Abstract
As the age profile of our population expands, we can expect subsequent increase in patients presenting with intracapsular fracture. The onus remains on the surgeon to make all reasonable efforts to find new and innovative means of reducing associated morbidity and mortality of the treatment of these injuries. This challenge is particularly relevant in the elderly and in patients with multiple co-morbidities. In this study, 100 patients were randomly allocated into two groups. One group had dissection to the level of the hip joint under direct diathermy control; the other group had dissection using a scalpel with supplementary electrocautery. Intraoperative total blood loss prior to dissection of the abductors was measured by collecting blood using wound swabs using a local protocol and results were statistically analysed using PROC GLM SAS. We demonstrate a clear advantage in the use of diathermy to create a hip incision showing a significant reduction in wound-related blood loss and a reduction, whilst not statistically significant, in total operative blood loss using diathermy incision. Larger randomised prospective trials are necessary to study the effects of this intervention in a larger patient population so that these end-points can be adequately assessed.
Résumé
Avec le vieillissement de notre population, nous pouvons nous attendre à une augmentation corrélative des patients présentant une fracture intracapsulaire du col du fémur.. C’est une importante responsabilité chirurgicale que de faire tous les efforts raisonnables afin de trouver de nouveaux et innovateurs moyens pour réduire la morbidité et la mortalité associées au traitement de ces lésions. Ce défi est particulièrement approprié pour les personnes âgées et pour les patients présentant des comorbidités multiples. Dans cette étude, cent patients ont été aléatoirement répartis dans deux groupes. Un groupe a bénéficié d’un abord de l’articulation coxo-fémorale par diathermie d’emblée; l’autre groupe a bénéficié d’une dissection à l’aide d’un bistouri avec électrocoagulation complémentaire. La perte totale peropératoire de sang avant la dissection des abducteurs a été mesurée en rassemblant le sang à l’aide de tampons et en utilisant un protocole local et les résultats ont été statistiquement analysés en utilisant PROC GLM SAS. Nous démontrons un avantage clair dans l’utilisation de la diathermie pour l’incision de hanche montrant une réduction significative de la perte de sang dans la plaie, ainsi qu’une réduction, celle-ci par contre statistiquement non significative, de la perte effective totale de sang en utilisant l’incision par diathermie. De plus grandes études randomisées sont nécessaires pour étudier les effets de cette intervention dans une plus grande population de patients afin que ces limites puissent être évaluées de façon exacte.
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Acknowledgments
The authors of this article greatly acknowledge the assistance of Dr. Sinéad Waters with all aspects of the statistical work in this study.
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Byrne, F.J., Kearns, S.R., Mulhall, K.J. et al. Diathermy versus scalpel incisions for hemiarthroplasty for hip fracture: a randomised prospective trial. Eur J Orthop Surg Traumatol (2007). https://doi.org/10.1007/s00590-007-0220-6
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DOI: https://doi.org/10.1007/s00590-007-0220-6