Estudo das complicações no tratamento das fraturas transtrocanterianas do fêmur utilizando pino deslizante extramedular com técnica minimamente invasiva, Sistema Minus / Treatment of transtrochanteric fractures of the femur complications associated with the use of extramedullar slidind pin and minimally invasive Minus System techique

AUTOR(ES)
FONTE

IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia

DATA DE PUBLICAÇÃO

19/12/2011

RESUMO

INTRODUCTION: The surgical treatment of intertrochanteric fractures is still controversial, resulting in further studies. Many papers have appeared in reference to the advantages of minimal invasive procedures for these fractures. The aim of this study was to evaluate the complications of a minimal invasive procedure using a specific implant and instruments developed for the treatment of intertrochanteric fractures (Minus System). MATERIAL AND METHOD: One hundred and seventy two patients with intertrochanteric fractures of the femur were studied, and submitted to treatment with the Minus System. Fifty two patients were excluded from the study as they did not fulfil all criteria for inclusion. The initial protocol registered gender, age, operative details such as length of operation, length of fluoroscopy use, quality of reduction and fixation of the fracture. The clinical parameters considered included deambulatory ability, pain, Tronzo fracture classification and anesthesia risk according to ASA classification. Complications were divided into two groups: general complications (infection and mortality rate) and specific complications (implant migration, loss of reduction and non-union). Although the migration of a sliding nail has not been considered in the literature as a DHS complication (Hrubna e Skotak, 2010)1 RESULTS: There were 93 feminine cases (77.5%) prevailing on 27 masculine cases (22.5%). Age span was 52 to 95 years, with an average of 80.06 years (standard deviation of 7.87 years). The average age for men was 76.19 years with a standard deviation of 8.321. The average age for women was 81.18 years with a standard deviation of 7.407. The average operative length of time was 39.35 minutes (25 to 65 minutes). The average time of fluoroscopy was 1min 7sec (0.6 to 2min 3sec). Fracture reduction was considered adequate in 92 cases (76.6%), , in the present study it was taken into account. It is important to mention that migration here is the lateral impaction of the fracture without loss of reduction. when alignment with weight-bearing axis was obtained, valgus in 20 cases (16.6%) and varus in eight cases (6.6%). The average Tip Apex Distance (TAD) on an anteroposterior view was 1.19cm (variation of 0.2 to 2.52 cm) and lateral view was 1.14cm (variaton of 0.3 to 2.52cm). One hundred and twelve patients (93,3%) were able to walk with postoperative pain (average of 4.4 on a pain scale of 0 to 10). The classification of the 120 patients is as follows: 11 patients with Tronzo I (9,1%), 24 cases of Tronzo II (20%), 58 Tronzo III (48.3%), seven Tronzo III variant (5.8%) and 20 Tronzo IV (16.7%). Unstable fractures occured in 85 (70.8%) patients, and 74 (61.6%) were over 75 years of age. There were 35 stable fractures (29.1%), with 17 patients (14.1%) over 75 years of age. As to the anesthesia risk eight (6.6%) were classified as ASA I, 33 (27.5%) ASA II, 74 (61.6%) ASA III and five patients as ASA IV (4.16%). There was one case of infection (0.83%). During the first postoperative year there were 13 deaths (10.8%). Of these, one patient (0.83%) had been classified as ASA II, five (4.16%) as ASA III and seven (5.83%) as ASA IV. There were 36 patients (30%) with complications out of 85 patients with unstable fractures, with loss of reduction in seven (5.88%) and migration of the sliding nail in 29 (24.1%). In the group of 35 stable fractures there were complications in four cases (3.3 %), with loss of reduction in one case (0.83%) and migration in three (2.5%). The total number of migrations was 33 (27.5%), but resulted in union in all patients. The loss in reduction occurred in eight patients (6.7%) and non-union in one case (0.83%). CONCLUSION: The minimal invasive procedure, the Minus System, is a safe procedure, that provides adequate surgery with a low incidence of complications, when compared to other existing techniques.

ASSUNTO(S)

minimally invasive fêmur - fratura ortopedia cirurgia ortopédica dispositivos de fixação ortopédica procedimento cirurgico minimamente invasivo femoral fractures orthopedics orthopedic sugery orthopedic fixation devices surgical procedures

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