Comparative, prospective, randomized study of the modified minimally invasive technique versus the conventional technique of dynamic hip screw (DHS), fixation for intertrochanteric fractures in the elderly

摘要

Background: The conventional dynamic hip screw constructs include the potential for delayed, non-union secondary to fracture site devascularization and higher morbidity to the elder population. Minimally invasive surgery is the current buzzword in all fields of surgery. The minimally invasive dynamic hip screw technique, compared to the conventional approach, had better outcome measures as decreasing the operating time, hospital stay, and blood loss while maintaining equal fixation stability.Patients and method: This is a prospective randomized study. Consent was taken from 85 patients suffering from intertrochanteric fractures from June 2010 to December 2012. Forty patients were treated by dynamic hip screw fracture fixation using the modified minimally invasive technique while 45 patients by the conventional technique. Patients having dementia or psychiatric illness or unable to walk before the injury were excluded.Results: There were 54 males and 31 females. The mean age was 65 years old with a range of 63–78 years, 48 on right side and 37 on left side. The mean follow-up period was 12 months with a range from 10 to 18 months. All patients had a complete fracture union with a mean of 4.2 (range 4–6) months. One case had a lag screw cut through the bone 3 weeks postoperatively in the minimally invasive group. The mean operative time of the modified minimally invasive technique was 35 (range 25–50) min. The mean incision length was 3.5 (range 3–5) cm in the modified group and 12 (range 10–15) cm in the conventional group. The mean pain visual analogue scale was 2.5 (range 2–5) in the modified group and 4.5 (range 5–8) in the conventional group. The mean postoperative hospital stay was 2.8 (range 2–5) days in the modified group and 5.9 (range 3–9) days in the conventional group.Conclusions: The modified minimally invasive dynamic hip screw fixation had less operative time than in previously reported studies. It has better outcome measures, which benefit the patients and reduce the hospital costs.Level of Clinical Evidence: Therapeutic level III