Volume 6, Issue 1, January 2020, Page: 5-11
Comparative Analysis of Three Internal Fixation Methods for Intertrochanteric Fracture of Femur in the Elder
Junze Chen, Department of Orthopaedics, The People's Hospital of Baiyun District, Guangzhou, China
Yanfen Zheng, Department of Psychological Rehabilitation, Kunming Special Service Recuperation Center of the Army, Kunming, China
Yongji Xing, The PLA 74th Group Army Hospital, Guangzhou, China
Ye Lin, The PLA 74th Group Army Hospital, Guangzhou, China
Wen Zhong, The PLA 75th Group Army Hospital, Dali, China
Received: Jan. 12, 2020;       Accepted: Feb. 24, 2020;       Published: Mar. 10, 2020
DOI: 10.11648/j.ijcems.20200601.12      View  44      Downloads  33
Abstract
As the average life span of the Chinese prolongs, the number of intertrochanteric fractures of the femur in elderly patients has increased all the time, and gradually becomes a more common type of fracture in elderly patients. From January 2011 to December 2016, 137 elderly patients with intertrochanteric fractures were treated with 3 mehhods, including locking plate, proximal femoral nail (PFNA) and artificial femoral head replacement. The mean age was 79.16±3.45 years. The mean follow-up time was 17.20±1.30 months. The operative time, intraoperative bleeding volume, postoperative complications, and Harris score of the hip joint at 1 month and 1 year after surgery were compared among the three groups. Statistical analysis by SPSS 22.0 software showed that the operation time of group C was the shortest, followed by group B and group A. The difference was statistically significant (p<0.05). There was no significant difference in operation time between group A and group B (p>0.05); There was no significant difference in bleeding volume between the three groups (p>0.05). Group A had the lowest complication rate, followed by group C and group B. But there was no significant difference between the three groups (X2=0.0618, p>0.05). All the patients were cured and discharged after active symptomatic treatment. Among the patients, the mean Harris score of group A was 38.52±6.51 at 1-month follow up postoperatively; the mean Harris score of group B was 44.28±5.97 at 1-month follow up postoperatively; the mean Harris score of group C was 70.59±6.99 at 1-month follow up postoperatively, the C group was the best and the B group was the second. There was a significant difference between the three groups (p<0.05). The mean Harris score of group A was 84.40±9.34 at 1-year follow up postoperatively; the mean Harris score of group B was 83.12±8.76 at 1-year follow up postoperatively; the mean Harris score of group C was 85.25±8.07 at 1-year follow up postoperatively. There was no significant difference between the three groups (p>0.05). During the follow-up period, there was no loosening or breakage in the internal fixation, and the fracture healed well. This study concluded that locking plate, PFNA or artificial femoral head replacement can achieve satisfactory clinical results in elderly patients with intertrochanteric fractures, but artificial femoral head replacement can achieve early functional recovery, more conducive to elderly patients.
Keywords
Intertrochanteric Fractures, Locking Plate, Proximal Femoral Anti-rotation Intramedullary Nail, Artificial Femoral Head Replacement
To cite this article
Junze Chen, Yanfen Zheng, Yongji Xing, Ye Lin, Wen Zhong, Comparative Analysis of Three Internal Fixation Methods for Intertrochanteric Fracture of Femur in the Elder, International Journal of Clinical and Experimental Medical Sciences. Vol. 6, No. 1, 2020, pp. 5-11. doi: 10.11648/j.ijcems.20200601.12
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Cooper, C., Cole, Z. A., Holroyd, C. R. et al. Secular trends in the incidence of hip and other osteoporotic fractures [J]. Osteoporos Int (2011) 22: 1277.
[2]
Hui Z, Zeng X, Nan Z, et al. INTERTAN nail versus proximal femoral nail antirotation-Asia for intertrochanteric femur fractures in elderly patients with primary osteoporosis [J]. Journal of International Medical Research, 2017, 45 (4): 300060517710584.
[3]
Banaszkiewicz P A. Traumatic Arthritis of the Hip After Dislocation and Acetabular Fractures: Treatment by Mold Arthroplasty: An End-Result Study Using a New Method of Result Evaluation [M]// Classic Papers in Orthopaedics. Springer London, 2014: 349-362.
[4]
Kim J T, Kim H H, Kim J H, et al. Mid-Term Survivals After Cementless Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients. [J]. Journal of Arthroplasty, 2017.
[5]
Streubel P N, Moustoukas M J, Obremskey W T. Mechanical failure after locking plate fixation of unstable intertrochanteric femur fractures [J]. Journal of Orthopaedic Trauma, 2013, 27 (1): 22.
[6]
Aktselis, I., Kokoroghiannis, C., Fragkomichalos, E. et al. Prospective randomised controlled trial of an intramedullary nail versus a sliding hip screw for intertrochanteric fractures of the femur [J]. International Orthopaedics (SICOT) (2014) 38: 155.
[7]
C. Rogmark, O. Leonardsson; Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients [J]. Bone Joint J 2016; 98-B: 291–7.
[8]
Bakken, M. S., Engeland, A., Engesæter, L. B. et al. Risk of hip fracture among older people using anxiolytic and hypnotic drugs: a nationwide prospective cohort study [J]. Eur J Clin Pharmacol (2014) 70: 873.
[9]
Neuman MD, Silber JH, Magaziner JS, Passarella MA, Mehta S, Werner RM. Survival and Functional Outcomes After Hip Fracture Among Nursing Home Residents. JAMA Intern Med. 2014; 174 (8): 1273–1280.
[10]
Zimmerman M, Roberts K C, Brox W T. From Evidence to Application: AAOS Clinical Practice Guideline on Management of Hip Fractures in the Elderly. [J]. Journal of Orthopaedic Trauma, 2015, 29 (3): 119.
[11]
Jacques Boddaert, Mathieu Raux, Frédéric Khiami, Bruno Riou; Perioperative Management of Elderly Patients with Hip Fracture. Anesthesiology 2014; 121 (6): 1336-1341. doi: 10.1097/ALN.0000000000000478.
[12]
Roberts K C, Brox W T, Jevsevar D S, et al. Management of hip fractures in the elderly [J]. Journal of the American Academy of Orthopaedic Surgeons, 2015, 23 (2): 131.
[13]
Li, J., Cheng, L. & Jing, J. The Asia proximal femoral nail antirotation versus the standard proximal femoral antirotation nail for unstable intertrochanteric fractures in elderly Chinese patients. Orthopaedics & traumatology, surgery & research: OTSR 101, 143–146.
[14]
Owsley, Kevin C, Gorczyca, et al. Displacement/Screw Cutout After Open Reduction and Locked Plate Fixation of Humeral Fractures [J]. Jbjs, 2008, 90 (2): 233-240.
[15]
Zhang H, Zhu X, Pei G, et al. A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in elderly patients with osteoporosis: a minimum follow-up of 3 years [J]. Journal of Orthopaedic Surgery & Research, 2017, 12 (1): 147.
[16]
Lems W F, Dreinhöfer K E, Bischoff-Ferrari H, et al. EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures [J]. Annals of the Rheumatic Diseases, 2017, 76 (5).
[17]
Li M, Wu L, Liu Y, et al. Clinical evaluation of the Asian proximal femur intramedullary nail antirotation system (PFNA-II) for treatment of intertrochanteric fractures [J]. Journal of Orthopaedic Surgery & Research, 2014, 9 (1): 112.
[18]
Yu W, Zhang X, Zhu X, et al. Proximal femoral nails anti-rotation versus dynamic hip screws for treatment of stable intertrochanteric femur fractures: an outcome analyses with a minimum 4 years of follow-up [J]. Bmc Musculoskeletal Disorders, 2016, 17 (1): 1-6.
[19]
Haidukewych GJ, Israel TA, Berry DJ. Reverse obliquity fractures of the intertrochanteric region of the femur. [J]. Journal of Bone and Joint Surgery-American Volume, 2001, 83-A (5): 643-650.
[20]
Yang Y, Zhao X, Dong T, Yang Z, Zhang Q, Zhang Y (2017) Risk factors for postoperative delirium following hip fracture repair in elderly patients: a systematic review and meta-analysis. Aging Clin Exp Res 29: 115–126.
[21]
K J Sheehan, L Williamson, J Alexander, C Filliter, B Sobolev, P Guy, L M Bearne, C Sackley; Prognostic factors of functional outcome after hip fracture surgery: a systematic review, Age and Ageing, Volume 47, Issue 5, 1 September 2018, Pages 661–670.
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