Estudo comparativo entre a Via Lateral de Hardinge e o Acesso Minimamente Invasivo para o tratamento de fraturas intertrocantéricas com o Dynamic Hip Screw

Abstract

Background: Intertrochanteric fractures are a public health problem, frequently high in the elderly. It is an ideally surgical teatment condition which makes this, a disease associed associated with serious morbidity. The technique fixation must be reproducible, less agressive, with low medical complication rates and good functional results. The Dynamic Hip Screw (DHS) system is one of several implants options used worldwide for the treatment of these fractures, and its installation through MIPO approach (Minimally Invasive Plate Osteosynthesis) is poorly documented in world literature. Objectives: The objective of this study is to compare the fixation techniques of intertrochanteric fractures with DHS, using the Hardinge approach and a minimally invasive approach, while assessing pain levels, hematimetric loss, inflammatory alterations, as well as evaluating functional aspects in the immediate post-operative follow-up. Method: This is a randomized, double-blind clinical trial in which 70 patients underwent osteosynthesis by the DHS system. The patients were divided into a test group, in which the approach used was MIPO and one control, with the Hardinge approach. The MIPO’s group showed a lower degree of postoperative pain, compared to the group treated with the Hardinge approach. Results: The Hardinge approach group presented an elevation of approximately 2 points on the pain scale in the immediate post-operative follow-up, while the patients in the test group showed a drop of 3 points on this scale (p <0.01). This result was reflected in the lower consumption of opioid medication. Elevation of the operated limb in the immediate postoperative follow-up was achieved by 73% of the patients in the test group and by only 18% of the control group. Patients submitted to the minimally invasive treatment also had a lower rate of hematimetric loss. The intertrochantericfracturefixation using the DHS system, through a minimally invasive approach, was superior to the treatment with the traditional Hardinge approach. The patients presented lower hematimetric loss (p <0.01) and the degree of postoperative pain was considerably lower (p<0.01). Conclusions: Because this is a treatment associated with serious morbidity, a less aggressive surgical option during the procedure of the intertrochanteric fractures, should be considered. The minimally invasive approach was superior to the traditional Hardinge approach and should therefore be a trend in the treatment of these fractures.