1
|
Lv J, Li X, Qiu W, Ji J, Cao L, Li L, Zhang Y, Su Z. Effect of knee osteoarthritis on the postoperative outcome of proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in the elderly: a retrospective analysis. BMC Musculoskelet Disord 2023; 24:868. [PMID: 37940993 PMCID: PMC10631145 DOI: 10.1186/s12891-023-07012-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND The proximal femoral nail anti-rotation (PFNA) is a commonly used internal fixation system for intertrochanteric fractures (IFs) in older adults. Knee osteoarthritis (KOA) is a degenerative lower extremity disease that occurs most frequently in the elderly. Some patients have already had KOA before the IFs. However, whether KOA impacts the postoperative outcome of IFs has not been reported. OBJECTIVE This study aimed to investigate the effect of KOA on the fracture side on the outcome after PFNA for IFs in the elderly. METHODS Between January 2016 and November 2021, 297 elderly patients treated with PFNA for IFs were enrolled in this study. They were divided into two groups according to the American Rheumatism Association KOA clinical and radiographic criteria: the control group and the KOA group. Intraoperative bleeding, operative time, length of hospital stay, postoperative time out of bed, fracture healing time, postoperative complications, postoperative Harris hip function score, and Barthel ability to daily living Score were compared between the two groups. Follow-up was routinely scheduled at 1, 3, 6, and 12 months postoperatively. RESULTS Based on the exclusion criteria, 254 patients who met the requirements were left to be included in this study, including the control group (n = 133) and the KOA group (n = 121). Patients were followed up for a mean of 17.5 months (12-24 months). There was no significant difference between the two groups in preoperative demographic data, intraoperative blood loss, operation time, and length of stay in the hospital. The control group was statistically significant compared to the KOA group in terms of postoperative time out of bed (17.8 ± 4.0 days vs. 19.1 ± 5.8 days), fracture healing time (13.7 ± 2.2 weeks vs. 14.6 ± 3.7 weeks), and postoperative complications (12.8 vs. 23.1%). The Harris hip function score and Barthel ability to daily living score were higher in the control group than in the KOA group at 1, 3, 6, and 12 months postoperatively (the control group: 63.8 ± 10.9, 71.8 ± 10.3, 81.5 ± 8.7, and 91.6 ± 6.3 vs. The KOA group 61.0 ± 10.4, 68.6 ± 9.1, 79.0 ± 9.2, and 88.5 ± 5.9). CONCLUSIONS In elderly patients with IFs combined with KOA of the fracture side treated with PFNA internal fixation, KOA increases the incidence of postoperative complications of the fracture, prolongs postoperative time out of bed and fracture healing, and reduces postoperative hip function and ability to daily living. Therefore, treating KOA on the fractured side needs to be considered when treating IFs in the elderly.
Collapse
Affiliation(s)
- Jiaxing Lv
- Kaifeng Central Hospital, Orthopedic Ward 2, Kaifeng/ Henan, 475000, P. R. China
| | - Xiaolong Li
- Kaifeng Central Hospital, Orthopedic Ward 2, Kaifeng/ Henan, 475000, P. R. China
| | - Wenkui Qiu
- Kaifeng Central Hospital, Orthopedic Ward 2, Kaifeng/ Henan, 475000, P. R. China
| | - Jianjun Ji
- Kaifeng Central Hospital, Orthopedic Ward 2, Kaifeng/ Henan, 475000, P. R. China
| | - Lichao Cao
- Kaifeng Central Hospital, Orthopedic Ward 2, Kaifeng/ Henan, 475000, P. R. China
| | - Lei Li
- Kaifeng Central Hospital, Orthopedic Ward 2, Kaifeng/ Henan, 475000, P. R. China
| | - Yihong Zhang
- Kaifeng Central Hospital, Orthopedic Ward 2, Kaifeng/ Henan, 475000, P. R. China.
| | - Zhenyan Su
- Kaifeng Central Hospital, Orthopedic Ward 2, Kaifeng/ Henan, 475000, P. R. China.
| |
Collapse
|
2
|
Zhang ZL, Li XS, Zhao WQ, Huang JF, Zhu YH. Early surgical treatment of closed reduction and internal fixation for a 30-day old intertrochanteric fracture with hemiplegia after acute stroke: A case report. Medicine (Baltimore) 2023; 102:e34098. [PMID: 37352071 PMCID: PMC10289562 DOI: 10.1097/md.0000000000034098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/25/2023] Open
Abstract
RATIONALE Currently, there are no clear guidelines to determine whether and when to perform surgical hip repair in patients with acute stroke and hip fracture. PATIENT CONCERNS In this case report, we report a case of 75-year-old woman admitted with left hip pain and limited mobility for 1 month. DIAGNOSES Patient had a history of acute cerebral infarction 42 days ago, and diagnosed with a left intertrochanteric fracture at another hospital 30 days ago. INTERVENTION Patient was treated with closed reduction and internal fixation with proximal femoral nail anti-rotation. OUTCOMES At 2-year follow-up, the patient's basic function was restored. The fracture healed well, and the Harris hip score was 75. LESSONS Without consistent guidelines, individualized treatment strategies including surgical methods and timing of surgery should be made to weigh the risks and benefits for patients with acute stroke and intertrochanteric fractures.
Collapse
Affiliation(s)
- Zeng-Li Zhang
- Department of Orthopaedics and Traumatology, Songyang Hospital of Traditional Chinese Medicine, Songyang, China
| | - Xu-Song Li
- Department of Orthopaedics and Traumatology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China
| | - Wei-Qiang Zhao
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jie-Feng Huang
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Ya-Hong Zhu
- Emergency Center, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| |
Collapse
|
3
|
Nho JH, Seo GW, Kang TW, Jang BW, Park JS, Suh YS. Bipolar Hemiarthroplasty in Unstable Intertrochanteric Fractures with an Effective Wiring Technique. Hip Pelvis 2023; 35:99-107. [PMID: 37323545 PMCID: PMC10264230 DOI: 10.5371/hp.2023.35.2.99] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose Bipolar hemiarthroplasty has recently been acknowledged as an effective option for treatment of unstable intertrochanteric fracture. Trochanteric fragment nonunion can cause postoperative weakness of the abductor muscle and dislocation; therefore, reduction and fixation of the fragment is essential. The purpose of this study was to perform an evaluation and analysis of the outcomes of bipolar hemiarthroplasty using a useful wiring technique for management of unstable intertrochanteric fractures. Materials and Methods A total of 217 patients who underwent bipolar hemiarthroplasty using a cementless stem and a wiring technique for management of unstable intertrochanteric femoral fractures (AO/OTA classification 31-A2) at our hospital from January 2017 to December 2020 were included in this study. Evaluation of clinical outcomes was performed using the Harris hip score (HHS) and the ambulatory capacity reported by patients was classified according to Koval stage at six months postoperatively. Evaluation of radiologic outcomes for subsidence, breakage of wiring, and loosening was also performed using plain radiographs at six months postoperatively. Results Among 217 patients, five patients died during the follow-up period as a result of problems unrelated to the operation. The mean HHS was 75±12 and the mean Koval category before the injury was 2.5±1.8. A broken wire was detected around the greater trochanter and lesser trochanter in 25 patients (11.5%). The mean distance of stem subsidence was 2.2±1.7 mm. Conclusion Our wiring fixation technique can be regarded as an effective additional surgical option for fixation of trochanteric fracture fragments during performance of bipolar hemiarthroplasty.
Collapse
Affiliation(s)
- Jae-Hwi Nho
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Gi-Won Seo
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Tae Wook Kang
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Byung-Woong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Gumi, Gumi, Korea
| | - Jong-Seok Park
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, Korea
| | - You-Sung Suh
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
| |
Collapse
|
4
|
Çelen ZE, Gazi O. Distal fixation modular stem hemiarthroplasty versus proximal femoral nailing for unstable intertrochanteric fractures: a retrospective cohort study. Acta Orthop Belg 2022; 88:599-608. [PMID: 36791715 DOI: 10.52628/88.3.9875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The treatment of unstable intertrochanteric fractures (UITF) is a controversial issue in the current literature. The aim of this study was to compare the curative effects of distal fixation modular stem (DFMS) hemiarthroplasty with proximal femoral nailing (PFN) on UITFs in the elderly. From February 2017 to November 2019, 98 elderly (≥65 years) patients with UITF were included in this single-center retrospective cohort study. Mean follow-up duration was 24.1±11.9 months. Patients were divided into the DFMS group (52 patients) and the PFN group (46 patients). In the DFMS group, trochanteric fixation was performed using a trochanteric cable plate system. Primary outcome measures included Harris hip score (HHS), mobility score, implant related complications and mortality. Secondary outcome measures included hospitalization duration, surgical time and transfusion rate. Mean age of the patients was 78.7±7.2 years (65-96 years). DFMS group had longer surgical time, higher transfusion rates and longer hospital stays (p<0.05). Mean HHS was 80.7±10.5 and 81.9±12.2 in the DFMS group and PFN group, respectively. There was no statistically significant difference between the two groups in terms of HHS, mobility score and mortality. Implant failure rates were significantly higher in the PFN group (p=0.015). Implant failure, one year mortality and overall mortality rates were 0%, 15.4% and 17.3% in DFMS group and 10.9%, 15.2% and 19.5% in PFN group, respectively. Both surgical methods can be effectively used in the treatment of UITFs with similar satisfactory functional results and similar mortality rates. In addition, the DFMS group exhibited significantly lower implant failure rates and PFN group provided significantly lower surgical time duration, transfusion rate and hospital stay duration.
Collapse
|
5
|
Li X, Xu J. Comparison of proximal femoral nail antirotation and total hip arthroplasty in the treatment of femoral intertrochanteric fracture. Pak J Med Sci 2022; 38:1016-1020. [PMID: 35634608 PMCID: PMC9121941 DOI: 10.12669/pjms.38.4.5830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/06/2021] [Accepted: 02/08/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives To investigate the effects of proximal femoral nail antirotation (PFNA) and total hip arthroplasty for the treatment of femoral intertrochanteric fractures. Methods Clinical data from 110 femoral intertrochanteric fracture patients treated at our hospital between January 2019 and July 2020 were analyzed retrospectively. Patients were divided into two groups based on the type of surgical intervention used. One group included patients (n= 59) who had undergone PFNA internal fixation and another group (n=51) included patients who had undergone total hip arthroplasty. Perioperative situation, joint function progression, and complication incidence were assessed. Results Total hip arthroplasty group was associated with longer operation durations, longer incisions, and more intraoperative blood loss than PFNA group (P<0.05). Joint function and pain scores in the total hip arthroplasty group were superior than PFNA group (P<0.05). The Harris score of total hip arthroplasty group was significantly higher than that of PFNA group at three, six and 12 months after operation (P<0.05). The rate of complications in patients after total hip arthroplasty was lower than that of PFNA group (P<0.05) within 12 months of the surgery. Conclusion PFNA and total hip arthroplasty can both achieve good results for treatment of femoral intertrochanteric fractures. PFNA offers less trauma and shorter operations, while total hip arthroplasty offers advantages in terms of more rapid limb function improvements and shorter rehabilitation processes. The two kinds of surgery have advantages, and the clinical needs to have a careful look at various factors and choose the appropriate operation method.
Collapse
Affiliation(s)
- Xuejun Li
- Xuejun Li, Department of Orthopedics, Fuyang People’s Hospital, Fuyang 421002, Anhui Province, P.R. China
| | - Jian Xu
- Jian Xu, Department of Orthopedics, Fuyang People’s Hospital, Fuyang 421002, Anhui Province, P.R. China
| |
Collapse
|
6
|
Garg A, Kamboj P, Sharma PK, Yadav U, Siwach RC, Kadyan V. Evaluation of functional outcome and comparison of three different surgical modalities for management of intertrochanteric fractures in elderly population. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2022; 12:13-22. [PMID: 35309106 PMCID: PMC8918764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The purpose of this study was to compare the role of the various surgical modalities ie, Hemiarthroplasty (HA), Dynamic Hip Screw (DHS), Cephalo-medullary nail (CMN) in the management of intertrochanteric fractures in elder patients with comparison of the results and assessment of the complications encountered with each method. METHODS Total 105 adult patients having intertrochanteric fractures managed during July 2013 to December 2018 at tertiary trauma care centre and followed for minimum 12 months were included in the study. Patients were divided into three groups. Primary hemiarthroplasty was done in 35 patients (group A) while DHS and PFN was done in 35 patients each in group B and group C respectively. Functional evaluation was done using Modified Harris Hip score (HHS) at different intervals while ambulatory function was measured using the Parker Mobility Score. RESULTS The mean age of patients was 72.14±2.9 years. Mean operative time and blood loss in group A was significantly higher than the other two groups. Hemiarthroplasty group could ambulate earlier than DHS/PFN group. Mean HHS at final follow up was 85.40±7 in group A while in group B and group C these values were 76.36±16.45 and 86.85±10.52 respectively. HHS was significantly higher (P, 0.01) in hemiarthroplasty group in comparison to DHS group. Post-operative complications were comparable in all the groups. CONCLUSION We support the use of hemiarthroplasty for unstable intertrochanteric fracture in elderly patients with lesser failure rates, early mobilization and better functional outcomes. Early mobilization and less hospital stay should be the goal of every surgical procedure in the elder population.
Collapse
Affiliation(s)
- Abhishek Garg
- Department of Orthopaedics, PGIMS RohtakHaryana 124001, India
| | - Pradeep Kamboj
- Department of Orthopaedics, PGIMS RohtakHaryana 124001, India
| | - Pankaj Kumar Sharma
- Department of Orthopaedics, All India Institute of Medical SciencesBathinda 151001, Punjab, India
| | - Umesh Yadav
- Department of Orthopaedics, PGIMS RohtakHaryana 124001, India
| | | | - Virender Kadyan
- Department of Orthopaedics, Malik HospitalHansi, Haryana 125033, India
| |
Collapse
|
7
|
Mingke Zhou, Chen Y, Qian J, Zeng Y, Huang L, Zheng Y. Treatment of Coronal Plane Femoral Intertrochanteric Fractures with a Microexternal Fixator Combined with Proximal Femoral Nail Antirotation. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1735603. [PMID: 35083021 PMCID: PMC8786500 DOI: 10.1155/2022/1735603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/25/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the different efficacy of proximal femoral nail antirotation (PFNA) combined with or without a microexternal fixator in the treatment of coral-plane femoral intertrochanteric fractures. METHODS 120 patients with intertrochanteric coronal fractures who received treatment in four hospitals from February 2020 to February 2021 were retrospectively included in this study. They were divided into control (PFNA alone, n = 60) and combined treatment group (a microexternal fixator + PFNA, n = 60) according to different surgery methods. All patients were followed up for 6 months. Operative time, amount of intraoperative blood loss, postoperative length of hospital stays, fracture healing time, Harris hip score, modified Barthel index, hip function excellent and good rate, and incidence of complications were compared between the two groups. RESULTS There were no significant differences in operative time, amount of intraoperative blood loss, postoperative length of hospital stay, and incidence of complications between the two groups (all P > 0.05). Fracture healing time in the combined treatment group was significantly shorter than that in the control group (P < 0.05). After surgery, Harris hip score and modified Barthel index in each group were significantly increased compared with before surgery (both P < 0.05). The increases in Harris hip score and modified Barthel index in the combined treatment group were significantly greater than those in the control group (both P < 0.05). After surgery, Harris hip function excellent and good rate in the combined treatment group was significantly higher than that in the control group (83.33% > 66.67%, P < 0.05). CONCLUSION Compared with PFNA alone, a microexternal fixator combined with PFNA for the treatment of coronal plane femoral intertrochanteric fractures can greatly shorten fracture healing time and improve postoperative hip function and activities of living ability, but it cannot greatly increase operative time, the amount of intraoperative blood loss, or the risk of postoperative complications.
Collapse
Affiliation(s)
- Mingke Zhou
- Department of Orthopedics, Cangnan County Hospital of Traditional Chinese Medicine, Cangnan 325800, Zhejiang Province, China
| | - Yuan Chen
- Department of Orthopedics, Xinchang County Hospital of Traditional Chinese Medicine, Xinchang 312599, Zhejiang Province, China
| | - Jun Qian
- Department of Orthopedics, Jinhua Fifth People's Hospital, Zhejiang Province 321399, China
| | - Yunji Zeng
- Department of Orthopedics, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
| | - Liangshan Huang
- Department of Orthopedics, Cangnan County Hospital of Traditional Chinese Medicine, Cangnan 325800, Zhejiang Province, China
| | - Yuanlei Zheng
- Department of Orthopedics, Cangnan County Hospital of Traditional Chinese Medicine, Cangnan 325800, Zhejiang Province, China
| |
Collapse
|
8
|
Wang Y, Wang X, Jin L, Wei X. X-Ray Film under Artificial Intelligence Algorithm in the Evaluation for Nursing Effect of Gamma Nail Internal Fixation in Elderly Patients with Intertrochanteric Fracture of Femur. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:2562575. [PMID: 34887939 PMCID: PMC8651362 DOI: 10.1155/2021/2562575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/31/2021] [Accepted: 11/06/2021] [Indexed: 01/13/2023]
Abstract
The aim of this work was to explore the effects of Gamma nail internal fixation for intertrochanteric fracture of femur by X-ray film classification and recognition method based on artificial intelligence algorithm. The study subjects were 100 elderly patients with intertrochanteric fracture of femur admitted to hospital. The cases were diagnosed as elderly (over 60 years old) femoral intertrochanteric fractures by X-ray or CT. They were divided into two groups, with 50 persons in each group: one group used the X-ray film evaluation image guidance based on the artificial intelligence algorithm (research group), and the other group did not use algorithmic guidance (control group). The results showed that the segmentation effect of the proposed algorithm was similar to the gold standard segmentation result, indicating that the algorithm was effective and feasible in the segmentation of fractures and bones. The global level set algorithm was set as the control. The ultimate measurement accuracy (UMA) value of the algorithm group was (1.77 ± 0.22), and the UMA value of the global level set algorithm group was (3.42 ± 0.36), indicating that the image processed by the algorithm group had obvious numerical effect, high accuracy, and good retention of details. The operation time, intraoperative blood loss, incision length, hospital stay, weight-bearing time, and fracture healing time of the two groups were all better than those of the control group. One month after surgery, the Harris score of the algorithm group was 67, and that of the control group was 51, with a 16-point difference between the two groups (p < 0.05). The patient had less pain and fast recovery speed, indicating that it was a good way to treat elderly intertrochanteric fractures with the nursing effect of X-ray Gamma nail internal fixation based on an artificial intelligence algorithm. The artificial intelligence algorithm not only can be applied to the Gamma nail internal fixation of elderly patients with intertrochanteric fractures but also can be applied to the X-ray image processing of other fractures and other surgical methods to provide effective treatment for fracture patients.
Collapse
Affiliation(s)
- Yudi Wang
- Department of Kidney Disease and Endocrine Disease, Sichuan Science City Hospital, Mianyang, 621900 Sichuan, China
| | - Xin Wang
- Department of Nursing, Sichuan Science City Hospital, Mianyang, 621900 Sichuan, China
| | - Lei Jin
- Department of Nursing, Sichuan Science City Hospital, Mianyang, 621900 Sichuan, China
| | - Xuemei Wei
- Department of Nursing, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000 Sichuan, China
| |
Collapse
|
9
|
Jin Z, Xu S, Yang Y, Wei Y, Tian Y, Wang Z, Bai L. Cemented hemiarthroplasty versus proximal femoral nail antirotation in the management of intertrochanteric femoral fractures in the elderly: a case control study. BMC Musculoskelet Disord 2021; 22:846. [PMID: 34610813 PMCID: PMC8493738 DOI: 10.1186/s12891-021-04586-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Background The treatment for intertrochanteric femoral fractures (IFF) among the elderly has been a controversial topic. Hemiarthroplasty (HA) and proximal femoral nail antirotation (PFNA) have their own advantages in the management of IFF. Hence, this study aims to compare and analyze differences in the effectiveness of both procedures on IFF among the elderly. Methods Overall, 99 patients (81.09 ± 8.29 years; 68 women) underwent HA or PFNA from January 2016 to May 2020. IFF were classified according to the Arbeitsgemeins für Osteosynthesefragen (AO) classification. The difference in underlying diseases, the American Society of Anesthesiologists (ASA) grade, Singh index, Harris scores, surgical time, intraoperative bleeding, postoperative blood test results, postoperative number of days to partially bearing weight, and survival outcomes were analyzed. Postoperative follow-ups were performed every 3 months. Results There was no significant difference in the AO classification, underlying diseases, ASA grade, Singh index, surgical time, and survival outcomes of the HA (45 patients) group and PFNA group (54 patients). The HA group was associated with earlier partial weight-bearing (HA: 4 [2 ~ 4.5] days, PFNA: 10 [8~14] days). It also had a higher total Harris score than the PFNA group at the 6-month follow-up visit (HA: 86.8 [81.90 ~ 90.23], PFNA: 83.48 [75.13 ~ 88.23]). Harris scores decreased more in patients aged ≥90 years in the PFNA group than in the HA group. The postoperative stress recovery rate in the HA group was faster based on postoperative blood test results. Conclusions PFNA and HA have good therapeutic effects in the treatment of IFF. The advantages of HA were reflected in short-term weight bearing, faster recovery from stress, and better joint function in the long term. This advantage is more obvious in the patient population aged over 90 years. Therefore, we suggest that surgeons should consider the benefit of HA in the treatment of IFF among the elderly. Trial registration Chinese Clinical Trial Registry, ChiCTR2000035814. Registered 17 August 2020, https://www.chictr.org.cn/showproj.aspx?proj=57083
Collapse
Affiliation(s)
- Zhuangzhuang Jin
- China Medical University, Shenyang, Liaoning, China.,Department of Emergence Medicine, Shengjing Hospital Affiliated China Medical University, Shenyang, Liaoning, China
| | - Shuoyan Xu
- China Medical University, Shenyang, Liaoning, China.,Department of Nuclear medicine, The First Hospital Affiliated China Medical University, Shenyang, Liaoning, China
| | - Yue Yang
- China Medical University, Shenyang, Liaoning, China.,Department of Orthopedics, Shengjing Hospital Affiliated China Medical University, Heping District, 110004, Liaoning, China
| | - Yingliang Wei
- China Medical University, Shenyang, Liaoning, China.,Department of Orthopedics, Shengjing Hospital Affiliated China Medical University, Heping District, 110004, Liaoning, China
| | - Yicheng Tian
- China Medical University, Shenyang, Liaoning, China.,Department of Orthopedics, Shengjing Hospital Affiliated China Medical University, Heping District, 110004, Liaoning, China
| | - Ziyuan Wang
- China Medical University, Shenyang, Liaoning, China.,Department of Orthopedics, Shengjing Hospital Affiliated China Medical University, Heping District, 110004, Liaoning, China
| | - Lunhao Bai
- China Medical University, Shenyang, Liaoning, China. .,Department of Orthopedics, Shengjing Hospital Affiliated China Medical University, Heping District, 110004, Liaoning, China.
| |
Collapse
|
10
|
Martinho T, Stoffel K. Treatment of Intertrochanteric Femur Fractures with Hip Arthroplasty in Older Patients: A Narrative Review of Indications and Outcomes. MEDICINA-LITHUANIA 2021; 57:medicina57080763. [PMID: 34440969 PMCID: PMC8400749 DOI: 10.3390/medicina57080763] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/26/2021] [Indexed: 12/28/2022]
Abstract
Intertrochanteric femur fractures are common in older patients and often have a significant impact on disability. The treatment aims to achieve a rapid return to the prior functional level with a low rate of complications and mortality. Surgical management by internal fixation is the mainstay of treatment for most of these fractures. Even when treated with intramedullary nails, the overall complication rates are high, especially for unstable or highly comminuted fractures or in the presence of poor bone quality. Hip arthroplasty is an alternative in older patients with intertrochanteric femur fractures at high risk of fixation failure or with concomitant intraarticular pathologies. Especially patients whose condition precludes prolonged bedrest and who are at risk of significant deterioration if their locomotor function cannot be restored rapidly are likely to benefit from hip arthroplasty. The choice of the surgical technique mainly depends on the surgeon’s preferences and the fracture characteristics. Bipolar hemiarthroplasty is the most common type of prosthesis used with primary or revision femoral stems. Compared with intramedullary nails, hip arthroplasty has a better early functional outcome and lower rates of surgical complications as well as reoperations. However, the functional outcome and the mortality rate in the longer term tend to favor intramedullary nails, even though the results are inconsistent, and a statistically significant difference cannot always be obtained. Currently, there are no guidelines that define the role of hip arthroplasty in the treatment of intertrochanteric femur fractures in older patients. The literature only offers an overview of the possibilities of the usage of hip arthroplasty, but methodological limitations are common, and evidence levels are low. Further studies are needed to identify the intertrochanteric fractures that are at high risk of internal fixation failure, the characteristics that determine which patients may benefit most from hip arthroplasty, and the optimal surgical technique.
Collapse
Affiliation(s)
- Tiago Martinho
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Street 22, 81675 Munich, Germany;
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Correspondence:
| |
Collapse
|
11
|
Liang Y, Xu X, Sun X, Song C. Application of oxycodone combined with intravenous inhalation anesthesia in pfna internal fixation of femoral intertrochanteric fracture in the elderly. Minerva Surg 2021; 77:90-92. [PMID: 34160179 DOI: 10.23736/s2724-5691.21.08953-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- You Liang
- Department of Orthopaedics Surgery, Jinan Municipal Hospital of Traditional Chinese Medicine, Jinan, China
| | - Xiuyun Xu
- Seventh Ward, Jinan Municipal Hospital of Traditional Chinese Medicine, Jinan, China
| | - Xiaona Sun
- Department of Orthopaedics Surgery, Jinan Municipal Hospital of Traditional Chinese Medicine, Jinan, China
| | - Chuanmin Song
- Department of Anesthesiology, Jinan Municipal Hospital of Traditional Chinese Medicine, Jinan, China -
| |
Collapse
|
12
|
Outcome of unstable pertrochanteric fractures in high-risk geriatric treated with external fixators. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:867-874. [PMID: 34155571 DOI: 10.1007/s00590-021-03066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/17/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To review the outcome of high-risk geriatrics with unstable pertrochanteric fractures treated with external fixator. METHODS Eighteen consecutive patients with pertrochanteric fractures were operated with external fixator by using closed reduction technique. AO type, accompanying diseases, operating time, transfused blood units, duration of hospitalization, complications, healing time and mortality were recorded. Patients were followed clinically and radiologically for two years at least. The Harris Hip Score was used to document hip function at each regular follow-up. RESULTS Fifteen patients with average age of 71.5 years were available for final evaluation. The mean operating time was 41.1 min and union was achieved in all cases with an average time of 16 weeks. The mean Harris Hip Score at one, three, six, twelve and twenty-four months post-operatively was 42.07 ± 8.55; 55.07 ± 11.62; 70.07 ± 10.32; 86.27 ± 9.06 and 89.27 ± 8.81 respectively. Complications included all the patients undergoing loss of some motion in the knee and four of them had to experience revision surgery because of knee stiffness, ten cases of pin-tract infections, seven cases of deep venous thrombosis, two cases of migration of the screws and two cases limb shortening. CONCLUSIONS The use of external fixator in high-risk geriatric provided a satisfactory long-term efficacy, but the short-term functional results were quite unsatisfactory owing to high complication rate. Therefore, the advantages and disadvantages should be fully weighed when using external fixators, which was especially suitable for those patients who could not tolerate prolonged operative time and open surgery. LEVEL OF EVIDENCE IV Therapeutic study, level 4.
Collapse
|
13
|
Chen J, Yue C, He P, Huang Z, Li L, Zhang X, Fan Y, Liu Y. Comparison of clinical outcomes with hip replacement versus PFNA in the treatment of intertrochanteric fractures in the elderly: A systematic review and meta-analysis (PRISMA). Medicine (Baltimore) 2021; 100:e24166. [PMID: 33655910 PMCID: PMC7939162 DOI: 10.1097/md.0000000000024166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/10/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The purpose of this meta-analysis was to evaluate the clinical efficacy and safety of HR and PFNA in the treatment of intertrochanteric fractures in the elderly. METHODS We carried out this review according to the principle of preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline. The clinical randomized controlled trials (RCTs), prospective cohort studies, retrospective cohort studies (RCSs), and case-control studies involving HR and PFNA in the treatment of intertrochanteric fractures in the elderly from 2000 to 2020 were compared by searching Web of Science, Pubmed, the Cochrane Library, and Embase. The quality of the included cohort study (CS) lines was evaluated using the Newcastle-Ottawa Scale (NOS). The quality of the included RCT lines was evaluated using Jadad. Forest plots were drawn by RevMan5.4 software based on the results and the data were analyzed. RESULTS After screening, a total of 9 articles were included, of which one was a clinical RCT and eight were RCSs with 1374 patients. The operative time of the PFNA group was shorter [WMD = 15.20; 95% CI (13.17, 17.23), P < .05] and the intraoperative blood loss was less [WMD = 178.81; 95% CI (97.24, 260.38), P < .05] than the HR group, while the first weight-bearing time of the HR group was shorter [WMD = -7.70; 95% CI (-10.54, -4.86), P < .05] than the PFNA group. There was no significant difference in the length of hospital stay, HHS, postoperative orthopedic complications, and postoperative medical complications between the 2 groups. CONCLUSION With the development of HR technology and minimally invasive technology, the trauma caused by surgery is decreasing. Under the premise of improving perioperative management, such as optimizing the preoperative preparation and postoperative management, shortening the operative time, reducing intraoperative blood loss, and actively managing co-existing diseases, HR has more advantages than PFNA in the treatment of senile intertrochanteric fractures.
Collapse
Affiliation(s)
- Junming Chen
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Chen Yue
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Peilin He
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Zeling Huang
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Li Li
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Xue Zhang
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Yanan Fan
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Youwen Liu
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| |
Collapse
|
14
|
Agar A, Sahin A, Gunes O, Gulabi D, Erturk C. Comparison of Cementless Calcar-Replacement Hemiarthroplasty With Proximal Femoral Nail for the Treatment of Unstable Intertrochanteric Fractures at Older Age Group. Cureus 2021; 13:e12854. [PMID: 33633886 PMCID: PMC7897399 DOI: 10.7759/cureus.12854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: The aim of this study was to compare the outcomes of unstable intertrochanteric femur fractures treated with cementless calcar-replacement bipolar hemiarthroplasty (CRH) and proximal femoral nail (PFN) in elderly patients. Methods: All consecutive unstable intertrochanteric fractures treated with cementless CRH or PFN at our institution between January 2015 and January 2019 were reviewed retrospectively. The primary outcome measures were postoperative complications, reoperation rate, and hip function. The secondary outcome measures were intraoperative blood loss, transfusion rate, surgical time, hospital stay, and two- year mortality. Results: Ninety-four patients in the hemiarthroplasty group and 77 patients in the PFN group were included for analysis. There were no significant differences between the two groups regarding the complications, ASA score, and reoperation rate. Significant differences were found between hemiarthroplasty and PFN group in comparison of the average length of hospital stay (P < 0.05), time from hospitalization to operation (P < 0.05), intraoperative blood loss (P < 0.001), transfusion rate (P < 0.001), operation time (P < 0.001), Harris Hip Score (HHS; P < 0.001), and two-year mortality (P < 0.05). Conclusion: Both hemiarthroplasty and PFN produce satisfactory results in surgically treated unstable intertrochanteric femur fractures in the elderly. Both groups are associated with their own complications, but in the PFN group, better functional results, less surgery-related trauma, and lower mortality rates are the main advantages.
Collapse
Affiliation(s)
- Anıl Agar
- Orthopaedics and Traumatology Department, Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, TUR
| | - Adem Sahin
- Orthopaedics and Traumatology Department, Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, TUR
| | - Orhan Gunes
- Orthopaedics and Traumatology Department, Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, TUR
| | - Deniz Gulabi
- Orthopaedics and Traumatology Department, Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, TUR
| | - Cemil Erturk
- Orthopaedics and Traumatology Department, Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, TUR
| |
Collapse
|
15
|
Nie S, Li M, Ji H, Li Z, Li W, Zhang H, Licheng Z, Tang P. Biomechanical comparison of medial sustainable nail and proximal femoral nail antirotation in the treatment of an unstable intertrochanteric fracture. Bone Joint Res 2020; 9:840-847. [PMID: 33275035 PMCID: PMC9021899 DOI: 10.1302/2046-3758.912.bjr-2020-0284.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIMS Restoration of proximal medial femoral support is the keystone in the treatment of intertrochanteric fractures. None of the available implants are effective in constructing the medial femoral support. Medial sustainable nail (MSN-II) is a novel cephalomedullary nail designed for this. In this study, biomechanical difference between MSN-II and proximal femoral nail anti-rotation (PFNA-II) was compared to determine whether or not MSN-II can effectively reconstruct the medial femoral support. METHODS A total of 36 synthetic femur models with simulated intertrochanteric fractures without medial support (AO/OTA 31-A2.3) were assigned to two groups with 18 specimens each for stabilization with MSN-II or PFNA-II. Each group was further divided into three subgroups of six specimens according to different experimental conditions respectively as follows: axial loading test; static torsional test; and cyclic loading test. RESULTS The mean axial stiffness, vertical displacement, and maximum failure load of MSN-II were 258.47 N/mm (SD 42.27), 2.99 mm (SD 0.56), and 4,886 N (SD 525.31), respectively, while those of PFNA-II were 170.28 N/mm (SD 64.63), 4.86 mm (SD 1.66), and 3,870.87 N (SD 552.21), respectively. The mean torsional stiffness and failure torque of MSN-II were 1.72 N m/° (SD 0.61) and 16.54 N m (SD 7.06), respectively, while those of PFNA-II were 0.61 N m/° (SD 0.39) and 6.6 N m (SD 6.65), respectively. The displacement of MSN-II in each cycle point was less than that of PFNA-II in cyclic loading test. Significantly higher stiffness and less displacement were detected in the MSN-II group (p < 0.05). CONCLUSION The biomechanical performance of MSN-II was better than that of PFNA-II, suggesting that MSN-II may provide more effective mechanical support in the treatment of unstable intertrochanteric fractures. Cite this article: Bone Joint Res 2020;9(12):840-847.
Collapse
Affiliation(s)
- Shaobo Nie
- Department of Orthopaedics, First Medical Center, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Ming Li
- Department of Orthopaedics, First Medical Center, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Hui Ji
- Department of Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China
| | - Zhirui Li
- Department of Orthopaedics, First Medical Center, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Wenwen Li
- Department of Orthopaedics, First Medical Center, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Hao Zhang
- Department of Orthopaedics, First Medical Center, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Zhang Licheng
- Department of Orthopaedics, First Medical Center, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Peifu Tang
- Department of Orthopaedics, First Medical Center, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| |
Collapse
|
16
|
Liu B, Li A, Wang J, Wang H, Zhai G, Ma H, Lian X, Zhang B, Liu L, Gao Y. Cemented versus uncemented hemiarthroplasty for elderly patients with displaced fracture of the femoral neck: A PRISMA-compliant meta-analysis of randomized controlled trial. Medicine (Baltimore) 2020; 99:e21731. [PMID: 32872057 PMCID: PMC7437858 DOI: 10.1097/md.0000000000021731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND This meta-analysis was performed to incorporate newly published, high-quality randomized controlled trials (RCTs) to determine the effects of cemented versus uncemented hemiarthroplasty for elderly patients with displaced fracture of the femoral neck. METHODS The following electronic databases were extensively searched from the inception of the database through December 2018: EMBASE, Medline, the Cochrane Library, and Web of Science. RCTs focusing on the outcomes of cemented and uncemented hemiarthroplasty were reviewed and screened for eligibility. We used the Cochrane Collaboration's Review Manager Software to perform meta-analyses. Two independent reviewers extracted the data and assessed the study quality and bias risk through the Cochrane Collaboration tool. Use fixed effect model or random effect model to pooled data. Cochran's Q statistic was used to evaluate heterogeneity, and I statistic was used to quantify heterogeneity. RESULTS Fifteen RCTs were enrolled (n = 3790) (uncemented hemiarthroplasty group = 1015; cemented hemiarthroplasty group = 1037) (mean age ranged from 70-85.3 years; all patients > 65 years). The meta-analysis showed that cemented hemiarthroplasty has a longer operating time (weighted mean difference, 8.03; 95% confidence interval (CI) 4.83-11.23; P < .00001), less pain (odds ratio, 0.48; 95% CI 4.83-11.23; P = .02), lower mortality 1-year (odds ratio, 0.78; 95% CI 0.62-0.98; P = .03) and fewer implant-related complications (odds ratio, 0.20; 95% CI 0.13-0.30; P < .00001) than Uncemented hemiarthroplasty. However, there are still some limitations in our study, such as the uniformity of the surgery administration programme and rehabilitation scheme, and the small sample size of the included studies. CONCLUSIONS Cemented hemiarthroplasty for elderly patients with displaced fracture of femoral neck may acquire better functional results.
Collapse
|
17
|
Tu DP, Liu Z, Yu YK, Xu C, Shi XL. Internal Fixation versus Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fractures in the Elderly: A Systematic Review and Meta-Analysis. Orthop Surg 2020; 12:1053-1064. [PMID: 32691520 PMCID: PMC7454150 DOI: 10.1111/os.12736] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/03/2020] [Accepted: 06/03/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To evaluate the clinical efficacy of internal fixation versus hemiarthroplasty in the treatment of unstable intertrochanteric fractures in the elderly. METHODS A search was conducted in PubMed, Web of Science, Embase, and Cochrane Library databases up to April 2020. The present study compared internal fixation and hemiarthroplasty in the treatment of unstable intertrochanteric fractures in the elderly. RevMan5.3 software provided by the International Cochrane Group was used for the meta-analysis. To compare the differences in the operation time, intraoperative bleeding, length of hospital stay, superficial infection, Harris hip score, mortality within 1 year, mortality within 2 years, reoperation, incidence of deep venous thrombosis (DVT), partial weight-bearing time, non-union, and implant-related complications between an internal fixation group and an hemiarthroplasty group. RESULTS A total of 1300 patients were included in nine studies. The results showed that the operation time (MD = -18.09, 95% CI: -27.85--8.34, P = 0.0003), intraoperative bleeding (MD = -195.31, 95% CI: -244.8--147.74, P < 0.0001), implant-related complications (MD = 3.83, 95% CI: 1.74-8.45, P = 0.0008), and partial weight-bearing time (MD = 17.21, 95% CI: 1.63-32.79, P = 0.03) have statistical significance. However, there is not statistical significance for the Harris hip joint function scale (HHS) (MD = 5.60, 95% CI: -1.13-12.33, P = 0.10), DVT (MD = 1.02, 95% CI: 0.45-2.27, P = 0.97), length of hospital stay (MD = -1.08, 95% CI: -2.82-0.66, P = 0.22), superficial Infection (OR = 0.92, 95% CI: 0.43-1.98, P = 0.89), mortality within 1 year (OR = 0.95, 95% CI: 0.61-1.48, P = 0.81), mortality within 2 years (OR = 0.93, 95% CI: 0.61-1.43, P = 0.75), reoperation (MD = 1.80, 95% CI: 0.64-5.04, P = 0.26), and non-union (OR = 1.20, 95% CI: 0.48-3.03, P = 0.70). The result of the subgroup analysis showed no significant differences between the less than 2 years follow-up and the 2 years or more follow-up group. The only difference was for the Harris hip score: the internal fixation group was superior to the hemiarthroplasty group in the less than 2 years subgroup analysis, while there was no difference between the internal fixation group hemiarthroplasty group in the 2 years or more subgroup analysis. CONCLUSION Compared with the internal fixation group, those in the hemiarthroplasty group could carry out weight-bearing training early and implant-related complications were reduced, but it requires longer operation time and there is greater intraoperative blood loss. There is no difference in mortality, the incidence of DVT, non-union, HHS, reoperation, length of hospital stay, and superficial infection. Hemiarthroplasty may be a better choice for unstable intertrochanteric fractures in the elderly.
Collapse
Affiliation(s)
- Dong-Peng Tu
- Zhejiang Chinese Medical University, Second Clinical Medical College of Zhejiang Chinese Medical University, Zhejiang, China
- Department of Orthopaedics, Xinhua Hospital of Zhejiang Province, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zheng Liu
- Zhejiang Chinese Medical University, Second Clinical Medical College of Zhejiang Chinese Medical University, Zhejiang, China
| | - Yi-Kang Yu
- Zhejiang Chinese Medical University, Second Clinical Medical College of Zhejiang Chinese Medical University, Zhejiang, China
| | - Chao Xu
- Zhejiang Chinese Medical University, Second Clinical Medical College of Zhejiang Chinese Medical University, Zhejiang, China
- Department of Orthopaedics, Xinhua Hospital of Zhejiang Province, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiao-Lin Shi
- Department of Orthopaedics, Xinhua Hospital of Zhejiang Province, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| |
Collapse
|
18
|
Preventive strategy for the clinical treatment of hip fractures in the elderly during the COVID-19 outbreak: Wuhan's experience. Aging (Albany NY) 2020; 12:7619-7625. [PMID: 32379057 PMCID: PMC7244021 DOI: 10.18632/aging.103201] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/25/2020] [Indexed: 02/07/2023]
Abstract
Hip fractures in the elderly account for more than half of osteoporotic fractures and represent a substantial economic and social burden. Novel coronavirus pneumonia (COVID-19), which began to spread in December 2019, has created challenges in the management of elderly hip fracture patients, not only by influencing the choice of operation and postoperative rehabilitation methods, but also by generating new risks for the medical staff. During this period, our infection and orthopedic treatment unit in the center of the epidemic area effectively treated 82 elderly patients with hip fracture, and no cross-infection occurred. Therefore, our experience in prevention and treatment is worth recommending to frontline anti-epidemic personnel.
Collapse
|