scholarly journals Management of stable intertrochanteric fractures with minimally invasive dynamic hip screw

2016 ◽  
Vol 2 (4) ◽  
pp. 414
Author(s):  
Kosalaraman Padmanaban ◽  
Vivekanandhan Ramasamy ◽  
Vijay Krishnan Arcot Subramaniyan
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Early Mobilization ◽  
Minimal Invasive ◽  
Dynamic Hip Screw ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Soft Tissue Dissection ◽  
Hip Screw ◽  
Blood Loss Reduction

<p class="abstract"><strong>Background:</strong> Trochanteric fracture is the commonest fracture which accounts to 90 % of the fractures in patients over 50 years. The aim of the treatment is to prevent malunion and early mobilization with ambulation which is accomplished by dynamic hip screw and sliding plate. Minimal invasive technique has advantages of less blood loss, minimal soft tissue dissection, early mobilization and shorter hospital stay<span lang="EN-IN">.</span>The study was done to evaluate the amount of intraoperative blood loss, reduction of postoperative haemoglobin, requirement of postoperative analgesics and duration of postoperative hospital stay in the patients with stable intertrochanteric fracture treated with minimal invasive dynamic hip screw (MIDHS).</p><p class="abstract"><strong>Methods:</strong> Twenty five patients with stable intertrochanteric fractures were treated with minimal invasive Dynamic hip screw fixation. Average intra operative blood loss, reduction of postoperative haemoglobin, requirement of post-operative analgesics and total duration of postoperative hospital stay were evaluated. All the patients were followed up periodically at 6 weeks, 3 months, 6 months, 1 year.  All the patients were evaluated radiologically in the follow up period. The functional assessment was done with Harris hip score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean intraoperative blood loss was found to be 75 ml. The mean duration of surgery was found to be 44.3 minutes. All the patients were mobilized 24 hours of surgery with non-weight bearing walking with walker support. The average time for union was found to be 4 months. No complications like postoperative infection, malunion, coxa vara, limb length discrepancy were seen. The final functional Harris hip score was found to be excellent in 14, good in 4, fair in 2<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> MIDHS is a safe technique having advantages of less blood loss, minimal soft tissue dissection and shorter hospital stay, early rehabilitation in treating stable intertrochanteric fractures compared to conventional DHS<span lang="EN-IN">.</span></p>

scholarly journals Minimally Invasive Dynamic Hip Screw Fixation for the treatment of stable Intertrochanteric Fractures of femur

2014 ◽  
Vol 2 (4) ◽  
pp. 170-174
Author(s):  
Bimal Kumar Pandey ◽  
Kiran Prasad Rijal ◽  
Tanup Prasai ◽  
Sagar Panthi ◽  
Rabindra Lal Pradhan ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Early Mobilization ◽  
Minimal Invasive ◽  
Dynamic Hip Screw ◽  
Intertrochanteric Fractures ◽  
Intraoperative Blood Loss ◽  
Soft Tissue Dissection ◽  
Hip Screw ◽  
Postoperative Haemoglobin

Background: Trochanteric fracture is the commonest fracture in elderly people. These fractures carry risks associated with prolonged immobility. Early fracture fixation allowing early mobilization of the patients is the aim of the treatment. Dynamic hip screw and plate remains the most common method for treating stable intertrochanteric fractures. Minimal invasive technique has advantages of less blood loss, minimal soft tissue dissection, early mobilization, lesser requirement of analgesics and shorter hospital stay.Objectives: The study was done to evaluate the amount of intraoperative blood loss, reduction of post operative haemoglobin, requirement of post-operative analgesics and days of postoperative hospital stay in the patients of stable intertrochanteric femur fracture treated with minimal invasive dynamic hip screw (MIDHS).Methods: Twenty-five cases of stable intertrochanteric fractures of femur were treated with minimal invasive Dynamichip screw technique. Average blood loss during surgery, reduction of postoperative haemoglobin, requirement of post-operative analgesics and total days of postoperative hospital stay were studied.Results: Mean intraoperative blood loss was 53 ml, mean reduction of postoperative haemoglobin was 0.9 gm/dl. Average wound size was of five cm. Postoperative analgesic requirement was twice a day in an average and for five days. Mean hospital stay after surgery was five days.Conclusion: Minimal invasive Dynamic hip screw is a safe technique having advantages of less blood loss, minimal soft tissue dissection, lesser requirement of post-operative analgesics and shorter hospital stay in treating stable intertrochanteric fractures.DOI: http://dx.doi.org/10.3126/jkmc.v2i4.11739  Journal of Kathmandu Medical CollegeVol. 2, No. 4, Issue 6, Oct.-Dec., 2013Page: 170-174

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

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 &lt; 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.

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

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
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.

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

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.

scholarly journals Comparative study between dynamic hip screw and plate with proximal femoral nailing in trochanteric fractures of femur

2017 ◽  
Vol 3 (3) ◽  
pp. 602
Author(s):  
M. K. Nizamoddin Khateeb ◽  
Satish Babu D. G.
Keyword(s):  
Early Mobilization ◽  
Dynamic Hip Screw ◽  
Care Hospital ◽  
Intertrochanteric Fractures ◽  
Sliding Hip Screw ◽  
Medical College ◽  
Femoral Nailing ◽  
Hip Screw ◽  
One Year ◽  
Proximal Femoral Nailing

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Incidence of intertrochanteric fractures has increased significantly during recent years and<strong> </strong>it will probably continue to rise in near future due to increased longevity of life. Closed methods of treatment for intertrochanteric fractures have increased mortality rates &amp; have largely been abandoned. Rigid internal fixation and early mobilization has been the standard protocol of treatment nowadays. This study was intended to compare the results of Intertrochanteric fractures treated by dynamic hip screw (DHS) over proximal femoral nailing (PFN)</span><span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This is a randomized prospective study of 102 cases of intertrochanteric fractures,<strong> </strong>admitted to Mysore Medical College &amp; Hospital, Mysore and ESIC medical college and hospital Kalaburagi and Kamareddy Ortho &amp; Trauma care Hospital Kalaburagi; treated with proximal femoral nailing and DHS. The patients were divided randomly into two groups, each of 51 patients, 51 were treated by Dynamic Hip Screw &amp; 51 were treated with proximal femoral nail (PFN).All patients were followed up for one year</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">In our series of 102 patients of Intertrochanteric fractures, 51 were treated with sliding hip screw with<strong> </strong>plate and 51 were treated by an intra-medullary hip screw. Most of the patients were between 51 to 80 years. Slip and trivial fall accounted for 70% cases. Right side was more common accounted for 58.34% of cases</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">From our study, we consider PFN as better alternative to DHS in more unstable fractures with technically difficulty and require more experience. Sliding hip screw remains the implant of choice for stable type fractures. We noticed less operative time, less blood loss, fewer intra-op complications in PFN group. The quality of the reduction achieved &amp; proper positioning of the implant are important to achieve the best post-operative outcome</span><span lang="EN-IN">.</span></p>

scholarly journals Randomized control trial comparing the functional outcomes of dynamic hip screw and locking plate dynamic hip screw in intertrochanteric fractures of femur

2020 ◽  
Vol 6 (3) ◽  
pp. 525
Author(s):  
Kiran Ramachandran ◽  
Dileep Sasidharan ◽  
Oommen Mathew
Keyword(s):  
Functional Outcomes ◽  
Locking Plate ◽  
Dynamic Hip Screw ◽  
Research Centre ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Neck Shaft Angle ◽  
Operative Care ◽  
Significant Difference ◽  
Hip Screw

<p class="abstract"><strong>Background:</strong> The objective of the study was to compare the functional outcomes of intertrochanteric fractures of the femur treated with dynamic hip screw (DHS) and locking plate DHS in elderly.</p><p class="abstract"><strong>Methods:</strong> 48 participants (23 in DHS and 25 in locking plate DHS) aged ≥ 50 years with intertrochanteric fracture of femur were enrolled in the present randomized open label parallel group trial conducted at Pushpagiri Institute of Medical Sciences and Research Centre during a period of 1 year. Open, pathological, other fractures in the same limb and participants with neurological involvement were excluded. Standard of care (pre and post-operative care) was given to all participants. Sociodemographic, radiological findings, fracture type and Singh’s index were recorded at baseline, 6 weeks, 3 and 6 months. Study commenced after approval from Institutional Ethics Committee and written informed consent was obtained from all study participants. Participants were randomized in 1:1 ratio using coin flip method. Quantitative variables were expressed means and medians and qualitative variables were expressed as proportions. Tests of significance were independent sample t test, Mann Whitney U test, Friedman test and Chi square test.<strong></strong></p><p class="abstract"><strong>Results:</strong> Between DHS and locking plate DHS, no significant difference in baseline parameters, neck shaft angle, tip apex distance, shortening, Harris hip score, range of motion score and length of hospital stay were observed.</p><p class="abstract"><strong>Conclusions:</strong> The functional outcomes and complications between DHS and locking plate DHS were not significantly different.</p>

scholarly journals A comparative study on the functional outcome of intertrochanteric fractures treated by proximal femoral nailing or dynamic hip screw fixation

2020 ◽  
Vol 7 (1) ◽  
pp. 51
Author(s):  
Gineshmon Chandy ◽  
Saju S.
Keyword(s):  
Functional Outcome ◽  
Dynamic Hip Screw ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Femoral Nailing ◽  
Hip Screw ◽  
Group 2 ◽  
Proximal Femoral Nailing ◽  
Radiological Union ◽  
Unstable Fractures

<p class="abstract"><strong>Background:</strong> Intertrochanteric fractures are one of the commonly occurring injuries in elderly patients and are high among females and those with osteoporosis. They were treated with either dynamic hip screw (DHS) fixation or proximal femoral nailing (PFNA2) here at our institution. The study was conducted in order to find which method of surgical fixation has better functional outcome.  </p><p class="abstract"><strong>Methods:</strong> Total 96 patients of intertrochanteric fractures admitted during the study period of November 2017 to April 2019 were included for the study. These patients were randomly divided into two groups; DHS was used as implant in group1 and PFNA2 in group 2. Postoperatively patients were followed up after 1 month, 3months and 6 months of the surgery and were assessed using Harris hip score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Harris hip score was higher with PFNA2 group compared to DHS group in all follow-ups. In unstable fractures DHS group had poor outcome compared to PFNA2. Radiological union occurred in 27.1 % cases by 3 months and 72.9% cases by 6 months with DHS whereas 70.8% and 97.9% respectively with PFNA2.  </p><p class="abstract"><strong>Conclusions:</strong> PFNA2 gives a better functional outcome when compared to DHS. Even though DHS gives good functional outcome in stable fractures it is not so in the case of unstable fractures. The radiological union also is faster with proximal femoral nailing. Hence in our opinion PFNA2 can be the better fixation device compared to DHS especially in unstable fractures.  </p>

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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

Reduction in Blood Loss with Tranexamic Acid use in Dynamic Hip Screw Surgery for Intertrochanteric Fractures

2021 ◽  
Vol 15 (7) ◽  
pp. 1657-1760
Author(s):  
Muhammad Akram ◽  
Ali Muqadas ◽  
Arif Mahmood ◽  
Faheem Mubashir Farooqi ◽  
Shumaila Jabbar
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Dynamic Hip Screw ◽  
Control Group ◽  
P Value ◽  
Intertrochanteric Fractures ◽  
Significant Difference ◽  
Group A ◽  
Hip Screw ◽  
Group B

Aim: To compare the mean decrease in hemoglobin levels in fixation of intertrochanteric fractures with or without use of Tranexamic acid. Methods: This study was conducted at Orthopedics Unit II, Mayo Hospital Lahore, Pakistan. Total 78 patients were included in the study. Duration of study was from 15-07-2017 till 15-01-2018.Study was approved by hospital ethical committee. A written informed consent was taken. Diagnosis was made clinically and with help of radiology. Patients were randomly divided into two groups. Patients in intervention Tranexamic acid (TXA) group received 15 mg/kg of Tranexamic acid at the time of induction of anesthesia and repeated after three hours, while those in the control group received placebo which is normal saline, intravenously. Results: There were 16(41%) males and 23(59%) females in group-A. There were 15(38.5%) males and 24(61.5%) females in group-B. Mean age in group A (control) with standard deviation was 44.2051±9.64141. Mean age in group B (TXA) was 45.9744±9.03061. p value 0.0046. Mean BMI in group A was 25.65±5.136. Mean BMI in group B was 24.307±2.153. p value 0.233. In group A 13(33.3%) patients had hypertension and 26(66.67%) did not have hypertension in group-A. In group B 16 (46.2%) patients had hypertension and 21 (53.8%) did not have hypertension in group-B. Mean fall in Hb in Group A was 9.47±1.054. Mean fall in Hb in group B was 9.547±0.9402. p value 0.001. Statistically significant difference was present in Group B (TXA) in term of mean fall in Hb ( p value 0.001). Conclusion: We in our study concluded that the patients in TXA group who were given tranexamic acid 1g intravenously before start of surgery had a lesser fall in mean Hb for the operative treatment of per trochanteric fractures with dynamic hip screw. Hence injecting tranexamic acid intravenously can effectively reduce the blood loss during DHS surgery for the intertrochanteric fractures. Keywords: Interochanteric fracture, tanexamic acid, blood loss

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