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

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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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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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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A comparative study between proximal femur locking compression plate and dynamic hip screw fixation in management of pertrochanteric fracture

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20192689 ◽

2019 ◽

Vol 5 (4) ◽

pp. 707

Author(s):

Hemeshwar Harshwardhan ◽

Sawai Ingh Mali ◽

Manish Sharma

Keyword(s):

Functional Result ◽

Trochanteric Fracture ◽

Good Alternative ◽

Locking Compression Plate ◽

Dynamic Hip Screw ◽

Pertrochanteric Fracture ◽

Harris Hip Score ◽

Bony Union ◽

Compression Plate ◽

Hip Screw

Background: Pertrochanteric fracture is common in elderly people. Dynamic hip screw is still considered the gold standard for treating intertrochantric fracture. Proximal femoral locking compression plate is newer device. The purpose of the study was to compare the outcome of surgical treatment of trochanteric fracture by dynamic hip screw and proximal femoral locking compression plate.Methods: We study 60 patient admitted and followed up at J.L.N. Medical College Ajmer from June 2016 to April 2018 for minimum 6 month or till the bony union. Every fracture classified according to AO classification and functional result will be assessed according to Harris hip score using unpaired t test.Results: The mean operative time and average intraoperative blood loss was more in PFLCP group when compared with DHS group it was statically significant. DHS group has marginally better functional result then PFLCP group. There was no difference in the radiological outcome between two group.Conclusions: DHS is best implant for stable intertrochantric fracture but PFLCP can also be good alternative for unstable IT femur fracture.

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Dynamic Hip Screw in Comparison with Proximal Femoral Nail Technique in Intertrochanteric Femur Fracture Patients

10.53350/pjmhs2115112966 ◽

2021 ◽

Vol 15 (11) ◽

pp. 2966-2968

Author(s):

Mudir Khan ◽

Muhammad Siraj ◽

Abbas Ali

Keyword(s):

Blood Loss ◽

Femur Fracture ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Femoral Nail ◽

Duration Of Surgery ◽

Hip Screw ◽

Intertrochanteric Femur Fracture ◽

Better Than

Background: Hip bone fractures are the main cause of concern on a worldwide level. The main two operative techniques involve dynamic hip screw and proximal femoral nail technique. Aim: To compare the dynamic hip screw with proximal femoral nail technique in intertrochanteric femur fracture patients. Study design: Retrospective study Place and duration of study: Department of Orthopaedics, Khyber Teaching Hospital, Peshawar from 1-7-2019 to 30-12- 2021. Methodology: Seventy patients were enrolled and they were divided in two groups; Group 1 patients were operated with dynamic hip screw (DHS) while group 2 patients were operated by proximal femoral nail (PFN) technique. The detailed pre and post-operative clinical information including blood loss, incision size, Harris hip score and rate of complication was documented. Results: The mean age of patients was 58.62±6.71 year with more male patients than females. The Harris hip score of proximal femoral nail technique was better than distal hip screw. The incision length of distal hip screw cases was 7.61±0.89 in comparison to 4.72±0.73 in proximal femoral nail technique cases with a longer duration of surgery and inter-operative blood loss in case of distal hip screw cases. Conclusion: Proximal femoral nail technique is comparatively better than the distal hip screw procedure. Keywords: Proximal femoral nail technique, distal hip screw, Hip fracture

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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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Outcome of dynamic hip screw with trochanteric stabilizing plate in treatment of unstable intertrochanteric femoral fractures in elderly patients.

The Professional Medical Journal ◽

10.29309/tpmj/2022.29.01.3433 ◽

2021 ◽

Vol 29 (01) ◽

pp. 31-35

Author(s):

Muhammad Asif ◽

Yaqoob ur Rehman ◽

Sardar Sohail Afsar

Keyword(s):

Elderly Patients ◽

Functional Outcome ◽

Femoral Fractures ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Trochanteric Fractures ◽

Poor Functional Outcome ◽

Hip Screw ◽

Study Setting

Objective: To know about the outcome of dynamic hip screw with trochanteric stabilizing plate in treatment of unstable inter-trochanteric femoral fractures in elderly patients. Study Design: Descriptive study. Setting: Maqsood Medical Complex, Pak Medical Centre and Habib Medical Complex. Period: August 2016 to July 2018. Material & Methods: Total of 70 patients with unstable inter-trochanteric fracture and age above 60 years were included in the study. The fracture was fixed with dynamic hip screw and trochanteric stabilizing plate. Patients were evaluated every month after surgery for healing of fracture. Final functional outcome was measured at 6 months after surgery with Harris Hip Score. Results: Out of 70 patients 44 (63%) were females and 26 (37%) were males. Mean age was 74.34(SD + 08.31) years with range of 60 to 87 years. Mean Harris Hip Score at 6 months was 85% with standard deviation of± 4.Ten (14%) patients had excellent, 40 (58%) patients had good, 16 (23%) patients fair and 4 (5%) patients poor functional outcome. Conclusion: Excellent and good functional outcome can be achieved in unstable inter-trochanteric fractures fixed with dynamic hip screw and trochanteric stabilizing plate in majority of patients.

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Management of stable intertrochanteric fractures with minimally invasive dynamic hip screw

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164179 ◽

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

Background: 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.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).Methods: 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.Results: 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. Conclusions: 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.

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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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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 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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