Minimal Invasive Dynamic Hip Screw for Intertrochanteric Fractures

DOI: 10.21276/sjams.2017.5.9.32 Abstract: Intertrochanteric fracture of femur is one of the most common fracture of the hip especially in elderly with osteoporotic bones, usually due to low energy trauma like simple falls. With rise in Osteoporosis and geriatric population the risk of getting intertrochanteric fracture is on rise. Rigid fixation with early mobilization of patients is the standard treatment. There is lot controversy about the choice of implant, between Dynamic Hip screw plate and the intra-medullary implants. The Intramedullary implants in treatment of Intertrochanteric fractures, are thought to be a superior choice because of minimal Invasiveness in its application, biomechanical stability and minimal loss of blood. For unstable fractures they are the gold standard now. But many studies still suggest that Dynamic hip screw fixation first introduced by Clawson in 1964 is still a gold standard for fixation of stable intertrochanteric fractures. To develop and evaluate role of minimal invasive approach for Dynamic Hip screw (MIDHS) for the treatment of stabIe intertrochanteric fracture. This is a prospective study of 28 patients of intertrochanteric fracture of OTA 31 A1, A2 and Boyd’s I ,-II fracture and Evan’s stable fracture who underwent treatment by MIDHS with 4 hole side Dynamic compression plate. They were operated with minimal invasive approach. Patients were reviewed immediate postoperatively and at one, two, three, four, six, and 12 months after fracture. They were evaluated for outcomes pertaining to approach, fixation and union.The mean length of incision was 4 cms, mean amount of blood loss.-75ml,and Mean time taken for completion of surgery was 42 minutes. The mean size of Hip screw was85 mm, 4 DCP plate was used , Hip screw were mostly placed Centrally and Posterio-inferior, Tip apex distance was within 5mm in 21cases and >5mmin 7 cases. There was 1 case of DVT, no screw cut through and no infection. Mean fall in postoperative hemoglobin was 0.5 5gm/dl. The Vas pain score was mean of 3.5 /10 after 24 hrs. Mean Time to mobilization to partial weight bearing was within 3 days. Mean radiological union time was10.6 weeks and mean follow up is 48.4 weeks. MIDHS is a innovative improvised technique for Dynamic hip screw fixation with small wound size, low blood loss, low pain, requires less hospital stay, low hospital cost, allows early mobilization and have low incidence of wound infection. It is a very effective way of maintain the adherences to gold standard of Dynamic Hip Screw fixation for Stable Intertrochanteric fracture of femur.