Technique to minimize the incision length, in Minimally Invasive Dynamic Hip Screw procedure for the treatment of Intertrochanteric fractures of femur
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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. 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. Early mobilization is only possible when stable fixation is achieved with less post-operative pain and when patients become haemo-dynamically stable.
Aims & Objective
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.
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.
The minimum incision required to perform Dynamic Hip Screw surgery is almost ONE INCH, roughly equal to the thickness of the plate.
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.
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.
Minimally invasive, Dynamic hip screw, Inter-trochanteric fracture.