الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 86 |  |  |
| | | from | 86 | | |
Abstract
Although dynamic hip screw (DHS) was early introduced in the treatment of trochanteric fractures, it became the standard method of treatment of these fractures. Newly developed implants with improved biotechniques aiming at improvement in management of complications of conventional dynamic hip screw operations with a trend of decrease surgical time, limit operative trauma, and decrease hospital stay. That prompted us to reconsider application of dynamic hip screw by a less invasive technique and improve its outcome.
Muscle splitting technique provides a smaller incision and theoretical a minimal invasive technique. The operative time is greatly decreased. We consider simplifying the operative technique to make it easy to be applied by surgeons without sacrificing the standard of good strong fixation so we use a 4 holes dynamic hip screw device. There is no need for intra-operative blood transfusions. Not to mention the advantage of sparing the periostium and the physiological muscular anatomy which is beneficial for rapid non-complicated healing.
Between September 2009 and April 2011, 40 trochanteric fractures presented to Orthopaedic department in Alexandria University (Al-Hadra University Hospital) were treated, of which 20 cases were treated using minimally invasive DHS and 20 cases using conventional DHS techniques.
The ages of the patients were between45-82 with a mean of 61.40 ± 7.14 and a median of 61.5 for minimally invasive DHS group and 45-73 with a mean of 59.25 ± 8.06 and a median of 60 for conventional DHS group. Our study included 7 (35%) male and 13 (65%) female in minimally invasive DHS group, while it included 8 (40%) male and 12 (60%) female in conventional DHS group. Most patients had a Singh grade of III and IV (mild -moderate osteoporosis).
The mean operative time was 38.0 ± 3.77in the minimally invasive DHS group and 59.0 ± 6.41in the conventional DHS group. Wound size showed a mean of 4.95 ± 0.33cm with 7.64% change in haemoglobin level in the minimally invasive DHS group and 14.80 ± 1.40 cm with 19.36% change in haemoglobin level in the conventional DHS group. No patients needed blood transfusion in minimally invasive DHS group, while 17 cases (85%) needed blood transfusion in conventional DHS group. The mean time for union was 10.25±1.71weeks in minimally invasive DHS group while in conventional DHS group was 12.50 ± 1.10.
Excellent anatomical results were detected in 19 cases (95%) and fair anatomical result was detected in one case (5%) in minimally invasive DHS group, while in conventional DHS group 17 (85%) cases showed excellent anatomical results and 3 cases (15%) showed good anatomical results. Regain the pre-operative functional state was excellent in 19 cases (95%) in the minimally invasive DHS group and 17 cases (85%) in the conventional DHS group.
It is documented from this study that minimally invasive DHS provides a good choice and even a better choice for patients having trochanteric fractures.