A comparative study of fixation of fracture intertrochanteric femur with d.h.s. by m.i.s. versus conventional muscle reflection surgical approach
Background: Hip fractures are a common cause of morbidity and mortality and are associated with considerable health expenditure. The dynamic hip screw (DHS) has been the standard type of fixation for intertrochanteric fractures. We have used a prospective study design to ascertain the short/ long-term safety and effectiveness of a standardised DHS device inserted using a minimally invasive technique compared with the same implant inserted in a traditional fashion to manage fracture intertrochanteric femur.
Materials and Methods: In the period June 2011 to June 2012, all patients admitted in orthopaedic ward of Jayarogya Group of Hospitals with fracture intertrochanteric femur needing surgical fixation, were evaluated with inclusion/exclusion criterion.They were assigned randomly in minimally invasive DHS approach or a conventional open/muscle reflection approach group and evaluated for following outcome measures: duration of surgery, intraoperative blood loss, drain use/ output, requirement of blood transfusion intra/postoperatively, analgesic intake, length of hospital stay, rate of infection, time to mobilisation and weight bearing postoperatively & overall functional outcome.
Conclusion: Minimally invasive surgical techniques, as a whole, reduce operative complications and postoperative morbidity. Our study shows that, when compared with the conventional approach in the implantation of the DHS device, the minimally invasive surgical technique described here resulted in shorter duration of surgery and length of hospital stay, as well as less intraoperative blood loss. This is accomplished without compromising the stability of fracture fixation
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