INTRODUCTION : the fixation of intertrochanteric fractures by dynamic hip screw is practiced conventionally by exposing the proximal portion of the femur extensively, except that we can be less invasive, without touching the focus and without detaching the vastus lateralis muscle using a mini open. We sought the benefit of a minimally invasive compared to the conventional open in early clinical results.
PATIENTS AND METHODS : This is a prospective study, continuous and comparative including 60 cases (60 dynamic hip screw) divided into 2 groups of equal and comparable preoperatively workforce. We only selected the intertrochanteric fractures type A1 of the classification AO. The two approaches were supine on a orthopedic table with classical instrumentation and the same type of implant. We studied the operative time, blood transfusions, operative pain and implant positioning.
RESULTS : Functional clinical results were evaluated (Harris score) at 6 weeks, 3 and 6 months. The average length of the incision was 3.6 cm against 10.5. The surgical blood loss calculated were significantly lower in the group mini open, well as post operative pain. The positioning of the implants was similar. A case of phlebitis, and a case of necrosis of the femoral head have been identified in the mini open group. In the other group, two cases of phlebitis and one case of pulmonary embolism were observed. The Harris index was better. At longer term functional results were comparable.
DISCUSSION : the use of the minimally invasive approach in the treatment of intertrochanteric fractures by dynamic hip screw, gave us full satisfaction. The superiority over the conventional approach cannot be discussed. Prospective and comparative studies analyzing the minimally invasive approach for treatment of intertrochanteric fractures with dynamic hip screw are still few.
CONCLUSION : the mini open provides a femoral get in less decaying and less bleeding, the intervention is faster, the surgical procedure is conducted in closed focus, continuity between vastus lateralis and medium gluteal remains intact.