50% of fractures are unstable. In old age, it occurs mostly due to trivial trauma. Various procedures of internal fixation had been proposed as a treatment. DHS considered to be the standard procedure for comparison of outcomes. The advantage of proximal femur nailing fixation is that it provides a more biomechanically stable construct by reducing the distance between hip joint and implant. The goal of this study is to compare the clinical and radio-graphical results of the DHS and PFN for the treatment of Intertrochanteric hip fractures (load bearing vs. load sharing).Methods: Seventy patients (more than 55 years old) presented to Adesh Hospital from March 2015 to November 2015 with trochanteric fracture femur. Patients were treated with osteosynthesis with dynamic hip screw (DHS) and proximal femoral nailing (PFN). The clinical results were compared between the dynamic hip screw and proximal femoral nailing groups of 35 patients each. All surgeries done on traction table and were followed up at regular intervals of 4 weeks, 6 weeks, 8 weeks, 10 weeks, 12 weeks, 6 months and at 1 year.Results: We observed no statistically significant difference between two groups in view of late & early complications and time to union. We observed significantly better outcomes in PFN group for unstable inter-trochanteric fractures and in unstable fractures reduction loss is significantly lower in PFN group.Conclusions: We concluded that PFN may be the better fixation device for most unstable inter-trochanteric fractures.

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Treatment of Trochanteric Fractures with Proximal Femoral Nail Antirotation or Dynamic Hip Screw Systems: A Meta-Analysis

Journal of International Medical Research ◽

10.1177/147323001204000302 ◽

2012 ◽

Vol 40 (3) ◽

pp. 839-851 ◽

Cited By ~ 16

Author(s):

C Zeng ◽

Y-R Wang ◽

J Wei ◽

S-G Gao ◽

F-J Zhang ◽

...

Keyword(s):

Blood Loss ◽

Meta Analysis ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Intraoperative Blood Loss ◽

Trochanteric Fractures ◽

Fixation Failure ◽

Duration Of Surgery ◽

Hip Screw ◽

Proximal Femoral Nail Antirotation

OBJECTIVE: A meta-analysis to compare the intraoperative and postoperative outcome data for the proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) implant systems for the treatment of patients with trochanteric fractures. METHODS: A detailed search of several electronic databases was undertaken to identify randomized controlled trials published before 5 December 2011 that compared PFNA with DHS in patients with trochanteric fractures. RESULTS: A quantitative meta-analysis of 11 studies including 798 patients was performed. PFNA was associated with significant reductions in duration of surgery (weighted mean difference [WMD] −21.38 min; 95% confidence interval [CI] −33.50, −9.26 min), intraoperative blood loss (WMD −176.36 ml; 95% CI −232.20, −120.52 ml), rate of fixation failure (relative risk [RR] 0.27, 95% CI 0.11, 0.62) and rate of postoperative complications (RR 0.46; 95% CI 0.31, 0.70) compared with DHS. CONCLUSION: The use of PFNA for treatment of trochanteric fractures was found to be superior to DHS in terms of the duration of surgery, intraoperative blood loss, and rates of fixation failure and overall complications.

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Dynamic Hip Screw (DHS) versus Proximal Femoral Nail Anti-rotation (PFNA) Fixation for Unstable (Evans-Jensen II and III) Inter-trochanteric Fractures of Femur in Elderly

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v15i3.25554 ◽

2019 ◽

Vol 15 (3) ◽

pp. 222-225

Author(s):

Manoj Kandel ◽

Robin Shrestha ◽

Krishna Prasad Poudel ◽

Shrawan Thapa ◽

Sushil Thapa ◽

...

Keyword(s):

Average Length ◽

Trochanteric Fracture ◽

Operation Time ◽

Healing Time ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Trochanteric Fractures ◽

Femoral Nail ◽

Fixation Group ◽

Hip Screw

Background: Dynamic hip screw (DHS) and proximal femoral nail anti-rotation (PFNA) are the two most commonly used fixation devices for inter-trochanteric fracture of femur. However, many clinical studies have shown lack of differences in the clinical outcome consistently with between these two fixation techniques. The main objective of this study is to compare the results of dynamic hip screw (DHS) and proximal femoral nail anti-rotation (PFNA) fixation in elderly patients with unstable inter-trochanteric fractures of femur. Methods: We retrospectively reviewed patients who underwent operative management for inter- trochanteric fractures of femur in our hospital between February 2013 and September 2017. Elderly patients (Age >60yrs) with unstable inter-trochanteric fracture of femur treated either with DHS fixation or with PFNA fixation were included and divided into two groups: DHS fixation group and PFNA fixation group. The comparative statistical analysis was done between two group using following parameters: average length of the incision, operation time, blood loss, fracture healing time, and degree of postoperative functional recovery. Results: The mean follow-up period, in DHS fixation group was 16 month (range 12 to 24 months) and in PFNA fixation group was 14 months (range 12 to 18 months). The differences between two groups regarding average length of the incision, operation time, and blood loss were statistically significant (p<0.05) and better in PFNA group whereas the differences between two groups regarding fracture healing time and the degree of postoperative functional recovery were not statistically significant (p >0.05). Conclusions: PFNA fixation may be better than DHS fixation for the treatment of unstable inter-trochanteric fractures of the femur in the elderly. However, the application and usage of DHS fixation could not be neglected and the choice of treatment depends upon the systemic condition and socioeconomic status of the patient, patient’s preferences, surgeon’s experience and availability of treatment facility.

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Fixation of AO-OTA 31-A1 and A2 trochanteric femur fractures using a sliding hip screw system: can we trust a two-hole side plate construct? A review of the literature

EFORT Open Reviews ◽

10.1302/2058-5241.5.190020 ◽

2020 ◽

Vol 5 (2) ◽

pp. 118-125

Author(s):

Faustine Vallon ◽

Axel Gamulin

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Operative Time ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Surgical Trauma ◽

Sliding Hip Screw ◽

Side Plate ◽

Femur Fractures ◽

Hip Screw

Trochanteric femur fractures are frequently fixed with a four-hole side plate sliding hip screw device, but in recent decades two-hole side plates have been used in an attempt to minimize operative time, surgical dissection, blood loss and post-operative pain. The aim of this review was to determine whether two-hole sliding hip screw constructs are an acceptable option for fixation of AO-OTA 31-A1 and A2 trochanteric femur fractures. An electronic MEDLINE® database search was performed using PubMed®, and articles were included in this review if they were reporting historical, biomechanical, clinical or outcome data on trochanteric fracture fixation using a two-hole sliding hip screw device. A two-hole dynamic hip screw with a minimally invasive muscle-splitting approach is recommended for fixation of AO-OTA 31-A1 simple trochanteric fractures; this implant is biomechanically safe, and allows the use of a minimally invasive muscle-splitting approach which potentially provides better clinical outcome, such as decreased surgical trauma, shorter operative time, less blood loss, decreased analgesics use, and shorter incision length. As the majority of reviewed publications relate to the dynamic hip screw, it is not clear whether the above recommendations can be extended to any other sliding hip screw device. An intramedullary device is recommended for all other extra-capsular proximal femoral fractures. Cite this article: EFORT Open Rev 2020;5:118-125. DOI: 10.1302/2058-5241.5.190020

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