Effectiveness of treatment of transtrochanteric fractures with Dynamic Hip Screws using minimally invasive access

Abstract

ObjectiveTo analyze the short-term results from treating unstable intertrochanteric fractures with Dynamic Hip Screws (DHS), using a minimally invasive route, focusing on the functional aspects and complication and mortality rates of the method.MethodsThis was a prospective longitudinal study on 140 patients who underwent fixation of transtrochanteric fractures with the DHS system with a lateral minimally invasive access in the hip, between January and December 2013. The patients were evaluated pre and postoperatively (after six months of follow-up) by means of the Parker and Palmer mobility score. Women comprised 65.7% of the sample, and 54.3% of the fractures were on the right side. The patients’ mean age was 80 years, ranging from 60 to 93 years.ResultsWe observed an overall decrease in the mobility score and an increase in the degree of dependence over the short term. However, we encountered only two deaths in the study sample and there were no cases of infection or nonunion.ConclusionDespite the efficacy of the treatment with DHS, with high rates of fracture consolidation and a low mortality rate, we noted that the patients still showed significant functional limitation at the follow-up six months after the operation.

Fraturas intertrocantéricas fixadas com parafuso dinâmico de quadril: Ensaio clínico randomizado comparando a via lateral de Hardinge e o acesso minimamente invasivo

“…The authors 14 observed consolidation in all 140 cases, with a death rate of only 1.4% until the sixth month of follow-up, which shows the efficacy of the method as a way of stabilizing the fracture and of the less aggressive access to improve the survival rate of patients. 14 …”

“…Thus began the trend towards minimally-invasive techniques, with indirect reduction of fractures and fixation with the maximum possible preservation of soft tissue adjacent to the focus, preserving the blood supply required for bone healing. 14 …”

“…The extramedullary implants for the stabilization of intertrochanteric fractures also underwent an important revolution, from the models that did not allow their impaction, and consequently presented high rates of mechanical failure, to the system developed by Richard with the sliding screw, the precursor of the DHS, which revolutionized the treatment of these patients. 14 …”

“…In a case series conducted in Brazil, 14 the DHS – through the minimally-invasive access – was the method used for the treatment of intertrochanteric fractures. The authors 14 observed consolidation in all 140 cases, with a death rate of only 1.4% until the sixth month of follow-up, which shows the efficacy of the method as a way of stabilizing the fracture and of the less aggressive access to improve the survival rate of patients. 14 …”

“…Começava aí a valorização das técnicas minimamente invasivas, com redução indireta das fraturas e fixação com máximo possível de preservação das partes moles adjacentes ao foco, com preservação do suprimento sanguíneo necessário para a cicatrização óssea. 14 …”