Technique to minimize the incision length, in Minimally Invasive Dynamic Hip Screw procedure for the treatment of Intertrochanteric fractures of femur
Journal Title: Indian Journal of Orthopaedics Surgery - Year 2016, Vol 2, Issue 3
Abstract
Background: Fractures around the hip not only are very prevalent, but need more attention also, since the enhanced average life expectancy, the resultant elderly-osteoporotic-population pool has expanded, present orthopaedic surgeons are aflood with such cases[1–4]. The intertrochanteric fractures comprise 50% of the fractures around the hip[5] . Intertrochanteric fractures in the elderly are associated with high rates of mortality, ranging from 15 to 20%, as they are at a high risk for deep vein thrombosis (DVT), urinary tract infections, and pulmonary embolism when they fail to mobilize or ambulate early[6]. Early mobilization is only possible when stable fixation is achieved with less post-operative pain and when patients become haemo-dynamically stable. Aims & Objective: 1. Even though minimally invasive DHS surgery is popular since last decade, still we intended to develop a truly minimally invasive technique without the need of any special instrumentation. 2. To confirm whether the proposed minimum incision allows sound fixation, without damaging the corners of the skin incision. Materials & Methods: This is a prospective study done over a period of 2 years at the Department of Orthopaedics at a Tertiary Care Centre. Patients presenting to the Department of Orthopaedics, Index Medical College with intertrochanteric fractures were evaluated and analysed to be included in the study. 54 patients, who presented with an intertrochanteric femur fracture and who fulfilled the inclusion criteria were enrolled in the study Generally, for an AO 31 A1.1 and an A1.2 fracture, a two hole DHS plate is enough(14) , but when we are not sure of the quality of implants or sound purchase of the screws in cortex, we use four hole standard barrel side 135 degrees plate. It is inserted first beneath the muscle inside-surface-out, grasping the barrel then slid along the shaft and then again turned inside-surface-inside, manually. Results: 1. The minimum incision required to perform Dynamic Hip Screw surgery is almost ONE INCH, roughly equal to the thickness of the plate. 2. The skin remains uninjured if the location of incision is proper. Out of 54 patients only in 8 patients we had to extend the incision due to initial learning curve, unstable fracture, to catch the bleeder. Conclusion: Our study emphasised the need of locating the right entry point for the guidewire and the placing the incision slightly distal to it, since we intend to locate the incision from 2nd to 3rd screws. This enables the surgeon to manoeuvre instruments and implants through the ’1-inch-incision’. 1-inch-incision’if properly placed doesn’t does not lead to skin edge damage at incision site due to retraction.
Authors and Affiliations
Abhay Manchanda, Viral K. Patel, Satya N. Shukla
Keywords
Related Articles
- EP ID EP242519
- DOI -
- Views 121
- Downloads 0
Outcome of plate osteosynthesis in pubic diastasis: an experience of teritiary care centre
Background: Pubic diastasis results from high energy trauma and is often component of polytrauma. When diastasis is >2.5 cm these are unstable fracture and needs fixation. We share our outcome in management of type II &...
Dynamic HIP screw vs proximal trochanteric contoured plate in proximal end fractures of femur
Purpose: To compare the outcome in patients who underwent surgery for proximal end femur fracture, intertrochanteric and Subtrochanteric, using dynamic hip screw vs proximal femoral locking plate. Methods: 11 men and 19...
Clinical outcome of tibial spine ACL avulsion fracture in adults treated with suture bridge fixation
Introduction Anterior cruciate ligament avulsion from the tibia with a bony fragment of the tibial spine is an uncommon injury of the knee joint These are predominantly seen in children and young adults Arthroscopic redu...
Profile of rare disabling musculoskeletal diseases in the North-Eastern Region of India: A hospital based study
Traditionally, research and development of treatments for rare diseases has been neglected in favour of more common diseases. Rare diseases are rare but rare disease patients may not be that rare in a populous country. I...
Evaluation of Indigenous Antibiotic Impregnated Cement Rod in the treatment of chronic osteomyelitis of long bones
Introduction: Management of chronic osteomyelitis demands prolonged Antibiotic therapy. Antibiotics may be administered systemically or locally. Local antibiotic therapies have definite advantages. In this study we used...