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Harna B, Kapoor A, Verma T, Sabat D. Cemented bipolar hemiarthroplasty for unstable intertrochanteric fracture in elderly patients over 70 years: Boon or bane? Eur J Orthop Surg Traumatol 2024; 34:1449-1456. [PMID: 38240826 DOI: 10.1007/s00590-023-03819-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/20/2023] [Indexed: 04/02/2024]
Abstract
INTRODUCTION The surgical management of intertrochanter femur fracture in elderly patient is still under debate. Various implants can be utilised but prosthetic replacement is gaining popularity. This study was performed to evaluate the functional and clinical outcomes of cemented bipolar arthroplasty as a primary treatment for unstable intertrochanteric fracture in elderly patients (> 70 years). MATERIALS AND METHODS Thirty-seven patients with unstable intertrochanteric fracture in elderly patient (> 70 years) who underwent cemented bipolar hemiarthroplasty. Intra-operative and post-operative complications were noted; functional outcomes were assessed using Harris hip score (HHS). All patients were followed up for a minimum of 12 months. RESULTS Overall 90% of patients has some minor or major intra or post-operative complication. One year mortality rate was 16% (6/37). Cardiopulmonary events were the most common life threatening incident. Mean fall in Haemoglobin was 1.6 gm/dL. The average time for full weight bearing mobilisation with the help of walker was 2.8 ± 1.2 days (1-8 days). The average duration of surgery was 58 ± 6 min (44-96 min) with an average blood loss of 126 ± 24 mL (90-380 mL). HHS at the end of 12 months was 77. CONCLUSIONS The use of bipolar hemiarthroplasty in senile patient with unstable hemiarthroplasty gives an advantage of early weight bearing. However, it is associated with risk of significant intra or post-operative morbidity due to intra-operative trauma, surgical time and blood loss during the surgery. Although hemiarthroplasty can be a single-time solution to the complexities of intertrochanter fracture in elderly patients but should be performed in selected patients only.
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Affiliation(s)
- Bushu Harna
- Department of Orthopaedics, Indus Hospital, Mohali, India
| | - Anil Kapoor
- Department of Orthopaedics, IVY Hospital, Mohali, India.
| | - Tarun Verma
- Department of Orthopaedics, Medical college Baroda and SSG Hospital, Vadodara, India
| | - Dhananjaya Sabat
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
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Rashid RH, Zahid M, Mariam F, Ali M, Moiz H, Mohib Y. Effectiveness of Proximal Femur Nail in the Management of Unstable Per-Trochanteric Fractures: A Retrospective Cohort Study. Cureus 2024; 16:e58078. [PMID: 38738121 PMCID: PMC11088713 DOI: 10.7759/cureus.58078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 05/14/2024] Open
Abstract
Background Intertrochanteric (IT) fractures in the elderly demand surgical intervention for optimal recovery. While dynamic hip screw (DHS) is standard for stable fractures, its use in unstable cases is debated. Proximal femur nail (PFN) addresses unstable per-trochanteric fractures, boasting biomechanical advantages. Many studies favor PFN over DHS, despite concerns like screw migration. In resource-constrained developing nations, the choice of implant is pivotal. This research assesses proximal femur nailing outcomes for unstable fractures, providing insights for regional orthopedic protocols and contributing to tailored treatment guidelines in contexts with limited resources. Objective To assess the clinical and radiological outcomes in patients undergoing proximal femur nailing for unstable per-trochanteric fractures. Material and Methods This retrospective single-arm cohort study was conducted from January 2020 to July 2022. All the consecutive patients who underwent PFN for unstable per-trochanteric fractures were included in this study. Harris Hip Score (HHS) and ambulation status were recorded to evaluate functional outcomes. In contrast, the radiological outcome was assessed by calculating Radiographic Union Score for Hip (RUSH) scores at six weeks, three months, and six months post-operatively. Results A total of 48 patients were included in this study with equal gender distribution and a mean age of 66 years. The functional outcome was recorded with 2.1% (1), 33.3% (16), and 50% (24) of patients achieving full weight bearing (FWB) without pain at six weeks, three months, and six months respectively while 14.6% (7) of the patients never achieved FWB. The radiological outcome was assessed by calculating RUSH score with 6.3% (3), 43.8% (21), and 50% (24) of the patients achieving complete union at the end of six weeks, three months, and six months respectively. One patient (2.1%) experienced malunion. Conclusion PFN remains an optimal treatment modality for the fixation of unstable per-trochanteric fractures yielding promising functional and radiological outcomes.
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Affiliation(s)
- Rizwan H Rashid
- Orthopedic Surgery, Aga Khan University Hospital, Karachi, PAK
| | - Marij Zahid
- Orthopedics and Traumatology, Aga Khan University Hospital, Karachi, PAK
| | - Fizzah Mariam
- Orthopedic Surgery, Aga Khan University Hospital, Karachi, PAK
| | - Moiz Ali
- Orthopedic Surgery, Aga Khan University Hospital, Karachi, PAK
| | - Hassan Moiz
- Orthopedic Surgery, Aga Khan University Hospital, Karachi, PAK
| | - Yasir Mohib
- Orthopedic Surgery, Aga Khan University Hospital, Karachi, PAK
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Mohammed Hassan Elbahri H, Ali Aydrouce Ahmed M, Omer Elgaili Yousif Y, Mohammed Ali Abd-Elmaged H. Quality of Life After Proximal Femoral Fractures Treated With Gamma Nail in Sudan. Cureus 2024; 16:e55702. [PMID: 38586703 PMCID: PMC10998661 DOI: 10.7759/cureus.55702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Background Hip fracture is a public health problem globally, and it poses one of the biggest challenges in healthcare due to its associated complications. Objectives The aim of this study is to investigate the quality of life in adult patients in Khartoum State, Sudan, after they have undergone treatment using a gamma nail for proximal femoral fractures. Methodology This cross-sectional descriptive hospital-based study was conducted at Ibrahim Malik, Omdurman, and Bahri Teaching Hospitals over six months, from April to October 2022. The data were collected using an interview questionnaire that covered relevant aspects of the study. The data were analyzed using IBM SPSS Statistics for Windows, V. 26.0 (IBM Corp., Armonk, NY). The study was approved by the Sudan Medical Specialization Board, and ethical clearance was obtained. Results The study included 37 patients. More than half of the patients (59.5%, n=22) were women. The mean age of cases was 66.7 years (standard deviation, ±15.6). The mean time from the time of the fracture to the time of surgery was eight days (±15). Twenty-three (62.2%, n=23) (JRB1) of the patients started weight bearing on the second postoperative day. Regarding the health-related quality of life, 21.6% of the patients had a good health-related quality of life, 67.6% had a fair health-related quality of life, and 10.8% had a poor health-related quality of life. None of the patients reported an excellent quality of life. Based on the Oxford Hip Score, 54.1% of the patients had satisfactory joint function, 29.7% had mild to moderate hip joint function, 13.5% had moderate to severe hip joint function disturbance, and one patient (2.7%) had severe hip joint function problems. Conclusion In this study, the vast majority of the patients who underwent gamma nail surgery for hip fracture had quality of life scores in the fair to good range afterward. The results indicate that nailing is associated with good outcomes regarding quality of life and is an acceptable option for femoral fracture surgeries in Sudan.
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Steffann F, Rubens-Duval B, Huten D. Should trochanteric fractures in elderly patients be treated by arthroplasty or internal fixation? Orthop Traumatol Surg Res 2024; 110:103778. [PMID: 38040114 DOI: 10.1016/j.otsr.2023.103778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 12/03/2023]
Abstract
Most trochanteric fractures are treated by fixation, most often intramedullary. Nevertheless, the desire to have patients walk as soon as possible and the fear of fixation failure has driven some surgeons to carry out an arthroplasty instead, especially for unstable fractures and/or in patients with severe osteoporosis, in order to avoid the difficult conversion to arthroplasty later on if the fixation fails. The aim of this review was to specify the role, technique and results of performing arthroplasty in this context. In which fractures? Unstable fractures (A2.2, A2.3 and A3), especially in osteoporotic bone, which are the most difficult to reduce and fix, and in cases with associated osteoarthritis. For which patients? Arthroplasty should not be done in patients who have ASA≤3 due to greater blood loss and longer operative time. Since the postoperative Parker score often drops, arthroplasty should not be done in patients having a Parker score<6. What are the technical problems? Arthroplasty must be done by an experienced surgeon because of the lack of anatomical landmarks, although fracture fixation has its own demands (satisfactory reduction, appropriate length and position of cervicocephalic screw). What are the results and complications? Despite several comparative studies (randomized trials, meta-analysis and prospective studies), it is difficult to draw any conclusions. These studies show worse performance of dynamic hip screws relative to intramedullary nails. The complication and revision rates were higher for nails than arthroplasty, but not in every study, while the functional outcomes with nails (with or without immediate weightbearing) were better than those of arthroplasty beyond 6 months. What is the mortality rate? It was lower after nailing in a few studies but was mainly determined by the patient's comorbidities and preoperative Parker score. The best indication for arthroplasty may be self-sufficient patients over 70 years of age who have an unstable fracture with severe osteoporosis. Nevertheless, new studies should be done to compare arthroplasty to nailing with immediate return to weightbearing in patients having the same type of fracture, defined using 3D CT scan. Level of evidence: Expert advice.
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Affiliation(s)
- François Steffann
- Clinique des Cèdres, 5, rue des Tropiques, Parc sud Galaxie, 38130 Échirolles, France.
| | - Brice Rubens-Duval
- Service de chirurgie de l'arthrose et du sport, urgences traumatiques des membres, hôpital Sud, CHU de Grenoble-Alpes, avenue de Kimberley, 38130 Échirolles, France
| | - Denis Huten
- Service de chirurgie orthopédique et réparatrice, hôpital Pontchaillou, CHU de Rennes, 2, rue H.-Le-Guilloux, 35000 Rennes, France
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Ghasemi F, Esmaeilnejad-Ganji SM, Manafi Rasi A, Afzal S, Baroutkoub M, Tavassoli M. Evaluation of quality of life and associated factors in patients with intertrochanteric femoral fracture. PLoS One 2023; 18:e0293686. [PMID: 37988350 PMCID: PMC10662741 DOI: 10.1371/journal.pone.0293686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/17/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Intertrochanteric fracture is a common injury among the elderly, causing fundamental lifestyle derangements, influencing the patients' social and psychological functioning. We aimed to study the quality of life (QoL) and its different parameters in patients with this type of injury. MATERIALS AND METHODS In this cross-sectional study, all patients hospitalized with intertrochanteric fracture aged above 50 from 2020 to 2022 at the Shahid Beheshti Hospital in Babol, Iran, were included. Patients were primarily managed surgically and, in exceptional cases non-surgically, were followed up for at least 12 months after receiving treatment. During the follow-up period, patients were dialled and completed a questionnaire to assess the patient's QoL by the 36-item Short Form Health Survey (SF-36). QoL parameters were analyzed based on patients' sex, age, type of treatment, and height of fall causing fracture. RESULT A total number of 200 patients, including 101 (50.5%) males and 99 (49.5%) females, with a mean age of 74.76±11.36 years (range: 50-99), were included. Regarding the received treatment, 192 (96.0%) patients underwent surgery, and 8 (4.0%) underwent non-surgical treatment. In the study of SF-36 scores, the mean score of male patients was 42.31±14.58, and females scored 37.83±15.35, and the difference was statistically significant (P = 0.04). The mean score of QoL and its subscales among the 50-75 group patients was significantly higher than the 76-99 group (P<0.001). The average score of QoL was considerably higher in patients who had surgery (40.75±14.57) compared to those who had non-surgical treatment (24.30±19.85) (P = 0.01). Patients having a fall from a higher height had higher QoL after treatment. CONCLUSION This study revealed that patients with an intertrochanteric femoral fracture had poor QoL in all aspects. The overall QoL was significantly higher among male patients, younger patients, those who underwent surgical treatment, and the falls from higher heights. These findings highlight the necessity of long-term follow-up and support in patients with intertrochanteric fractures.
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Affiliation(s)
- Fatemeh Ghasemi
- Department of Orthopedic and Trauma Surgery, Babol University of Medical Sciences, Babol, Iran
| | | | - Alireza Manafi Rasi
- Department of Orthopedic and Trauma Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Afzal
- Department of Orthopedic and Trauma Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Baroutkoub
- Department of Orthopedic and Trauma Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Tavassoli
- Department of Orthopedic and Trauma Surgery, Babol University of Medical Sciences, Babol, Iran
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Wang Z, Gu F, Xu S, Yue Y, Sun K, Nie W. Intramedullary Nail or Primary Arthroplasty? A System Review and Meta-Analysis on the Prognosis of Intertrochanteric Femoral Fractures Based on Randomized Controlled Trials. Geriatr Orthop Surg Rehabil 2022; 13:21514593221118212. [PMID: 35967750 PMCID: PMC9364206 DOI: 10.1177/21514593221118212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/29/2022] [Accepted: 07/18/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction There is no consensus regarding the superiority between intramedullary nailing and
primary arthroplasty in the management of intertrochanteric femoral fractures. This
systematic review was performed to investigate and compare the clinical efficacy of
intertrochanteric femoral fractures treated with these 2 methods. Materials and methods We systematically searched PubMed, Embase, Cochrane, Web of science core collection and
ClinicalTrials.gov for randomized controlled trials which compared the clinical outcomes
of intertrochanteric fractures treated with either intramedullary nails or primary
arthroplasty. Relevant data of the postoperative complications, reoperations, mortality
and functional assessment, were pooled and presented graphically. Results A total of 6 trials with 427 participants were identified and included in the analyses.
The pooled estimates suggested these 2 techniques have comparable risks in terms of
overall complications (pooled risk ratio [RR] .80; 95% confidence interval [CI] .43 to
1.43; I2 = 79.94%), the rate of patients with orthopedic complications (RR
.71, 95% CI .40 to 1.27; I2 = .00%), reoperations (RR 1.33, 95% CI .48 to
3.71; I2 = .00%), the overall mortality (RR .52; 95%CI .26 to 1.02;
I2 = 31.35%) and 1-year mortality (RR .67; 95%CI .38 to 1.19; I2
= .00%). Primary arthroplasty associated with higher HHS at 3 months postoperatively (MD
-21.95, 95% CI -28.29 to −15.60; I2 = 70.44%). While the difference was not
significant at 6 months (MD 2.32, 95% CI -1.55 to 6.18; I2 = .00%), and even
reversed at 12 months postoperatively (MD 13.02, 95% CI 8.14 to 17.90; I2 =
73.42%). Conclusions Meta-analytic pooling of current evidences demonstrated that primary arthroplasty is
related to a better early functional recovery at the early stage postoperatively, but
the long-term result tends to favor to intramedullary nailing. The differences in
overall complications, the rate of patients with orthopedic complications, reoperations,
overall and 1-year mortality did not reach a significant level.
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Affiliation(s)
- Zhaojun Wang
- Department of Orthopedic Surgery, Lianyungang No. 2 People's Hospital, Lianyungang, Jiangsu, China
| | - Fei Gu
- Department of Orthopedic Surgery, Lianyungang No. 2 People's Hospital, Lianyungang, Jiangsu, China
| | - Shizhuang Xu
- Department of Orthopedic Surgery, Lianyungang No. 2 People's Hospital, Lianyungang, Jiangsu, China
| | - Yang Yue
- Department of Orthopedic Surgery, Lianyungang No. 2 People's Hospital, Lianyungang, Jiangsu, China
| | - Kefu Sun
- Department of Orthopedic Surgery, Lianyungang No. 2 People's Hospital, Lianyungang, Jiangsu, China
| | - Wei Nie
- Department of Orthopedic Surgery, Lianyungang No. 2 People's Hospital, Lianyungang, Jiangsu, China
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Cici H, Bektas YE, Demirkiran ND, Ozmanevra R. Primary Arthroplasty or Internal Fixation in Intertrochanteric Femur Fractures: A Survey of Surgical Attitudes of Orthopedic Surgeons in Turkey. Geriatrics (Basel) 2022; 7:18. [PMID: 35200523 PMCID: PMC8872122 DOI: 10.3390/geriatrics7010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to examine the primary arthroplasty attitudes of Turkish orthopedics and traumatology specialists and residents to patients with intertrochanteric fractures, of various ages, comorbidity situations and fracture types, using an internet-based questionnaire. Between March and April 2021, a cross-sectional survey was conducted with a total of 159 orthopedics and traumatology specialists and residents in Turkey, using an online questionnaire that consisted of 16 different patient scenarios of varying intertrochanteric fracture types, ages, and comorbidity conditions. Respondents’ preference ratio for primary arthroplasty was 24.1% in the scenarios with patients over the age of 71, while it was 8.4% in the scenarios with patients aged between 50 and 70. The ratios of primary arthroplasty preference were 12.4%, 21% and 27.3% in 2-part, 3-part and 4-part fracture scenarios, respectively. The primary arthroplasty preferences of respondents with 10 years or more of professional experience were observed to be statistically significantly different to those of the respondents with 1 to 10 years of experience in the 4-part fracture scenario where the patient was aged 71 years and above with an ASA (American Society of Anesthesiologists) score of 3–4 (p < 0.05). Despite varying opinions in the literature in recent years, primary arthroplasty can be considered a valuable alternative approach for Turkish surgeons, and in older adult patients with unstable intertrochanteric fractures, particularly those who need early mobilization and have high ASA scores.
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Lewis SR, Macey R, Lewis J, Stokes J, Gill JR, Cook JA, Eardley WG, Parker MJ, Griffin XL. Surgical interventions for treating extracapsular hip fractures in older adults: a network meta-analysis. Cochrane Database Syst Rev 2022; 2:CD013405. [PMID: 35142366 PMCID: PMC8830342 DOI: 10.1002/14651858.cd013405.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hip fractures are a major healthcare problem, presenting a challenge and burden to individuals and healthcare systems. The number of hip fractures globally is rising. The majority of extracapsular hip fractures are treated surgically. OBJECTIVES To assess the relative effects (benefits and harms) of all surgical treatments used in the management of extracapsular hip fractures in older adults, using a network meta-analysis of randomised trials, and to generate a hierarchy of interventions according to their outcomes. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, Web of Science and five other databases in July 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs comparing different treatments for fragility extracapsular hip fractures in older adults. We included internal and external fixation, arthroplasties and non-operative treatment. We excluded studies of hip fractures with specific pathologies other than osteoporosis or resulting from high-energy trauma. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion. One review author completed data extraction which was checked by a second review author. We collected data for three outcomes at different time points: mortality and health-related quality of life (HRQoL) - both reported within 4 months, at 12 months and after 24 months of surgery, and unplanned return to theatre (at end of study follow-up). We performed a network meta-analysis (NMA) with Stata software, using frequentist methods, and calculated the differences between treatments using risk ratios (RRs) and standardised mean differences (SMDs) and their corresponding 95% confidence intervals (CIs). We also performed direct comparisons using the same codes. MAIN RESULTS We included 184 studies (160 RCTs and 24 quasi-RCTs) with 26,073 participants with 26,086 extracapsular hip fractures in the review. The mean age in most studies ranged from 60 to 93 years, and 69% were women. After discussion with clinical experts, we selected nine nodes that represented the best balance between clinical plausibility and efficiency of the networks: fixed angle plate (dynamic and static), cephalomedullary nail (short and long), condylocephalic nail, external fixation, hemiarthroplasty, total hip arthroplasty (THA) and non-operative treatment. Seventy-three studies (with 11,126 participants) with data for at least two of these treatments contributed to the NMA. We selected the dynamic fixed angle plate as a reference treatment against which other treatments were compared. This was a common treatment in the networks, providing a clinically appropriate comparison. We downgraded the certainty of the evidence for serious and very serious risks of bias, and because some of the estimates included the possibility of transitivity owing to the proportion of stable and unstable fractures between treatment comparisons. We also downgraded if we noted evidence of inconsistency in direct or indirect estimates from which the network estimate was derived. Most estimates included the possibility of benefits and harms, and we downgraded the evidence for these treatments for imprecision. Overall, 20.2% of participants who received the reference treatment had died by 12 months after surgery. We noted no evidence of any differences in mortality at this time point between the treatments compared. Effect estimates of all treatments included plausible benefits as well as harms. Short cephalomedullary nails had the narrowest confidence interval (CI), with 7 fewer deaths (26 fewer to 15 more) per 1000 participants, compared to the reference treatment (risk ratio (RR) 0.97, 95% CI 0.87 to 1.07). THA had the widest CI, with 62 fewer deaths (177 fewer to 610 more) per 1000 participants, compared to the reference treatment (RR 0.69, 95% CI 0.12 to 4.03). The certainty of the evidence for all treatments was low to very low. Although we ranked the treatments, this ranking should be interpreted cautiously because of the imprecision in all the network estimates for these treatments. Overall, 4.3% of participants who received the reference treatment had unplanned return to theatre. Compared to this treatment, we found very low-certainty evidence that 58 more participants (14 to 137 more) per 1000 participants returned to theatre if they were treated with a static fixed angle plate (RR 2.48, 95% CI 1.36 to 4.50), and 91 more participants (37 to 182 more) per 1000 participants returned to theatre if treated with a condylocephalic nail (RR 3.33, 95% CI 1.95 to 5.68). We also found that these treatments were ranked as having the highest probability of unplanned return to theatre. In the remaining treatments, we noted no evidence of any differences in unplanned return to theatre, with effect estimates including benefits as well as harms. The certainty of the evidence for these other treatments ranged from low to very low. We did not use GRADE to assess the certainty of the evidence for early mortality, but our findings were similar to those for 12-month mortality, with no evidence of any differences in treatments when compared to dynamic fixed angle plate. Very few studies reported HRQoL and we were unable to build networks from these studies and perform network meta-analysis. AUTHORS' CONCLUSIONS: Across the networks, we found that there was considerable variability in the ranking of each treatment such that there was no one outstanding, or subset of outstanding, superior treatments. However, static implants such as condylocephalic nails and static fixed angle plates did yield a higher risk of unplanned return to theatre. We had insufficient evidence to determine the effects of any treatments on HRQoL, and this review includes data for only two outcomes. More detailed pairwise comparisons of some of the included treatments are reported in other Cochrane Reviews in this series. Short cephalomedullary nails versus dynamic fixed angle plates contributed the most evidence to each network, and our findings indicate that there may be no difference between these treatments. These data included people with both stable and unstable extracapsular fractures. At this time, there are too few studies to draw any conclusions regarding the benefits or harms of arthroplasty or external fixation for extracapsular fracture in older adults. Future research could focus on the benefits and harms of arthroplasty interventions compared with internal fixation using a dynamic implant.
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Affiliation(s)
- Sharon R Lewis
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Richard Macey
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Joseph Lewis
- c/o Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Jamie Stokes
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - James R Gill
- Department of Trauma and Orthopaedics, Cambridge University Hospitals, Cambridge, UK
| | - Jonathan A Cook
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - William Gp Eardley
- Department of Trauma and Orthopaedics, The James Cook University Hospital, Middlesbrough, UK
| | - Martyn J Parker
- Department of Orthopaedics, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, UK
| | - Xavier L Griffin
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
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Hongku N, Woratanarat P, Nitiwarangkul L, Rattanasiri S, Thakkinstian A. Fracture fixation versus hemiarthroplasty for unstable intertrochanteric fractures in elderly patients: A systematic review and network meta-analysis of randomized controlled trials. Orthop Traumatol Surg Res 2022; 108:102838. [PMID: 33529729 DOI: 10.1016/j.otsr.2021.102838] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 10/03/2020] [Accepted: 10/08/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION There are three common types of operative options for unstable intertrochanteric fracture (ITF), i.e. dynamic hip screw (DHS), proximal femoral nail (PFN), and bipolar hemiarthroplasty (BHA). Results of these operations are still inconclusive. This systematic review and network meta-analysis was therefore conducted to compare the efficacy among those operative strategies. HYPOTHESIS These three operative techniques (i.e., DHS, PFN, and BHA) were not different in operative failure, reoperation, and Harris Hip Score (HHS) for unstable ITF. MATERIAL AND METHODS Randomized controlled trials (RCTs) comparing outcomes among DHS, PFN, and BHA in patients with unstable ITFs were searched from Medline and Scopus databases. Primary outcomes included operative failure, reoperation, and HHS. Direct meta-analysis (DMA) and network meta-analysis (NMA) were performed to compare among three operative techniques. Qualitative and quantitative evidences of all included studies were tested for heterogeneity, transitivity, and consistency in NMA. The surface under the cumulative ranking curve (SUCRA) was used to estimate the probability of being the best in lowering poor clinical outcomes, but high HHS. RESULTS Seven RCTs (n=528) were eligible. DMA showed that DHS and PFN were significantly higher risk of operative failure compared with BHA with risk ratio (RR) and 95% confidence interval of 7.98 (1.35, 47.06) and 3.08 (1.00, 9.51), respectively. Compared with BHA, PFN was 4.47 (1.04, 21.60) times significantly higher risk of reoperation, and lower HHS at 3-6months [mean difference (MD)=-5.41 (-15.91, 5.10)], but higher HHS at>6-12months [MD 11.67 (2.98, 20.36)], although these HHSs were not significant. NMA and SUCRA demonstrated the highest ranks for operative failure and reoperation were DHS and PFN, whereas the highest HHS was BHA. DISCUSSION In specific group of unstable ITF, BHA might be the best operative technique in term of lower operative failure and reoperation, and highest HHS during short to intermediate period comparing with PFN and DHS. However, PFN had higher long-term HHS than BHA. LEVEL OF EVIDENCE I, meta-analysis of RCTs.
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Affiliation(s)
- Natthapong Hongku
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Patarawan Woratanarat
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Lertkong Nitiwarangkul
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasivimol Rattanasiri
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Chen WH, Guo WX, Gao SH, Wei QS, Li ZQ, He W. Arthroplasty vs proximal femoral nails for unstable intertrochanteric femoral fractures in elderly patients: A systematic review and meta-analysis. World J Clin Cases 2021; 9:9878-9888. [PMID: 34877326 PMCID: PMC8610898 DOI: 10.12998/wjcc.v9.i32.9878] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/27/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Proximal femoral nails (PFNs) are the most common method for the treatment of unstable intertrochanteric femoral fractures (IFFs), but postoperative bed rest is required. There is a large amount of blood loss during the operation. Osteoporosis in elderly patients may cause nonunion of fractures and other complications. Arthroplasty can give patients early weight bearing and reduce financial burden, but whether it can replace PFNs remains controversial.
AIM To compare the clinical outcomes of arthroplasty and PFNs in the treatment of unstable IFFs in elderly patients.
METHODS A search was conducted in the PubMed, Embase, and Cochrane Library databases and included relevant articles comparing arthroplasty and PFN. The search time was limited from January 1, 2005 to November 1, 2020. Two investigators independently screened studies, extracted data and evaluated the quality according to the inclusion and exclusion criteria. According to the research results, the fixed effect model or random effect model were selected for analysis. The following outcomes were analyzed: Harris Hip score, mortality, complications, operation time, blood loos, hospital stay, weight-bearing time, fracture classification and type of anesthesia.
RESULTS We analyzed four randomized controlled trials that met the requirements. A total of 298 patients were included in these studies. According to the AO/OTA classification, there are 20 A1 types, 136 A2 types, 42 A3 types and 100 unrecorded types. Primary outcome: The Harris Hip Score at the final follow-up of the PFN group was higher [mean difference (MD): 9.01, 95% confidence interval (CI): 16.57 to 1.45), P = 0.02]. There was no significant difference between the two groups in the rate of overall mortality [risk ratio (RR): 1.44, P = 0.44] or the number of complications (RR: 0.77, P = 0.05). Secondary outcomes: blood loss of the arthroplasty group was higher (MD: 241.01, 95% CI: 43.06–438.96, P = 0.02); the operation time of the PFN group was shorter (MD: 23.12, 95%CI: 10.46–35.77, P = 0.0003); and the length of hospital stay of the arthroplasty group was shorter [MD: 0.97, 95% CI: 1.29 to 0.66), P < 0.00001]. There was no difference between the two groups in the type of anesthesia (RR: 0.99). There were only two studies recording the weight-bearing time, and the time of full weight bearing in the arthroplasty group was significantly earlier.
CONCLUSION Compared with PFN, arthroplasty can achieve weight bearing earlier and shorten hospital stay, but it cannot achieve a better clinical outcome. Arthroplasty cannot replace PFNs in the treatment of unstable IFFs in elderly individuals.
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Affiliation(s)
- Wen-Huan Chen
- The Third Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Wen-Xuan Guo
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Shi-Hua Gao
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Qiu-Shi Wei
- Department of Joint Surgery, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Zi-Qi Li
- Department of Joint Surgery, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Wei He
- Department of Joint Surgery, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
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Martinho T, Stoffel K. Treatment of Intertrochanteric Femur Fractures with Hip Arthroplasty in Older Patients: A Narrative Review of Indications and Outcomes. Medicina (Kaunas) 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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:
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Lin TC, Wang PW, Lin CT, Chang YJ, Lin YJ, Liang WM, Lin JCF. Primary hemiarthroplasty after unstable trochanteric fracture in elderly patients: mortality, readmission and reoperation. BMC Musculoskelet Disord 2021; 22:403. [PMID: 33941152 PMCID: PMC8091504 DOI: 10.1186/s12891-021-04277-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/14/2021] [Indexed: 12/26/2022] Open
Abstract
Background Most unstable trochanteric fractures are treated with internal fixation and often with high complication rates. Hemiarthroplasty might be an alternative method in difficult condition, especially in unstable comminuted fracture in fragile bone. However, few have investigated the long-term outcomes after hemiarthroplasty for unstable trochanteric fracture. We conducted a population-based retrospective cohort study of trochanteric fracture after primary hemiarthroplasty using competing risk analysis on their long-term outcomes, including mortality, readmission and reoperation. Methods We studied a total of 2798 patients over 60 years old, with a mean age of 79 years, of which 68% are females and 67.23% have at least one comorbidity. They underwent a hemiarthroplasty for unstable trochanteric fracture during the period between January 1, 2000 and December 31, 2010 and were follow-up until the end of 2012, or death. Survival analysis and Cox model were used to characterize mortality. Competing risk analysis and Fine and Gray model were used to estimate the cumulative incidences of the first readmission and the first reoperation. Results The follow-up mortality rate for 1-year was 17.94%; 2-year, 29.76%; 5-year, 56.8%; and 10-year, 83.38%. The cumulative incidence of the first readmission was 16.4% for 1-year and 22.44% for 3-year. The cumulative incidence of the first reoperation was 13.87% for 1-year, 18.11% for 2-year, 25.79% for 5-year, and 38.24% for 10-year. Male gender, older age, higher Charlson Comorbidity Index (CCI) and lower insured amount were all risk factors for the overall mortality. Older age and higher CCI were risk factors for the first readmission. Older age was a protective factor for reoperation, which is likely due to the competing death. Conclusions The mortality and revision rates after hemiarthroplasty for unstable trochanteric fracture are acceptable as a salvage procedure for this fragile sub-population. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04277-7.
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Affiliation(s)
- Tzu-Chieh Lin
- Department of Public Health, China Medical University, Taichung, Taiwan.,Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pin-Wen Wang
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chun-Teng Lin
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Rd, Taichung, 406040, Taiwan
| | - Yu-Jun Chang
- Big Data Center, Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Ying-Ju Lin
- Genetic Center, Proteomics Core Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Miin Liang
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Rd, Taichung, 406040, Taiwan.
| | - Jeff Chien-Fu Lin
- Department of Statistics, National Taipei University, No.67, Sec. 3, Ming-Shen E. Rd, Taipei, 10478, Taipei, Taiwan. .,Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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Zeng J, Ye J, Xie Y, Chen C, Lin Z. [Effect of screw blade position on proximal femoral nail anti-rotation internal fixation for unstable intertrochanteric fractures in the elderly]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020; 34:569-573. [PMID: 32410422 DOI: 10.7507/1002-1892.201909069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effect of the screw blade position on the effectiveness of proximal femoral nail anti-rotation (PFNA) internal fixation for unstable intertrochanteric fractures in the elderly. Methods A clinical data of 131 elderly patients with unstable intertrochanteric fractures who were treated with PFNA internal fixation between January 2010 and January 2017 was retrospectively analyzed. According to the anteroposterior X-ray films, the screw blades were placed in the middle of the femoral neck in 72 patients (group A) and at one-third of the femoral neck in 59 patients (group B). There was no significant difference between the two groups ( P>0.05) in the gender, age, bone density, classification of fractures, other medical diseases, and the time between injury and operation. Multiple treatment indexes were analyzed, including complications, hip Harris score, the healing status of fracture, tip-apex distance (TAD), and the height of the tail nail. Results All patients were followed up 11-14 months, with an average of 12.1 months. All incisions healed by first intention with no complications. All fractures healed and no significant difference in bone healing time between the two groups ( Z=-0.190, P=0.849). At 6 months after operation, TAD was (2.23±0.07) cm in group A and (2.85±0.12) cm in group B, showing significant difference ( t=-47.643, P=0.000); and the height of the tail nail was (1.72±0.14) cm in group A and (0.53±0.26) cm in group B, showing significant difference ( t=31.031, P=0.000). According to the Harris score, the hip functions were rated as excellent in 48 cases, good in 15 cases, and poor in 9 cases in group A, while as excellent in 38 cases, good in 16 cases, and poor in 5 cases in group B, with no significant difference between the two groups ( Z=-0.075, P=0.941). Conclusion For the unstable intertrochanteric fracture in the elderly, the PFNA internal fixation with appropriated TAD and the screw blades placed in the middle or at one-third of the femoral neck can obtain good effectiveness.
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Affiliation(s)
- Jinyuan Zeng
- Department of Orthopaedic Trauma, the First Affiliated Hospital of Fujian Medical University, Trauma Center of Fujian, Fuzhou Fujian, 350005, P.R.China
| | - Junjian Ye
- Department of Orthopaedic Trauma, the First Affiliated Hospital of Fujian Medical University, Trauma Center of Fujian, Fuzhou Fujian, 350005, P.R.China
| | - Yun Xie
- Department of Orthopaedic Trauma, the First Affiliated Hospital of Fujian Medical University, Trauma Center of Fujian, Fuzhou Fujian, 350005, P.R.China
| | - Chunyong Chen
- Department of Orthopaedic Trauma, the First Affiliated Hospital of Fujian Medical University, Trauma Center of Fujian, Fuzhou Fujian, 350005, P.R.China
| | - Zhangxiong Lin
- Department of Orthopaedic Trauma, the First Affiliated Hospital of Fujian Medical University, Trauma Center of Fujian, Fuzhou Fujian, 350005, P.R.China
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Ekinci Y, Gürbüz K, Batın S, Kahraman M, Doğar F, Kaya Erten Z. A multicenter intertrochanteric fracture study in the elderly: Hemiarthroplasty versus proximal femoral nailing. Jt Dis Relat Surg 2020; 31:209-17. [PMID: 32584716 DOI: 10.5606/ehc.2020.72421] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/05/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives
This study aims to compare the clinical and functional results of intertrochanteric femoral fractures treated with bipolar hemiarthroplasty (BHA) or proximal femoral nailing (PFN) in elderly patients. Patients and methods
This multicenter, prospectively followed-up, retrospectively compared cohort-type study included 308 patients (81 males, 227 females; mean age 78.4±7.2 years; range, 65 to 95 years) who were treated with BHA or PFN for intertrochanteric fractures by five orthopedic surgeons in four provinces and seven clinics between January 2014 and May 2018. Clinical follow-up was performed at third week, third and sixth months, and at the end of the first and second years. The American Society of Anesthesiologists for preoperative status, Singh index for bone quality, and Harris Hip Score (HHS) for functional outcomes were evaluated. Results
While 156 patients (38 males, 118 females; mean age 77.7±5.9) were treated with BHA, 152 patients (43 males, 109 females; mean age 79±6.1) were treated with PFN. While there was no significant difference between the two groups in terms of total HHS, a significant difference was found in the sub-parameters (p<0.001). Good and excellent results were found in 78.2% of BHA and 86.2% of PFN patients. Mortality rates were similar at the end of two years (14% and 13.6%, respectively). Conclusion In general, clinical and functional outcomes of BHA and PFN are similar. The rates of pulmonary embolism and deep vein thrombosis are significantly higher in BHA. However, BHA is advantageous in terms of operation time and early weight bearing compared to PFN.
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Ju JB, Zhang PX, Jiang BG. Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta-Analysis. Orthop Surg 2020; 11:745-754. [PMID: 31663280 PMCID: PMC6819185 DOI: 10.1111/os.12532] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 08/15/2019] [Accepted: 08/15/2019] [Indexed: 12/16/2022] Open
Abstract
Objective To evaluate the efficacy and safety of hip replacement and intramedullary nails for treating unstable intertrochanteric fractures in elderly patients. Methods Randomized clinical trials (RCTs) to compare hip replacement with intramedullary nail in the management of elderly patients with unstable intertrochanteric femur fracture were retrieved from Cochrane Library (up to January 2018), CNKI (China National Knowledge Infrastructure), Wanfang Data, PubMed, and Embase. The methodological quality of the included trials was assessed using the Cochrane risk of bias assessment tool, and relevant data was extracted. Statistical analysis was performed by Revman 5.3. Where possible, we performed the limited pooling of data. Results Fourteen trials including a total of 1067 participants aged 65 and above were included for qualitative synthesis and meta‐analysis. The methodological quality of the included study was poor. The meta‐analysis indicated that the hip replacement group benefited more than the intramedullary nail group in terms of the bearing load time (WMD ‐14.61, 95% CI −21.51 to −7.7, P < 0.0001), mechanical complications (OR 0.34, 95% CI 0.21 to 0.57, P < 0.0001), and post‐operative complications (OR 0.46, 95% CI 0.22 to 0.93, P = 0.03). While the intramedullary nail was superior to arthroplasty regarding the intraoperative blood loss (WMD 58.36, 95% CI 30.77 to 85.94, P < 0.0001). However, there were no statistical significances in the length of surgery (WMD 5.27, 95% CI 4.23 to 14.77, P = 0.28), units of blood transfusion (WMD 0.34, 95% CI ‐0.16 to 0.85, P = 0.18), length of hospital stay (WMD ‐1.00, 95% CI ‐2.93 to 0.93, P = 0.31), Harris hip score (WMD 0.31, 95% CI ‐0.39 to 1.01, P = 0.38), and mortality (OR 1.24, 95% CI 0.12 to 13.10, P = 0.86). Conclusions This systematic review and meta‐analysis provided evidence for the efficacy and safety of hip replacement and intramedullary nail in treating unstable intertrochanteric fractures. However, the results should be interpreted cautiously because of methodological limitations and publication bias.
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Affiliation(s)
- Jia-Bao Ju
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Pei-Xun Zhang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Bao-Guo Jiang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
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Ju JB, Zhang PX, Jiang BG. Risk Factors for Functional Outcomes of the Elderly with Intertrochanteric Fracture: A Retrospective Cohort Study. Orthop Surg 2020; 11:643-652. [PMID: 31456321 PMCID: PMC6712441 DOI: 10.1111/os.12512] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/07/2019] [Accepted: 07/10/2019] [Indexed: 11/28/2022] Open
Abstract
Objective To identify baseline factors relevant to functional outcomes and health‐related quality of life in the elderly with intertrochanteric fractures. Methods For the present study, 168 patients with intertrochanteric fracture who were assigned to different treatments between January 2016 and December 2017 were retrospectively selected. Hip function was assessed by Harris hip score (HHS), and health‐related quality of life was evaluated by Barthel index (BI) of activities of daily living (ADL) and EuroQol 5‐dimensions (EQ‐5D) score, respectively. Data were analyzed by t‐test, ANOVA, Pearson's correlation, χ2‐test, and multivariate linear regression. Results A total of 164 (97.6%) patients completed the follow‐up, with an average follow‐up time of 15.7 ± 6.9 months; 39 (23.8%) patients died during the follow‐up period and 125 (76.2%) patients were eligible for the functional analysis. HHS at final follow‐up of 125 patients was 71.8 ± 13.1, and the following were associated with hip functional recovery: age (−0.45, 95% confidence interval (CI) −0.73 to −0.18, P < 0.01), serum albumin (0.65, 95% CI 0.04 to 1.27, P < 0.05), and ADL at discharge (0.18, 95% CI 0.01 to 0.33, P < 0.05). The Barthel index at final follow up in this cohort was 80.2 ± 18.1, and multivariable linear regression analysis showed that age (−0.49, 95% CI −0.85 to −0.12; P < 0.05), ADL score at discharge (0.29, 95% CI 0.07 to 0.51; P < 0.05) and internal fixation (16.3, 95% CI 3.3 to 29.3; P < 0.05) were associated with ADL at final follow‐up. EQ‐5D at final follow‐up was 0.74 ± 0.2, with which HHS (0.012, 95% CI 0.011 to 0.013; P < 0.01) was positively associated. Conclusion We identify several baseline factors associated with hip functional outcome, health utility, and ADL in the elderly after an intertrochanteric fracture, of which we could modify mutable factors to achieve better outcomes. These findings could help to inform treatment and functional prognosis.
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Affiliation(s)
- Jia-Bao Ju
- Department of Orthopaedics and Traumatology, Peking University People's Hospital, Beijing, China
| | - Pei-Xun Zhang
- Department of Orthopaedics and Traumatology, Peking University People's Hospital, Beijing, China
| | - Bao-Guo Jiang
- Department of Orthopaedics and Traumatology, Peking University People's Hospital, Beijing, China
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Jang SY, Cha YH, Kim KJ, Kim HY, Choy WS. The effect of surgery type on mortality in elderly patients with pertrochanteric femoral fracture: A Korean nationwide cohort study. Asian J Surg 2019; 43:550-556. [PMID: 31324508 DOI: 10.1016/j.asjsur.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/07/2019] [Accepted: 06/18/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND/OBJECTIVE The purpose of this study is to analyze the effect of surgical methods on mortality and the relative risk of patients who underwent internal fixation (IF) or hemiarthroplasty (HA) after being diagnosed as a pertrochanteric fracture over 65 years old in a Korean nationwide cohort with a single insurance medical system. METHODS The Korean National Health Insurance Service-Senior cohort (NHIS-Senior, NHIS-2018-2-111) was used in this study. The eligibility criteria for incident hip fracture patients were the following: (1) first-time admission to acute care hospitals (index admission) with pertrochanteric fracture (ICD-10 S721), (2) three years of hip fracture-free period, (3) recipients of typical surgeries including IF, HA, (4) age between 65 and 99. RESULTS a total of 7223 patients were enrolled in the cohort. There were 1662 patients (23%) in the HA group and 5561 patients (77%) in the IF group. Mortality rates of the IF group and HA group were 13.46 and 17.94 cases per 100 person-years, respectively. In the multivariable-adjusted Cox proportional hazard model, the HA group had 1.22 times more hazard of all-cause mortality than IF group (aHR 1.22, 95% CI 1.13-1.32). In subgroup analysis, aged 65-79 and female patients showed a prominent association between surgery type and mortality (aHR 1.52, 95% CI 1.29-1.79). CONCLUSIONS In patients with pertrochanter fracture over 65 years, 1.22-fold mortality rate was observed when HA was performed compared to that of IF, and the difference in mortality was particularly prominent within 1-year after surgery.
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Affiliation(s)
- Suk-Yong Jang
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, South Korea
| | - Yong-Han Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea.
| | - Kap-Jung Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Ha-Yong Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
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Kumar P, Rajnish RK, Sharma S, Dhillon MS. Proximal femoral nailing is superior to hemiarthroplasty in AO/OTA A2 and A3 intertrochanteric femur fractures in the elderly: a systematic literature review and meta-analysis. Int Orthop 2019; 44:623-633. [PMID: 31201487 DOI: 10.1007/s00264-019-04351-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 05/21/2019] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Unstable intertrochanteric femoral fractures in the elderly require either fixation or joint sacrificing surgery; proximal femoral nail (PFN) and bipolar hemiarthroplasties (BPH) are the most common interventions. PFN is considered to be the ideal construct for these fractures; however, the usage of hemiarthroplasties to facilitate earlier mobilization has been on a rise. Currently there is no consensus on the superiority of one of these two techniques over the other and the present review was done to determine this. RESEARCH QUESTION Is PFN a better alternative to BPH for unstable intertrochanteric femur fractures in the elderly? OBJECTIVE The present systematic review and meta-analysis was conducted to determine the superiority of PFN over BPH by comparing the primary outcomes like mortality, Harris Hip scores (HHS), complications, and re-operations. Additionally, secondary outcomes like blood loss, duration of surgery, and period of hospital stays were also compared. METHODOLOGY Three databases of PubMed, EMBASE, and SCOPUS were searched for relevant articles that directly compared PFN and BPH in unstable intertrochanteric femur fractures in the elderly. RESULTS We analyzed a total of seven studies published between the years 2005 to 2017. There were four retrospective and three prospective randomized controlled studies. The number of patients in these studies ranged from 53 to 303. PRIMARY OUTCOMES There was a significant difference in HHS between two groups with standard mean difference of - 0.51 (range - 0.67 to -0.36), favouring the PFN group. The rate of mortality was higher in the BPH group with odds ratio of 2.07 (range 1.40-3.08). Implant-related complications like fractures and subsidence were more in BPH group but this was not significant. SECONDARY OUTCOMES Mean surgical time (standard mean difference 2.19) and blood loss (3.75) were significantly less in the PFN group. The duration of hospital stay was also found to be significantly less in the PFN group (2.66). CONCLUSION Proximal femoral nails are superior to bipolar hemiarthroplasties for unstable intertrochanteric femoral fractures in the elderly. PFN imparts better functional outcomes and has lower rates of overall mortality. Additionally it is faster surgery, with lesser blood loss contributing to better results.
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Affiliation(s)
- Prasoon Kumar
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Rajesh Kumar Rajnish
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Siddhartha Sharma
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Mandeep Singh Dhillon
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
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Qin Y, Zhou K, Wang D, Zhou Z, Yang J, Kang P, Pei F, Shen B. [Safety and efficacy of total hip arthroplasty following failed internal fixation of intertrochanteric fractures]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2019; 33:160-165. [PMID: 30739408 DOI: 10.7507/1002-1892.201807089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To evaluate the safety and efficacy of total hip arthroplasty (THA) following failed internal fixation of intertrochanteric fractures. Methods Between January 2007 and January 2016, THAs were performed in 32 patients (33 hips) for failed internal fixation of intertrochanteric fractures. There were 15 males and 17 females, with mean age of 74.0 years old (range, 65-87 years). There were 3 hips of Evans-Jensen type Ⅱ, 10 hips of type Ⅲ, 8 hips of type Ⅳ, and 12 hips of type Ⅴ. The fractures were fixed with dynamic hip screw in 18 hips, proximal femoral nail antirotation in 9 hips, locking plate in 5 hips, and hollow screw in 1 hip. The internal fixation failure caused by fracture displacement and nonunion in 22 patients, traumatic arthritis in 6 patients, fracture nonunion and infection in 3 patients, and avascular necrosis of the femoral head in 2 patients. The mean interval from initial fracture fixation to THA was 20 months (range, 2-48 months). The safety evaluation indicators included operation time, amount of operative bleeding and postoperative drainage, blood transfusion, and perioperative complications. The efficacy indexes included the hip Harris score, the range of motion (ROM), visual analogue scale (VAS) score, and the length difference between both legs; the X- ray films were taken to assess the prosthesis survival condition. Results The average operation time was 92 minutes (range, 55-135 minutes). The average amount of operative bleeding and postoperative drainage were 480 mL (range, 360-620 mL) and 350 mL (range, 220-520 mL), respectively. Intraoperative proximal femur fissure fracture occurred in 2 hips. After operation, 10 cases received allogeneic blood transfusion, 1 case occurred cerebral infarction, 2 hips experienced dislocation, 1 hip occurred greater trochanter re-fracture and dislocation because of spraining, and 1 case died of myocardial infarction. Twenty-nine patients (30 hips) were followed up 2-10 years (mean, 4.9 years). At last follow-up, there was no infection recurrence in 3 infected hips, and there was no prosthesis loosening, subsidence, or rupture in all cases. The Harris score, ROM, VAS score, and the length difference between both legs were significantly superior to preoperative ones ( P<0.05). Conclusion THA is an effective salvage procedure after failed internal fixation of intertrochanteric fracture. But its perioperative risks and complications are pretty high. Adequate preoperative evaluation, elaborate and individualized perioperative management are keys to make sure the patient can safely survive the perioperative period.
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Affiliation(s)
- Yongzhi Qin
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;Department of Orthopedics, the People,s Hospital of Guang'an, Guang'an Sichuan, 638000, P.R.China
| | - Kai Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Duan Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Zongke Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
| | - Jing Yang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Pengde Kang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Fuxing Pei
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Bin Shen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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Yoo JI, Cha YH, Kim KJ, Kim HY, Choy WS, Hwang SC. Comparison between Cementless and Cemented Bipolar Hemiarthroplasty for Treatment of Unstable Intertrochanteric Fractures: Systematic Review and Meta-analysis. Hip Pelvis 2018; 30:241-253. [PMID: 30534543 PMCID: PMC6284077 DOI: 10.5371/hp.2018.30.4.241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose This study was conducted to compare cemented and cementless bipolar hemiarthroplasty in elderly patients with unstable intertrochanteric fractures via meta-analysis and systematic review of relevant studies. Materials and Methods Systematic review and meta-analysis were performed on 31 available clinical studies; 19 of these studies used cemented stems, 12 used cementless stems, one used both types of stems, and two studies involved a comparative analysis of both stem types. Results There were statistically significant differences in rates of leg length discrepancy (LLD) greater than 1 cm between the cemented (event rate, 0.089) and cementless groups (event rate, 0.015 and 0.047; P=0.03). Conclusion Cemented bipolar hemiarthroplasty and cementless bipolar hemiarthroplasty performed on elderly patients with unstable intertrochanteric fracture revealed similar mortality and complication rates; however, the rate of LLD greater than 1 cm was significantly higher in the cemented group compared with the cementless group.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Yong-Han Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Kap-Jung Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Ha-Yong Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Sun-Chul Hwang
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
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Saeed Younis A, Mahmoud S, Salem Eid A, Khairy Mahmoud A. Functional outcomes of internal fixation and arthroplasty in the treatment of intertrochanteric femoral fractures: a systematic review. Current Orthopaedic Practice 2018; 29:365-72. [DOI: 10.1097/bco.0000000000000645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Yu X, Wang H, Duan X, Liu M, Xiang Z. Intramedullary versus extramedullary internal fixation for unstable intertrochanteric fracture, a meta-analysis. Acta Orthop Traumatol Turc 2018; 52:299-307. [PMID: 29602699 PMCID: PMC6150441 DOI: 10.1016/j.aott.2018.02.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 02/26/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this meta-analysis was to explore the difference between and compare intramedullary fixation (IF) and extramedullary fixation (EF) for unstable intertrochanteric fractures. METHODS We searched Pubmed database and Cochrane library following by including and excluding articles based from inception to December, 2016. All randomized controlled trials (RCTs) comparing IF and EF for unstable intertrochanteric fractures were assessed and selected by two researchers independently. Data were analyzed using Review Manager 5.1 version. RESULTS 17 RCTs were enrolled in our meta-analysis comparing IF and EF and showed evidence that IF had lower rate of implant failure RR = 0.2695%CI 0.13-0.51, P < 0.0001 and re-operation (RR = 0.60, 95%CI 0.37-0.98, P = 0.04), while there was no statistical differences of cut-out, postoperative infections and other complications. Moreover, PPM scores verified that IF had better postoperative hip mobility recovery (MD = 0.87, 95%CI 0.08-1.66, P = 0.03). CONCLUSION IF has lower incidence of failure of implant and reoperation and shows better postoperative functional recovery when treating adult unstable intertrochanteric fracture while the most postoperative complications were not statistically different from EF. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Xi Yu
- Rehabilitation Medicine Center, West China School of Medicine, Sichuan University, Chengdu, Sichuan, PR China
| | - Hong Wang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xin Duan
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Ming Liu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Zhou Xiang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
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Schmitz P, Lüdeck S, Baumann F, Kretschmer R, Nerlich M, Kerschbaum M. Patient-related quality of life after pelvic ring fractures in elderly. Int Orthop 2018; 43:261-267. [PMID: 29946740 DOI: 10.1007/s00264-018-4030-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Pelvic ring fractures, occurring in elderly patients are a challenging problem. Little known is about the patient-related outcome after these injuries. The primary objective of this study is to evaluate the quality of life after pelvic ring injuries in patients aged over 60 years. METHODS Patients (≥ 60 years) with pelvic ring fractures treated in our trauma department between 2004 and 2014 were included. Next to patient data, injury-related details as well as treatment details were assessed. After a follow-up of at least two years, the survival rate and the patient-related outcome were evaluated using the SF-36 and the EQ-5D score. RESULTS One hundred ninety-six patients (138 women; 58 men; mean age 75.3 ± 7.8 years) were identified. Ninety-six patients were treated operatively, 100 patients conservatively. The overall complication rate was significantly lower for conservatively compared to operatively treated patients (conservatively 18% vs. operatively 33%; p = 0.014). The total mortality rate over 2 years is 29% with no significant difference of the two-year survival rate (2-year survival rate: operatively 77% vs. non-operatively 65%; p = 0.126). Fifty-five patients completed the SF-36 and EQ-5D score after a mean follow-up of 4.2 ± 2.9 years. The mean physical component score of the SF-36 is 33.6 ± 8.3, and the mean mental component score is 45.3 ± 8.4. The mean EQ-5D VAS reached 62.5 ± 27.9. CONCLUSION Elderly patients with pelvic ring fractures show a high mortality rate and a limited patient-related outcome. While the complication rate of conservatively treated patients is lower compared to operated patients, the two year survival rate is steady.
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Affiliation(s)
- Paul Schmitz
- Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Stephan Lüdeck
- Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Florian Baumann
- Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Rainer Kretschmer
- Caritas-Krankenhaus St. Josef, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Michael Nerlich
- Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Maximilian Kerschbaum
- Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
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Codesido P, Mejía A, Riego J, Ojeda-Thies C. Subtrochanteric fractures in elderly people treated with intramedullary fixation: quality of life and complications following open reduction and cerclage wiring versus closed reduction. Arch Orthop Trauma Surg 2017; 137:1077-1085. [PMID: 28555367 DOI: 10.1007/s00402-017-2722-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Subtrochanteric fractures are more difficult to treat than other proximal femoral fractures. The aim of this study was to report the outcomes for patients with subtrochanteric fractures treated using a cephalomedullary nail following open reduction and cerclage wiring versus closed reduction alone, regarding health-related quality of life (HRQoL) and social function. MATERIALS AND METHODS We performed a prospective cohort study including patients aged 60 years or older suffering fragility subtrochanteric fractures of the femur treated with cephalomedullary nails, with a minimum 2-year follow-up. We defined two treatment groups: one treated with closed reduction manoeuvres (60 patients), and another treated with open reduction and cerclage wiring (30 patients). The outcomes were mortality, orthopaedic complications (reoperation and no-union), social function (Jensen Index), and HRQoL (EQ-5D index score). RESULTS There were no differences regarding sex, age, side affected, type of implant, anaesthetic risk, 1-year mortality, and orthopaedic complications. Surgical time was longer in the cerclage wire group, but length of stay was 2 days shorter for the cerclage group and reduction was better. Patients treated with cerclage wiring had significantly better EQ-ED at 12 months (0.66 ± 0.22 points vs. 0.78 ± 0.15 points); and social status at 12 and 18 months (2.77 ± 1.00 points vs. 2.10 ± 1.22 points). CONCLUSIONS Better reduction is achieved when using cerclage wires for fragility subtrochanteric fractures. These fractures had a negative effect on quality of life and social function, but better outcomes were observed in the cerclage group.
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Affiliation(s)
- Pablo Codesido
- Department of Traumatology and Orthopaedic Surgery, Lucus Augusti University Hospital, Calle San Cibrao, 27003, Lugo, Spain.
| | - Ana Mejía
- Department of Traumatology and Orthopaedic Surgery, Lucus Augusti University Hospital, Calle San Cibrao, 27003, Lugo, Spain
| | - Jonathan Riego
- Department of Traumatology and Orthopaedic Surgery, Lucus Augusti University Hospital, Calle San Cibrao, 27003, Lugo, Spain
| | - Cristina Ojeda-Thies
- Trauma Unit, Department of Traumatology and Orthopaedic Surgery, 12 de Octubre University Hospital, Madrid, Spain
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Abstract
BACKGROUND More and more studies conduct to compare intramedullary fixation (IMF) with arthroplasty in treating intertrochanteric hip fractures, but it remains controversy. The aim of this meta-analysis was to find out whether IMF or arthroplasty was more appropriate for treating intertrochanteric hip fractures in elderly patients. METHODS Relevant studies were searched in the electronic databases of PubMed, Embase, and The Cochrane Central Register of Controlled Trials from January 1980 to September 2016 with English language restriction. Surgical information and postoperative outcomes were analyzed using RevMan 5.3 version. RESULTS A total of 1239 patients from 11 studies which satisfied the eligibility criteria were included. Compared with IMF, the use of arthroplasty reduced implant-related complications (odds ratio [OR]: 2.05, P = .02) and reoperation rate (OR: 7.06, P < .001), and had similar length of hospital stay (weighted mean difference [WMD]: -0.41, P = .63). However, IMF reduced blood loss (WMD: -375.01, P = .001) and transfusion requirement (OR: 0.07, P < .001), shorter operation time (WMD: -18.92, P = .010), higher Harris hip score (WMD: 4.19, P < .001), and lower rate of 1-year mortality (OR: 0.67, P = .02) compared with arthroplasty. CONCLUSION The main treatment of intertrochanteric hip fractures is internal fixation using IMF. In the absence of concrete evidence, arthroplasty should be undertaken with caution in carefully selected patient and surgeon should be aware of the increased complexity of doing the arthroplasty in these elderly patients. Further high-quality randomized controlled trials (RCTs) are needed to provide robust evidence and evaluate the treatment options.
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Affiliation(s)
- Boyuan Nie
- Department of Orthopedics, Dayi Hospital of Shanxi Medical University Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
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