Abstract
INTRODUCTION: Good results have been achieved consistently with compression hip screw fixation for stable intertrochanteric femur fractures by conventional method. Thus, this present study was conducted to find out the outcomes for such hip fracture fixation with minimal invasive technique. MATERIALS AND METHOD: This retrospective study was carried out by collecting the records of 66 adult patients with stable intertrochanteric femur fracture managed by Dynamic Hip Screw (DHS) fixation with minimal invasive technique under Spinal Anaesthesia and Epidural Analgesia in Universal College of Medical Sciences and Teaching Hospital (UCMSTH) over a period of 3 years. The patients were in follow up visits for 1 year postoperatively. Operating time, blood loss, decrease in haemoglobin level, analgesic demand, length of hospital stay, fracture union time, early and delayed complications and functional outcome were recorded. RESULTS: This study showed less operative time, less blood loss and less reduction in mean haemoglobin value postoperatively by only 1.53 gm/dl when compared with baseline values. Though complications like pain, stitch infection at surgical site and UTI was seen in few patients, all patients were mobilized within 2nd postoperative day with less rescue analgesic demand and shorter duration of hospital stay of only 8.23 days. However, plate breakage, nonunion, implant cut out, joint infection, delayed union and varus deformity was not observed in any of these patients. Moreover, Harris Hip Score showed good functional outcome. CONCLUSION: Fixation of DHS with minimal invasive technique for stable hip fracture has good functional outcome in cost effective way with fewer incidences of complications resulting in great advantage over the conventional method of fixation.
Highlights
Hip fractures are leading cause of death and disability among the elderly
AIM: Good results have been achieved consistently with compression hip screw fixation for stable intertrochanteric femur fractures by conventional method. This present study was conducted to find out the outcomes for such hip fracture fixation with minimal invasive technique. This retrospective study was carried out by collecting the records of 66 adult patients with stable intertrochanteric femur fracture managed by Dynamic Hip Screw (DHS) fixation with minimal invasive technique under Spinal Anaesthesia and Epidural Analgesia in Universal College of Medical Sciences and Teaching Hospital (UCMSTH) over a period of 3 years
Fixation of DHS with minimal invasive technique for stable hip fracture has good functional outcome in cost effective way with fewer incidences of complications resulting in great advantage over the conventional method of fixation
Summary
Hip fractures are leading cause of death and disability among the elderly. Proximal femoral fracture accounts 30% of all hospital admissions with mortality of 15-20% worldwide. Trochanteric fractures are around four times more with female predominance. Treatment goals for these populations include early rehabilitation, restoration of the anatomic alignment of the proximal part of femur and maintenance of fracture reduction[1,2,3,4]. Though resistance augmented Baixauli plates, Medroff plates, trochanteric stabilizing plates, percutaneous compression plates and intra medullary devices are focused on unstable inter-trochantric fracture, it is almost universally accepted that internal fixation is the best method in which fixation with Dynamic Hip Screw (DHS) is considered as the standard one[5,6,7,8,9]. The experimental basis of minimal invasive surgery is based on the fact that nutrient artery gives 2/3rd of the blood supply to the bone, and 1/3rd comes from the periosteum inflow[3]
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