Prognostic factors between the proximal femoral nail and bipolar hemiarthroplasty in femoral intertrochanteric fractures

Year 2022, , 438 - 443, 22.10.2022

Ümit Aygün , Ömer Ayık

https://doi.org/10.38053/acmj.1147770

Abstract

Aim: In the treatment of intertrochanteric femur fractures, proximal femoral nail (PFN), and bipolar hemiarthroplasty (BPH) are widely used. This study aimed to compare these two types of implants depending on risk factors regarding patients.
Material and Method: PFN (Group 1) was applied to 40 of the 89 patients (44 female, 45 male) aged between 51-80 (mean 68.16±6.78) and BPH (Group 2) was applied to 49 of them. Age, gender, fracture side, fracture mechanism, additional disease, Body mass index (BMI), Albumin level, Hemoglobin (Hb) decrease level, T-score, American Society of Anesthesiologists (ASA) classification, type of anesthesia, surgery type, operation time, hospital stay and full weight-bearing time, Harris Hip Score (HHS) in preoperative and postoperative periods, classification of intertrochanter fracture according to the AO Foundation and Orthopedic Trauma Association (AO/OTA), postoperative complications were recorded.
Results: Group 1 was younger with a mean age of 64.55±6.23 years compared to Group 2 (p <0.05). Most of the fractures were 3A2 type and the result of low energy (p>0.05). In group 1, operation time was 46.78±5.29 minutes and hospital stay was 2.48±0.75 days, which was shorter, most surgery types were closed, T-score was -2.49±0.59 and better, the time of full weight-bearing was 3.48±0.78 months, Hb decrease was 1.17±0.37 g/dL and less, Albumin level was 3.11±0.4 g/dL and higher (p<0.05). In Group 2, the age was the highest (72.6±5.2) and the T score was the lowest (-2.9±0.4) in the 3A2 fracture type (p<0.05). HHS was better in the BPH group at the sixth month (p<0.05), and there was no difference between the two groups at the end of one year (p>0.05).
Conclusion: Prognostic markers for treatment outcomes in individuals with intertrochanteric fractures are still unknown. It is important to determine the factors that will contribute to the long-term functional results in these patients.

Keywords

Intertrochanteric femur fracture, proximal femoral nail, bipolar hemiarthroplasty, prognostic factors, functional outcomes

References

• Ekinci Y, Gürbüz K, Batın S, Kahraman M, Doğar F, Erten ZK. A multicenter intertrochanteric fracture study in the elderly: Hemiarthroplasty versus proximal femoral nailing. Jt Dis Relat Surg 2020; 31: 209-17.
• Papadimitriou N, Tsilidis KK, Orfanos P, et al. Burden of hip fracture using disability-adjusted life-years: a pooled analysis of prospective cohorts in the CHANCES consortium. Lancet Public Health 2017; 2: 239–46.
• LeBlanc ES, Hillier TA, Pedula KL, et al. Hip fracture and increased short-term but not long-term mortality in healthy older women. Arch Intern Med 2011; 171: 1831–7.
• Gaumetou E, Zilber S, Hernigou P. Non-simultaneous bilateral hip fracture: epidemiologic study of 241 hip fractures. Orthop Traumatol Surg Res 2011; 97: 22–7.
• Zhou S, Liu J, Zhen P, et al. Proximal femoral nail anti-rotation versus cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture in the elderly: a retrospective study. BMC Musculoskelet Disord 2019; 20: 500.
• Uzun M, Ertürer E, Oztürk I, Akman S, Seçkin F, Ozçelik IB. Long-term radiographic complications following treatment of unstable intertrochanteric femoral fractures with the proximal femoral nail and effects on functional results. Acta Orthop Traumatol Turc 2009; 43: 457-63.
• Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969; 51: 737-55.
• Özkayın N, Okçu G, Aktuğlu K. Intertrochanteric femur fractures in the elderly treated with either proximal femur nailing or hemiarthroplasty: A prospective randomised clinical study. Injury 2015; 46: S3-8.
• Friedl W, Colombo-Benkmann M, S Dockter, Machens HG, Mieck U. Gamma nail osteosynthesis of per- and subtrochanteric femoral fractures. 4 years experiences and their consequences for further implant development. Chirurg 1994; 65: 953-63.
• Jokinen H, Pulkkinen P, Korpelainen J, et al. Risk factors for cervical and trochanteric hip fractures in elderly women: a population-based 10-year follow-up study. Calcif Tissue Int 2010; 87: 44-51.
• Vergara I, Vrotsou K, Orive M, Gonzalez N, Garcia S, Quintana JM. Factors related to functional prognosis in elderly patients after accidental hip fractures: a prospective cohort study. BMC Geriatr 2014; 14: 124.
• Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) investigators. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial. Lancet 2017; 389: 1519–27.
• Hsueh KK, Fang CK, Chen CM, Su YP, Wu HF, Chiu FY. Risk factors in cutout of sliding hip screw in intertrochanteric fractures: an evaluation of 937 patients. Int Orthop 2010; 34: 1273–6.
• De Bruijn K, Den Hartog D, Tuinebreijer W, Roukema G. Reliability of predictors for screw cutout in intertrochanteric hip fractures. J Bone Joint Surg Am 2012; 94: 1266–72.
• Tokgöz MA, Atik OŞ, Esendağlı G, Öğüt B, Bozkurt HH. Is it possible that the pathogenesis of osteoarthritis could start with subchondral trabecular bone loss like osteoporosis? Eklem Hastalık Cerrahisi 2018; 29: 152-8.
• Akan K, Cift H, Ozkan K, Eceviz E, Tasyikan L, Eren A. Effect of osteoporosis on clinical outcomes in intertrochanteric hip fractures treated with a proximal femoral nail. J Int Med Res 2011; 39: 857-65.
• Görmeli G, Korkmaz MF, Görmeli CA, Adanaş C, Karataş T, Şimşek SA. Comparison of femur intertrochanteric fracture fixation with hemiarthroplasty and proximal femoral nail systems. Ulus Travma Acil Cerrahi Derg 2015; 21: 503-8.
• Öztürk İ, Toker S, Ertürer E, Aksoy B, Seçkin F. Analysis of risk factors affecting mortality in elderly patients (aged over 65 years) operated on for hip fractures. Acta Orthop Traumatol Turc 2008; 42: 16-21.
• Jones HW, Johnston P, Parker M. Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures. Int Orthop 2006; 30: 69-78.
• Tang P, Hu F, Shen J, Zhang L, Zhang L. Proximal femoral nail antirotation versus hemiarthroplasty: a study for the treatment of intertrochanteric fractures. Injury 2012; 43: 876-81.
• Jalan H, Perumal R, Prabhu S, Palanivelayutham S, Viswanathan VK, Rajasekaran S. Intravenous bisphosphonate therapy does not delay fracture healing in inter-trochanteric femur fractures - A randomised controlled study. J Clin Orthop Trauma 2021; 20: 101472.
• Pérez Durillo FT, Ruiz López MD, Bouzas PR, Martín-Lagos A. Nutritional status in elderly patients with a hip fracture. Nutr Hosp 2010; 25: 676–81.
• Maffulli N, Dougall TW, Brown MT, Golden MH. Nutritional differences in patients with proximal femoral fractures. Age Ageing 1999; 28: 458–62.
• Torres MJ, Féart C, Samieri C, et al. Poor nutritional status is associated with a higher risk of falling and fracture in elderly people living at home in France: The Three-City cohort study. Osteoporos Int 2015; 26: 2157–64.
• Koren-Hakim T, Weiss A, Hershkovitz A, et al. The relationship between nutritional status of hip fracture operated elderly patients and their functioning, comorbidity and outcome. Clin Nutr 2012; 31: 917–21.
• Cabrerizo S, Cuadras D, Gomez-Busto F, Artaza-Artabe I, Marín-Ciancas F, Malafarina V. Serum albumin and health in older people: review and meta analysis. Maturitas 2015; 81: 17–27.
• Mizrahi EH, Fleissig Y, Arad M, Blumstein T, Adunsky A. Admission albumin levels and functional outcome of elderly hip fracture patients: is it that important? Aging Clin Exp Res 2007; 19: 284–9.
• Desteli EE, İmren Y, Erdoğan M, Aydagün Ö. Quality of life following treatment of trochanteric fractures with proximal femoral nail versus cementless bipolar hemiarthroplasty in elderly. Clin Invest Med 2015; 38: E63-72.
• Ekström W, Nemeth G, Samnegard E, Dalen N, Tidermark J. Quality of life after a subtrochanteric fracture. A prospective cohort study on 87 elderly patients. Injury 2009; 40: 371-6.
• Ju JB, Zhang PX, Jiang BG. Risk factors for functional outcomes of the elderly with ıntertrochanteric fracture: a retrospective cohort study. Orthop Surg 2019; 11: 643-52.