Management of Intertrochanteric Fractures of Femur by Minimally Invasive Dynamic Hip Screw

Abstract

Introduction: Intertrochanteric fractures comprise approximately 50% of all hip fractures. In view of associated comorbid conditions in elderly patients the aim of treatment is to prevent malunion and early mobilization, which is provided by Dynamic Hip Screw and Sliding Plate. A large exposure is necessary for implantation of the traditional 4 holed plate which leads to more blood loss and increased operating time adding to increased morbidity and mortality. The two holed side plate affords the surgeon the opportunity to implement a minimally invasive approach in certain intertrochanteric fractures like Boyd and Griffin type I and II fractures. This can potentially reduce operative time, blood loss and possibly improve patient outcome. Materials and Method : A prospective study was done in 50 patients with Intertrochanteric fractures who were managed with dynamic hip screw and side plate using minimally invasive technique from November 2006 to December 2012 in our institute. Patients with type I and II Boyd and Griffin intertrochanteric fractures were included. Duration of surgery and Intraoperative blood loss was measured. All the patients were examined clinically and radiographically every 6 weeks and any complications were recorded. Sanders 60 point traumatic hip rating score was used to evaluate the functional results. Results: The average follow up duration was 7 months ranging 3 to 18 months. One death occurred and one was lost to follow up. The average age of the patient was 60 years with a range of 21 to 80 years. There were 15 type I fractures and 35 type II fractures, The average surgical time was 45 minutes ranging from 30 to 80 min and average blood loss was 90 cc, The average time to union was 9 weeks ranging from 6 to 12 weeks. There were no nonunion. There was knee pain in 4 patients, shortening of less than or equal to 2 cm in 4 patients and one patient with superficial infection which responded to appropriate antibiotics. Two malunion with varus angulation of less than 10 degrees was seen. According to Sanders traumatic hip scoring there were 31 % excellent results, 58% good results and 11% poor results. One death occurred due to comorbid conditions. Conclusion: Minimally Invasive technique for the management of intertrochanteric fractures (types I and II Boyd and Griffin) with DHS and two holed side plate makes “biological osteosynthesis” possible with less operative time, minimal soft tissue stripping, minimal blood loss and adequate biomechanical stability . We conclude that minimally invasive DHS with 2 holed side plate is a reliable and reproducible technique, which requires initial learning curve.