AN EVALUATION OF ENDOPROSTHESIS AND PERTROCHANTERIC EXTERNAL FIXATOR RESULTS IN ELDERLY INTERTROCHANTERIC FEMORAL FRACTURES

Ekrem Aydın, Ali Ateş

Abstract


Objective:In this study, 14-month clinical outcomes of the endoprosthesis and pertrochanteric external fixator application are retrospectively evaluated in elderly patients with pertrochanteric fractures.

Patients and Method: A total of 45 patients of 65 years old and older (25 females and 20 males) with a mean age of 78.1, who were treated due to intertrochanteric femur fracture between November 2013 and December 2014 and whose controls could be made were included in this study. The deaths that occurred within the postoperative 1 year were not included in the study. 28 patients with endoprosthesis as Group I, and 17 patients with pertrochanteric external fixator as Group II were evaluated.

Results: Table 2 shows the clinical evaluation results of the patients according to different criteria by the groups. The mean operation time was 45 min in Group I and 20 min in Group II. The external fixator application time is significantly shorter. The mean hospital stay was 14 days for Group I and 10 days for Group II. The hospital stay period of the external fixator group is 4 days shorter.

While 7 patients were taken into the intensive care unit in Group I postoperatively, only 1 patient was taken into the same unit in Group II. This difference was significantly in favor of the external fixator group.

While 14 patients in Group I needed a preoperative and postoperative blood transfusion, no patient needed blood transfusions in Group II. External fixator application is significantly more advantageous in terms of patient hemodynamics.

The mean time to postoperatively move the extremity independently in the bed was 24 hours in Group I and 36 hours in Group II.

All patients were exposed to the Harris hip scoring  in the postoperative 12. month (the fixator was removed for the external fixator group)

Conclusion: In addition to internal fixation options and endoprosthesis applications in elderly intertrochanteric femoral fractures, an external fixator may also be a good treatment alternative with appropriate patient selection and proper application in accordance with the technique thanks to its short surgical time, less blood loss and easy applicability.


Keywords


Elderly patient, proximal femoral fracture

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References


Olson SA, Schemitsch G, Morwood M, Schemitsch E, Russell TA., Latta LL. Hot topics in biomechanics: hip fracture fixation. J Orthop Trauma. 2015; 29(suppl 12): S1-5.

Russell TA, Browne TD, Jacofsky M, Chang J, Angle SR, YetkinleD et al. The problem of fracture fixation augmentation and description of a novel technique and implant for femoral neck stabilization.Techniques in Orthopaedics. 2015; 30(1): 22-7.

Srinivas K, Raghunandan G, Ramana Y, Rajaiah D, Kumar PK, Omkaram S et al. A study on surgical management of intertrochanteric and subtrochanteric fractures of femur by proximal femoral nail. Journal of Evidence-based Medicine and Healthcare. 2015;2(3): 228-35.

Sharma H, Loomba DS. Comparison of outcome of management of unstable pertrochanteric femoral fractures with dynamic hip screw and proximal femoral nail. African Journal of Trauma. 2015;4(1): 21.

Aydın E, Dulgeroglu TC, Metineren H.Bilateral simultaneous intertrochanteric fractures of femur without major trauma. Int Med Case Rep J.2015; 8: 137-9.

Bridle SH, Patel AD, Bircher M, Calvert PT.Fixation of intertrochanteric fractures of the femur. A randomized prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br.1991; 73(2): 330-4.

Gupta SV, Valisetti VS.Comparative study between dynamic hip screw vs proximal femoral nailing in inter-trochanteric fractures of the femur in adults. Int. J. Orthod. Sci. 2015; 1(1): 7-11.

Kazemian GH, Manafi AR, Najafi F, Najafi MA. Treatment of intertrochanteric fractures in elderly high-risk patients: Dynamic hip screw vs. external fixation. Injury. 2014;45(3): 568-72.

Ozkaya U, Parmaksızoglu AS, Gul M, Kabukcuoglu Y, Ozkazanlı G, Basılgan S. Osteoporotik yaslı hastalarda pertrokanterik kırıkların eksternal fiksasyonla tedavisi. Acta Orthop Traumatol Turc. 2008;42(4):246-51.

Von Roth P, Abdel MP, Harmsen WS, Berry DJ. Cemented bipolar hemiarthroplasty provides definitive treatment for femoral neck fractures at 20 years and beyond. Clin Ortho Relat Res. 2015; 473(11): 3595-9.

Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. Orthopedic Trauma Directions. 2007; 5(1): 29-31.

Inal S, Taspinar F, Gulbandilar E, Gok K.Comparison of the biomechanical effects of pertrochanteric fixator and dynamic hip screw on an intertrochanteric femoral fracture using the finite element method. The International Journal of Medical Robotics and Computer Assisted Surgery.2015; 11(1): 95-103.

Kesmezacar H, Ogut T, Bilgili MG, Gokay S, Tenekecioglu Y. Yaşlılarda intertrokanterikfemur kırıklarının tedavisi: İnternal tespit mi, hemiartroplasti mi. Acta OrthopTraumatol Turc.2005; 39(4):287-94.

Edipoglu E, Bilgili MG, Sarı C, Basaran SH, Kural C, Avkan MC. Geriatrik hastalardaki intertrokanterik femur kırıklarının eksternal fiksatorle tedavisi. Med J Bakirkoy 2013; 9(1): 28-32.

Vossinakis IC, Badras LS. The external fixator compared with the sliding hip screw for pertrochanteric fractures of the femur. Bone Joint J.2002; 84(1): 23-9.

Moroni A, Faldini C, Pegreffi F, Hoang-Kim A, Vannini F, Giannini S. Dynamic hip screw compared with external fixation for treatment of osteoporotic pertrochanteric fractures. J Bone Joint Surg Am. 2005;87(4): 753-9.

Ferreira N, Marais LC. Prevention and management of external fixator pin track sepsis. StrategiesTrauma Limb Reconstr.2012; 7(2): 67-72.

Leaper D, Ousey K. Evidence update on prevention of surgical site infection. Curr Opin Infect Dis.2015; 28(2): 158-63.

Ciortea V, Irsay L, Borda IM, Onac I, Ungur R. Correlation of periprosthetic bone mineral density and skeletal bone mineral density values in patients with total hip arthroplasty. Palestrica of the Third Millennium Civilization&Sport. 2014;15(1):11-5.

Zhao J, Zhang J, Ji X, Li X, Qian Q, Xu Q. Does intramedullary canal irrigation reduce fat emboli? A randomized clinical trial with transesophageal echocardiography. The Journal of arthroplasty.2015; 30(3), 451-5.




DOI: http://dx.doi.org/10.24125/sanamed.v14i3.369

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