Abstract

Aim: Does the preferred anesthetical technique (spinal/general) influence the quality of fracture reduction and early functional outcomes during intramedullary nailing of intertrochanteric fractures in elderly? Material and Methods: Patients that were treated for intertrochanteric fractures with a nail who were graded as ASA(American Society of Anesthesiologists) 3 and had postoperative intensive care and aged 65 years or older with a AO type 31A2 fracture were retrospectively included in the study. Patient demographic data, surgical notes and radiographies before and after surgery were obtained from hospital records. Patients were asked for a visit at 6th months of surgery and examined for Harris and Oxford hip scores and Barthes independence index. Patients were divided into two groups as spinal or general anesthesia and groups were compared. Results: A total of 60 patients with intertrochanteric fractures (Group 1; 30 spinal anesthesia / Group 2; 30 general anesthesia) were studied. The mean age of the patients in Group 1 was 80.4 ± 7.9, while it was 80.4 ± 9.8 (p = 0.994) in Group 2. In group 1; 16 patient had good, 14 had acceptable and in group 2; 13 patient had good, 14 had acceptable and 3 had poor fracture reduction after surgery, this difference was not statistically significant (p = 0.191). In the functional results of the patients, the 6th month Harris hip scores of Group 1 patients were 84.4 ± 7.3 while it was 80.7 ± 6.8 in Group 2 (p = 0.154); while the average Oxford hip scores were 43 ± 3.3 in Group 1, it was 41.3 ± 3.7 (p = 0.123) in Group 2. In the independence evaluations, the Barthel index of Group 1 patients at the 6th month was 82 ± 18.4 while it was 80.7 ± 16.4 in Group 2 (p = 0.327). The functional assessments revealed no significant differences throughout groups regarding Harris, Oxford and Barthel scores 6 months after surgery. Conclusion: The anesthetical method which is preferred for the intertrochanteric fracture surgery has no effect on postoperative quality of fracture reduction and early functional outcomes.

Keywords

• hip fracture,
• intertrochanteric fracture
• proximal femoral nail

İNTERTROKANTERİK KALÇA KIRIĞI CERRAHİSİNDE, GENEL VEYA SPİNAL ANESTEZİ TERCİHİ KAPALI REDÜKSİYONUN KALİTESİNİ VE KALÇA EKLEM FONKSİYONUNU ETKİLER Mİ?

Abstract

Amaç: Yaşlı hastaların intertrokanterik kırıklarının intramedüller çivi ile tedavisi sırasında kullanılan anestezi yöntemi (spinal/ genel), elde edilen redüksiyon kalitesini ve erken fonksiyonel sonuçları etkiler mi? Gereç ve Yöntem: 65 yaş ve üzeri, AO 31A2 tip intertrokanterik kırık tanısı koyulup çivi ile tedavi edilmiş hastalar retrospektif olarak çalışmaya alındı. ASA skoru 3 olup ameliyat sonrası yoğun bakımda kalmış olan hastaların, demografik bilgileri, ameliyat notları, ameliyat öncesi ve sonrası grafileri hastane kayıtlarından elde edildi. Hastalar 6. ayda kontrole çağrılarak Harris ve Oxford kalça skoru ile Barthel bağımsızlık indeksi hesaplandı. Hastalar spinal veya genel anestezi olanlar şeklinde gruplandırılarak analiz edildi. Bulgular: Toplam 60 intertrokanterik kırıklı hasta (Grup 1; 30 spinal / Grup 2; 30 genel anestezi) çalışmada incelendi. Grup 1’deki hastaların yaş ortalaması 80,4± 7,9 iken Grup 2’de 80,4± 9,8 (p=0,994) idi. Operasyon sonrası Grup 1’deki 16 hastada iyi, 14 hastada orta; Grup 2’deki 13 hastada iyi, 14 hastada orta ve 3 hastada kötü redüksiyon elde edildi, bu fark istatistiksel olarak anlamlı bulunmadı (p=0.191). Hastaların fonksiyonel sonuçlarında Grup 1 hastalarının 6. ay Harris kalça skorları 84,4±7,3 iken Grup 2’de 80,7±6,8 (p=0,154); Oxford kalça skorları Grup 1’de ortalama 43±3,3 iken Grup 2’de 41,3±3,7 (p=0,123) idi. Bağımsızlık değerlendirmelerinde ise Grup 1 hastalarının 6. aydaki Barthel indeksi 82 ±18,4 iken Grup 2’de 80,7±16,4 olarak bulundu (p=0,327). Altıncı aydaki değerlendirmede gruplar arasında Harris, Oxford ve Barthel skorları arasında fark bulunmadı. Sonuç: İntertrokanterik kırık cerrahisi sırasında tercih edilen anestezi yöntemi; kırık redüksiyon kalitesini ve erken dönem fonksiyonel sonuçları etkilemez.

Keywords

• Kalça kırığı
• intertrokanterik kırık
• proksimal femur civisi

References

1. 1.)LaVelle DG, Canale ST. Fractures of hip. In: Canale ST. Campbell's operative orthopaedics. 10th ed. Philadelphia: Mosby Press;2003.p.2873
2. 2.)Kannus P, Parkkari J, Sievänen H, et al. Epidemiology of hip fractures. Bone 1996; 18: 57-63
3. 3.)Available at: www.ahrq.gov/data/hcup Erişim tarihi 01.08.2020 (Accessed 01.08.2020)
4. 4.)Karagas MR, Lu-Yao GL, Barrett JA, et al. Heterogeneity of hip fracture: age, race, sex, and geographic patterns of femoral neck and trochanteric fractures among the US elderly. Am J Epidemiol 1996; 143: 677
5. 5.)Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med 2017; 377: 2053-2062
6. 6.)Gültaç E, Kılınç CY, Açan AE, ve ark. Ortopedik implant enfeksiyonlarında izole edilen bakteri çeşitliliği ve antibiyotik duyarlılıkları. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 2017; 4: 19-20
7. 7.)Handoll HH, Parker MJ. Conservative versus operative treatment for hip fractures in adults. Cochrane Database Syst Rev 2008; 16: CD000337
8. 8.)Öztürk A, Iltar S, Alemdaroglu KB, et al. Is functional outcome better after arthroplasty for trochanteric fractures in older adults? Acta Ortop Bras. 2018; 26: 8-10

9. 9.)Díaz VJ, Cañizares AC, Martín IA, et al. Predictive variables of open reduction in intertrochanteric fracture nailing: a report of 210 cases. Injury 2016; 47: 51-55
10. 10.)O'Hara DA, Duff A, Berlin JA, et al. The effect of anesthetic technique on postoperative outcomes in hip fracture repair. Anesthesiology 2000; 92: 947-957
11. 11.)Baumgaertner MR, Curtin SL, Lindskog DM, et al. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 1995; 77: 1058-1064
12. 12.)Sharma A, Mahajan A, John B. A Comparison of the clinico-radiological outcomes with Proximal Femoral Nail (PFN) and Proximal Femoral Nail Antirotation (PFNA) in fixation of unstable intertrochanteric fractures. J Clin Diagn Res 2017; 11: RC05RC09
13. 13.)Uzun M, Erturker E, Ozturk İ, et al. Longterm 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: 457-463
14. 14.)Desai V, Chan PH, Prentice HA, et al. Is anesthesia technique associated with a higher risk of mortality or complications within 90 days of surgery for geriatric patients with hip fractures?. Clin Orthop Relat Res 2018; 476: 11781188
15. 15.)Zuo D, Jin C, Shan M, et al. A comparison of general versus regional anesthesia for hip fracture surgery: a meta-analysis. Int J Clin Exp Med 2015; 8: 20295–20301
16. 16.)Arıcan G, Subaşı Ö, Özmeriç A, ve ark. Geriatrik kalça kırıklarında talon proksimal femoral çivileme (pfn) proksimal femoral çivi-antirotasyon (PFN-A) kadar başarılı mı? Acta Medica Alanya 2019;3(3):261-266
17. 17.)Lu XD, Wang B, Xu W, et al. Comparison of calcar replacement arthroplasty and Intertan nail in treatment of intertrochanteric fracture in the aged. National Medical Journal of China 2016; 96: 2466-2471
18. 18.)Tanoğlu O, Arıcan G, Özmeriç A, ve ark. Femur boyun kırığı nedeniyle hemartroplasti uygulanan yaşlı hastalarda, erken mortalitenin öngörücüleri. Acta Medica Alanya 2020; 4(3): 220-225
19. 19.) Özyalvaç ON, Çiftçi S, Telatar A, ve ark. Proksimal femur çivisi cerrahisinde C-kollu floroskopi kullanımı ile ilgili sorunlar. Med Bull Haseki 2018; 56(3):209-212
20. 20.)Pincus D, Ravi B, Wasserstein D, et al. Association between wait time and 30-day mortality in adults undergoing hip fracture surgery. JAMA 2017; 318: 1994–2003
21. 21.)Simunovic N, Devereaux PJ, Sprague S, et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ 2010; 182: 16091616