PDF herunterladen
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(01): 150-158
DOI: 10.1055/s-0042-1742348
Artigos Originais
Quadril

Fixation of Intertrochanteric Fractures with Dynamic Hip Screws: Randomized Controlled Trial Comparing Hardinge and Minimally Invasive Approaches[*]

Artikel in mehreren Sprachen: português | English
Eduardo Lima de Abreu 
1   Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas (UEA), Boca do Acre, AM, Brasil
,
Jonas Byk
2   Programa de Pós-Graduação em Cirurgia, Universidade Federal do Amazonas (PPGRACI-UFAM), Manaus, AM, Brasil
,
Fernando Westphal
2   Programa de Pós-Graduação em Cirurgia, Universidade Federal do Amazonas (PPGRACI-UFAM), Manaus, AM, Brasil
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Objective To compare the techniques for the osteosynthesis of intertrochanteric fractures with dynamic hip screws (DHSs) through the Hardinge and minimally-invasive access routes of the hip, evaluating the operative time, the degree of pain in the immediate postoperative period, the hematimetric loss, and the functional aspects of active mobility.

Methods A randomized, double-blinded clinical trial in which 66 patients with intertrochanteric fractures were submitted to osteosynthesis by DHS. The patients were divided into a test group, submitted to the minimally-invasive access, and a control group, in whom the surgery was performed through the Hardinge route.

Results Patients submitted to the minimally-invasive treatment presented a lower degree of postoperative pain compared to the group treated by the Hardinge lateral route (p < 0.001), as well as lower hematimetric loss (p < 0.001), shorter operative time (p < 0.001), and improvement in immediate postoperative active mobility tests (p <0.05).

Conclusion The study demonstrated the clinical superiority of the minimally-invasive access route parameters analyzed in relation to the Hardinge access for the fixation of intertrochanteric fractures when DHS is the choice osteosynthesis method.

Level of evidence I.

Keywords

intertrochanteric fracture - minimally-invasive surgical procedures - osteosynthesis - pain, postoperative - clinical trial

Sources of Funding

The present research did not receive any specific grants from funding agencies in the public, commercial or non-profit sectors.


* Work developed at Universidade do Estado do Amazonas (UEA), Boca do Acre, AM, Brazil.


Supplementary Material



Publikationsverlauf

Eingereicht: 07. Mai 2020

Angenommen: 14. Oktober 2021

Artikel online veröffentlicht:
18. Februar 2022

© 2022. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referências

  • 1 De Abreu EL, de Oliveira MH. Avaliação da qualidade de vida dos pacientes submetidos à hemiartroplastia do quadril. Rev Bras Ortop 2015; 50 (05) 530-536
    CrossrefPubMedGoogle Scholar
  • 2 Sahin S, Ertürer E, Oztürk I, Toker S, Seçkin F, Akman S. Radiographic and functional results of osteosynthesis using the proximal femoral nail antirotation (PFNA) in the treatment of unstable intertrochanteric femoral fractures. Acta Orthop Traumatol Turc 2010; 44 (02) 127-134
    CrossrefPubMedGoogle Scholar
  • 3 Sambandam SN, Chandrasekharan J, Mounasamy V, Mauffrey C. Intertrochanteric fractures: a review of fixation methods. Eur J Orthop Surg Traumatol 2016; 26 (04) 339-353
    CrossrefPubMedGoogle Scholar
  • 4 Yu W, Zhang X, Zhu X. et al. Proximal femoral nails anti-rotation versus dynamic hip screws for treatment of stable intertrochanteric femur fractures: an outcome analyses with a minimum 4 years of follow-up. BMC Musculoskelet Disord 2016; 17: 222
    CrossrefPubMedGoogle Scholar
  • 5 Egol K. Intertrochanteric hip fractures: the sliding hip screw. In: Wiss D. Master techniques in orthopaedic surgery: fractures. Philadelphia: Lippincott Williams & Wilkins; 2013: 331-341
    Google Scholar
  • 6 Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg Br 1982; 64 (01) 17-19
    CrossrefPubMedGoogle Scholar
  • 7 Agrawal M, Yuvarajan P, Maini L. Modified minimally invasive approach for dynamic hip screw fixation. Eur J Orthop Surg Traumatol 2011; 21 (05) 375-379
    CrossrefGoogle Scholar
  • 8 Vidyarthi K, Paluvadi S, Sinha A. Minimally invasive dynamic hip screw for intertrochanteric fractures: comparison with conventional method and surgical tips. Int J Res Orthop 2017; 3 (04) 712-717
    CrossrefGoogle Scholar
  • 9 Mahmood A, Kalra M, Patralekh MK. Comparison between Conventional and Minimally Invasive Dynamic Hip Screws for Fixation of Intertrochanteric Fractures of the Femur. ISRN Orthop 2013; 2013: 484289
    CrossrefPubMedGoogle Scholar
  • 10 Ropars M, Mitton D, Skalli W. Minimally invasive screw plates for surgery of unstable intertrochanteric femoral fractures: a biomechanical comparative study. Clin Biomech (Bristol, Avon) 2008; 23 (08) 1012-1017
    CrossrefPubMedGoogle Scholar
  • 11 Martini LA, Moura EC, Santos LC, Malta DC, Pinheiro MdeM. Prevalence of self-reported diagnosis of osteoporosis in Brazil, 2006. Rev Saude Publica 2009; 43 (Suppl. 02) 107-116
    CrossrefPubMedGoogle Scholar
  • 12 Ho M, Garau G, Walley G. et al. Minimally invasive dynamic hip screw for fixation of hip fractures. Int Orthop 2009; 33 (02) 555-560
    CrossrefPubMedGoogle Scholar
  • 13 Kammerlander C, Neuerburg C, Verlaan JJ, Schmoelz W, Miclau T, Larsson S. The use of augmentation techniques in osteoporotic fracture fixation. Injury 2016; 47 (Suppl. 02) S36-S43
    CrossrefPubMedGoogle Scholar
  • 14 De Abreu EL, Sena CB, Saldanha Rodrigues Filho as. Effectiveness of treatment of transtrochanteric fractures with Dynamic Hip Screws using minimally invasive access. Rev Bras Ortop 2016; 51 (02) 138-142
    CrossrefPubMedGoogle Scholar
  • 15 Sawaia RN, Belangero WD. THE MINUS(®) System Minimally Invasive Technique For The Treatment Of Trantrochanteric Fractures. Rev Bras Ortop 2012; 47 (01) 113-117
    CrossrefPubMedGoogle Scholar
  • 16 Zhang K, Zhang S, Yang J. et al. Proximal femoral nail vs. dynamic hip screw in treatment of intertrochanteric fractures: a meta-analysis. Med Sci Monit 2014; 20: 1628-1633
    CrossrefPubMedGoogle Scholar
  • 17 Huang X, Leung F, Xiang Z. et al. Proximal femoral nail versus dynamic hip screw fixation for trochanteric fractures: a meta-analysis of randomized controlled trials. ScientificWorldJournal 2013; 2013: 805805
    CrossrefPubMedGoogle Scholar
  • 18 Foss NB, Kristensen MT, Jensen PS, Palm H, Krasheninnikoff M, Kehlet H. The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery. Transfusion 2009; 49 (02) 227-234
    CrossrefPubMedGoogle Scholar
  • 19 Janzing HM, Houben BJ, Brandt SE. et al. The Gotfried PerCutaneous Compression Plate versus the Dynamic Hip Screw in the treatment of pertrochanteric hip fractures: minimal invasive treatment reduces operative time and postoperative pain. J Trauma 2002; 52 (02) 293-298
    CrossrefPubMedGoogle Scholar
  • 20 Cleveland M, Bosworth DM, Thompson FR, Wilson Jr HJ, Ishizuka T. A ten-year analysis of intertrochanteric fractures of the femur. J Bone Joint Surg Am 1959; 41-A: 1399-1408
    CrossrefPubMedGoogle Scholar