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

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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Comparison between Conventional and Minimally Invasive Dynamic Hip Screws for Fixation of Intertrochanteric Fractures of the Femur

ISRN Orthopedics ◽

10.1155/2013/484289 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

A. Mahmood ◽

M. Kalra ◽

M. K. Patralekh

Keyword(s):

Surgical Technique ◽

Minimally Invasive ◽

Early Mobilization ◽

Dynamic Hip Screw ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Intertrochanteric Fractures ◽

Tissue Destruction ◽

Side Plate ◽

Hip Screw

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.

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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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386 Proximal Femoral Nail (PFN) Versus Dynamic Hip Screw (DHS) In Unstable Intertrochanteric Fractures of Femur -A Comparative Clinical Study

British Journal of Surgery ◽

10.1093/bjs/znab134.267 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

V Dubey ◽

B Spiegelberg ◽

S Shahane ◽

A Samant

Keyword(s):

Blood Loss ◽

Randomized Study ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Leg Length ◽

Femur Fractures ◽

Intertrochanteric Femoral Fracture ◽

Duration Of Surgery ◽

Hip Screw

Abstract Introduction The goal of treatment of an intertrochanteric femoral fracture is restoration of patient's mobility as early as possible. The dynamic hip screw (DHS) has been used for several decades to treat these fractures. Proximal femoral nails (PFN) are reported to have an advantage in such fractures. This study aims at comparing the results of unstable intertrochanteric fractures femur treated with PFN and DHS. Method This was a prospective, randomized study which includes sixty patients. All patients were available for follow up with 30 patients in each group. The data about intraoperative blood loss, time to union, leg length shortening was collected. The functional outcome at the end of one year was evaluated using Harris Hip Score. Results Blood loss, duration of surgery, time to union and leg length shortening was significantly less in the patients treated with PFN (p < 0.05). The mean harris hip score for patients managed with PFN was significantly more than in DHS group, 12 months after surgery (p = 0.05). Conclusions PFN requires a smaller incision, lesser operative time, less blood loss and has improved functional results. In our opinion PFN may be a better fixation device for most of the unstable intertrochanteric femur fractures.

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Study internal fixation of subtrochanteric fracture of femur with dynamic hip screw, dynamic condylar screw and proximal femoral nail-a retro-prospective study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20180632 ◽

2018 ◽

Vol 6 (3) ◽

pp. 1011

Author(s):

Sandeep Kumar Mishra ◽

Deepak C. E. ◽

Kushal Goari ◽

Shurendra Shukla

Keyword(s):

High Velocity ◽

Trochanteric Fracture ◽

Early Mobilization ◽

Subtrochanteric Fracture ◽

Fracture Pattern ◽

Surgical Trauma ◽

Union Rate ◽

Sliding Hip Screw ◽

Fixation Devices ◽

Hip Screw

Background: Sub trochanteric fracture is commonly seen in young adult and middle age man by high velocity trauma. Present study was taken up to study fracture fixation by PFN, DHS and DCS and compare their result in view of union rate, complication, functional out come, operative risk and effectiveness of implant. This study helps to decide appropriate implant for sub trochanteric fracture. In literature comparison of these PFN, DHS, DCS commonly used implants are rare and most of the studies are done in western population by using one or two implants.Methods: Study is done clinically, in a retro to prospective manner by comparing 75 (50 cases retro and 25 cases prospectively) cases of either sex above the age of 18years from May 2010 to May 2014. All fractures are classified by Seinsheimer classification system. Fracture is fixed with DHS, PFN or DCS in 25 cases each.Results: Males with an average age group 21-40-year were commonly affected with right femur fracture due to high velocity RTA. Fracture pattern was commonly type IIC as per seinsheimer classification. Mean union rate and clinical outcome for PFN is high.Conclusions: PFN attempts to combine advantage of a sliding hip screw with those of intramedullary fixation devices. Cases treated with PFN nail have shown easier rehabilitation, less blood loos, less surgical trauma, early mobilization, early rate of fracture union when compared to those cases treated with DHS and DCS barrel plate as per observation of our study. With our study PFN has given us encouraging results over conventional DHS and DCS. Hence, we recommend PFN as better implant for fixation of sub-trochanteric fracture.

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

Journal of Orthopaedic Surgery ◽

10.1177/1602400322 ◽

2016 ◽

Vol 24 (3) ◽

pp. 379-382 ◽

Cited By ~ 16

Author(s):

Ranjit Kumar Baruah ◽

Pranab Jyoti Borah ◽

Russel Haque

Keyword(s):

Adverse Event ◽

Blood Transfusion ◽

Blood Loss ◽

Plate Fixation ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Trochanteric Fractures ◽

Control Groups ◽

Hip Screw ◽

And Control

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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The Emerging Role of Robotic Single-site Approach for Myomectomy: A Systematic Review of the Literature

Surgical Innovation ◽

10.1177/1553350620988227 ◽

2021 ◽

pp. 155335062098822

Author(s):

Eirini Giovannopoulou ◽

Anastasia Prodromidou ◽

Nikolaos Blontzos ◽

Christos Iavazzo

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Complication Rate ◽

Operative Time ◽

Intraoperative Complications ◽

Single Site ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Robotic Myomectomy ◽

The Mean

Objective. To review the existing studies on single-site robotic myomectomy and test the safety and feasibility of this innovative minimally invasive technique. Data Sources. PubMed, Scopus, Google Scholar (from their inception to October 2019), as well as Clinicaltrials.gov databases up to April 2020. Methods of Study Selection. Clinical trials (prospective or retrospective) that reported the outcomes of single-site robotic myomectomy, with a sample of at least 20 patients were considered eligible for the review. Results. The present review was performed in accordance with the guidelines for Systematic Reviews and Meta-Analyses (PRISMA). Four (4) studies met the inclusion criteria, and a total of 267 patients were included with a mean age from 37.1 to 39.1 years and BMI from 21.6 to 29.4 kg/m2. The mean operative time ranged from 131.4 to 154.2 min, the mean docking time from 5.1 to 5.45 min, and the mean blood loss from 57.9 to 182.62 ml. No intraoperative complications were observed, and a conversion rate of 3.8% was reported by a sole study. The overall postoperative complication rate was estimated at 2.2%, and the mean hospital stay ranged from 0.57 to 4.7 days. No significant differences were detected when single-site robotic myomectomy was compared to the multiport technique concerning operative time, blood loss, and total complication rate. Conclusion. Our findings support the safety of single-site robotic myomectomy and its equivalency with the multiport technique on the most studied outcomes. Further studies are needed to conclude on the optimal minimally invasive technique for myomectomy.

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Gotfried percutaneous compression plating (PCCP) versus dynamic hip screw (DHS) in hip fractures: blood loss and 1-year mortality

Aging Clinical and Experimental Research ◽

10.1007/s40520-014-0205-3 ◽

2014 ◽

Vol 26 (5) ◽

pp. 497-503 ◽

Cited By ~ 2

Author(s):

Diego Gaddi ◽

Giorgio Piarulli ◽

Andrea Angeloni ◽

Marta Gandolla ◽

Daniele Munegato ◽

...

Keyword(s):

Blood Loss ◽

Hip Fractures ◽

Dynamic Hip Screw ◽

Hip Screw ◽

Compression Plating

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A study of results of fixation of pertrochanteric femur fractures with dynamic hip screw (DHS) & comparision with past studies

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2019.v5.i3c.1520 ◽

2019 ◽

Vol 5 (3) ◽

pp. 141-147

Author(s):

Dr. Janak Rathod ◽

Dr. Prabhav Tijoriwala

Keyword(s):

Dynamic Hip Screw ◽

Femur Fractures ◽

Hip Screw ◽

Pertrochanteric Femur Fractures

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A study to assess proximal femoral nailing versus dynamic hip screw device in surgical management of intertrochanteric fractures: a comparative study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20184719 ◽

2018 ◽

Vol 5 (1) ◽

pp. 23

Author(s):

E. S. Radhe Shyam ◽

K. Ashwin

Keyword(s):

Functional Outcome ◽

Intertrochanteric Fracture ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Technical Failure ◽

Intertrochanteric Fractures ◽

Femoral Nail ◽

Fracture Management ◽

Hip Screw

Background: The incidence of inter trochanteric fracture is expected to have doubled by 2040. Inter trochanteric fractures account for about 45% to 50% of all hip fractures in the elderly populationand out of these, near about 50% to 60% are classified as unstable intertrochanteric fractures. The goal of treatment is restoring mobility safely and efficiently, while minimizing the risk of medical complications and technical failure. This study as performed to assess functional outcome with dynamic hip screw and proximal femoral nail in intertrochanteric fracture management.Methods: It was prospective observational study done for a period of 1year from January 2016-January 2017 among patients who attended OPD or emergency department with intertrochanteric fracture. Two different implants were used dynamic hip screw (DHS) and proximal femoral nail (PFN).Results: Excellent results in functional outcome was more in case of PFN (66.6%) compared to DHS (50%). The type of trauma in DHS group was road traffic accident in 38.8%, domestic fall in 50% and others such as assault was in 11.1% while in PFN group intertrochanteric fracture was seen in 61.1% due to domestic fall.Conclusions: The functional outcome was more better with proximal femoral nail (PFN) compared to dynamic hip screw (DHS). Therefore, proximal femoral nail (PFN) should be preferred for management of intertrochanteric fractures.

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