Metabolic Shock in Elderly Pertrochanteric or Intertrochanteric Surgery. Comparison of Three Surgical Methods. Is there a Much Safer?

Comparison of proximal femoral nail antirotation internal fixation and artificial hip replacement for elderly patients with intertrochanteric fractures

OBJECTIVE

To compare the effects of proximal femoral nail antirotation (PFNA) internal fixation and artificial hip replacement (AHR) on serum inflammatory factors and hip function recovery in elderly patients with intertrochanteric fractures (IFs).

METHODS

One hundred and thirty patients with IFs who underwent surgery at the People's Hospital of Pingyang between July 2018 and July 2020 were enrolled. Sixty-five patients received PFNA internal fixation (fixation group) and 65 received AHR (replacement group). Surgical indicators and complications were recorded in both groups. The Harris Hip Scale was used to score hip joint function, the Visual Analog Scale (VAS) to assess pain, the MOS 36-Item Short-Form Health Survey (SF-36) to evaluate life quality, and enzyme-linked immunosorbent assay to measure serum tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and IL-1β.

RESULTS

The replacement group experienced notably shorter hospitalization times, less complete weight-bearing time, and earlier time to walk compared to the fixation group (all P<0.05). The replacement group also showed a lower incidence of poor fracture healing and complications (both P<0.05). Additionally, on postoperative days 3, 15, and 45, the replacement group had notably lower VAS scores (all P<0.05). Furthermore, the replacement group exhibited higher Harris Hip Scale scores at 1, 2, and 3 months post-surgery (all P<0.05). Higher postoperative SF-36 scores were also observed in the replacement group (P<0.05). On postoperative day 30, both groups presented decreases in TNF-α, IL-6, and IL-1β levels compared to preoperative levels, with even lower levels in the replacement group (all P<0.05).

CONCLUSIONS

AHR can help elderly patients with IFs ambulate earlier, speed up hip function recovery, reduce inflammation, and improve life quality with fewer postoperative complications, making it worthy of clinical promotion.

Analysis of the Surgical Outcomes in Elderly Patients with Hip Fractures Combined with Hemiplegia

Objective

This study aimed to investigate the surgical outcomes in elderly (age ≥65) patients with hip fractures combined with hemiplegia and compare them with the surgical outcomes in elderly patients with hip fractures but no hemiplegia.

Methods

A total of 761 elderly patients with hip fractures who were treated between January 2013 and December 2019 were enrolled in this study using a retrospective study design. The patients were divided into two groups: a hemiplegia group (77 cases, 10.1%) and a non-hemiplegia group (684 cases, 89.9%). Length of hospital stay, postoperative complications, 30-day and one-year mortalities, and one-year functional status were compared between the two groups.

Results

The average length of hospital stay in the hemiplegia group (13.51 ± 10.17 days) was longer than in the non-hemiplegia group (12.60 ± 7.83 days), but the difference was not statistically significant (P = 0.354). The incidence of postoperative complications in patients with hemiplegia (28.6%, 22/77) was higher than in patients without hemiplegia (15.4%, 105/684), and the difference was statistically significant (P = 0.003). The 30-day and one-year mortalities in the hemiplegia group were higher than in the non-hemiplegia group (30 days after surgery: 10.4%, 8/77 vs 4.5%, 31/684; one year after surgery: 29.9%, 23/77 vs 15.2%, 104/684), and the difference was statistically significant (30 days after surgery: P = 0.027; one year after surgery: P = 0.001). One year after surgery, the average activity of daily living score was 56.02 ± 9.63 in the hemiplegia group and 76.89 ± 8.40 in the non-hemiplegia group, and the difference was statistically significant (P = 0.000).

Conclusion

Hemiplegia can increase the incidence of postoperative complications and 30-day and one-year mortalities in patients with hip fractures.

Effect of proximal femoral nail antirotation on clinical outcome, inflammatory factors and myocardial injury markers in patients with femoral trochanteric fracture

OBJECTIVE

To compare the differences between proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) in treatment of femoral trochanteric fracture and analyze the factors influencing recovery after PFNA treatment.

METHODS

Eighty-six patients with femoral trochanteric fracture admitted to Taizhou Hospital of Traditional Chinese Medicine between January 2019 and June 2021 were enrolled in the study and assigned into a PFNA group and DHS group (n=43 in each group) before undergoing these treatments. The clinical efficacy, inflammatory factors, and myocardial injury markers were compared between the two groups. The influencing factors on recovery after PFNA treatment were analyzed by univariate and multivariate analysis.

RESULTS

Compared to the DHS group, the PFNA group had shorter surgical time, length of stay in hospital, postoperative weight-bearing time, time of healing and detumescence, and less intraoperative blood loss (all P<0.001). The incidence of post-surgical complications with PFNA was lower than with DHS (P<0.05). The serum levels of interleukin-6, C-reactive protein and tumor necrosis factor-αof the PFNA group were lower than those of the DHS group (all P<0.05). Moreover, the serum levels of cardiac troponin T, creatine kinase-MB and myoglobin in the PFNA group were also lower than for the DHS (all P<0.05). At the first, third, and sixth months after surgery, the Harris scores for PFNA were higher than for DHS (all P<0.05). The univariate and multivariate analysis showed that instability of fracture, history of osteoporosis, excessive intraoperative bleeding, poor compliance with rehabilitation exercise, and long time from injury to surgery were risk factors for poor recovery following PFNA treatment for patients with femoral trochanteric fracture.

CONCLUSION

Compared to DHS, PFNA had better clinical efficacy and gave lower serum levels of inflammatory factors and myocardial injury markers. Fracture classification, history of osteoporosis, intraoperative amount of bleeding, compliance of rehabilitation exercise, and time from injury to surgery were closely associated with recovery following PFNA treatment.