Comparison of long-stemmed cementless hemiarthroplasty with proximal femur nail in unstable intertrochanteric femur fractures over 85 years of age

Abstract

Aim: The most appropriate treatment option for intertrochanteric femoral fractures is still controversial. While there are articles showing that proximal femoral nails are superior to partial prostheses, other studies claim that partial prostheses result in better patient outcomes. We aimed to compare long-stemmed cementless hemiarthroplasty (LFS-BPH) and proximal femur nail (PFN), which are the treatment options applied in unstable intertrochanteric hip fractures in patients over 85 years of age. Methods: The records of 64 patients with unstable intertrochanteric femur fractures who were operated between May 2016 and December 2018 in the Orthopedics and Traumatology Clinic of Maltepe University Medical Faculty Hospital were evaluated. A retrospective cohort study was conducted and 42 patients who met the inclusion criteria were included in the study. The patients were divided into 2 groups as the proximal nail group and the prosthesis group, and evaluated in terms of total hospitalization time, operation time, amount of blood transfusion, time until the patient walked independently, postoperative complications, and Harris hip scores. Results: There were statistically significant differences in favor of the PP group in terms of total length of stay, fully independent mobilization time, deep vein thrombosis and decubitus development in the postoperative period. There was no difference between LFS-BPH and PFN in terms of total hospitalization time, blood transfusion amount, and Harris hip scores in unstable intertrochanteric hip fractures occurring above 85 years of age. Conclusion: LFS-BPH was superior to PFN in terms of operation time, early independent mobilization, reduction of deep vein thrombosis and decubitus development rate in the postoperative period.

Keywords

• Intertrochanteric Fractures
• Intramedullary nailing
• Hip prosthesis

85 yaş üstü instabil intertrokanterik femur kırıklarında uzun stemli sementsiz hemiartroplasti ile proksimal femur çivisinin karşılaştırılması

Öz

Amaç: İntertrokanterik femur kırıkları için en uygun tedavi seçeneği halen tartışmalıdır. Proksimal femoral tırnakların parsiyel protezlerden üstün olduğunu gösteren makaleler varken, diğer çalışmalar kısmi protezlerin daha iyi hasta sonuçları verdiğini iddia etmektedir. Mayıs 2016 ile Aralık 2018 tarihleri arasında Maltepe Üniversitesi Tıp Fakültesi Hastanesi Ortopedi ve Travmatoloji Kliniğinde opere edilen 85 yaş üstü instabil intertrokanterik kalça kırığı vakalarında uygulanan tedavi seçeneklerinden uzun stemli sementsiz hemiartroplasti (UFS-BPH) ile proksimal femur çivisinin(PFN)karşılaştırılması amaçlandı. Yöntemler: 64 AO/OTA 31-A2.3 instabil intertrokanterik femur kırığı hastasının kayıtları retrospektif olarak değerlendirildi. Dâhil edilme kriterlerine uyan 42 hasta çalışmaya alınıp 2 homojen gruba ayrıldı. Gruplar toplam yatış süresi, operasyon süresi, kan transfüzyon miktarı, hastanın tek başına bağımsız olarak yürümesine kadar geçen süre, postoperatif dönemde gelişebilecek derin ven trombozu ve dekübitüs yara gelişimi ve Harris kalça skorları açısından değerlendirildi. Bulgular: Gruplar arasında toplam yatış süresi, tam bağımsız mobilizasyon süresi ve postoperatif dönemde derin ven trombozu ve dekübitüs gelişimi açısından PP grubu lehine istatistiksel olarak anlamlı fark saptanmıştır. Yapılan çalışma sonucunda 85 yaş üstü instabil intertrokanterik kalça kırığı vakalarında toplam yatış süresi, kan transfüzyon miktarı ve Harris kalça skorları açısından UFS-BPH ile PFN arasında bir farka rastlanmadı. Sonuç: Ameliyat süresi, erken bağımsız mobilizasyon ve postoperatif dönemde gelişebilecek derin ven trombozu ve dekübitüs yara gelişim oranının azaltılması açısından UFS-BPH nin PFN ne göre daha üstün olduğu görüldü.

Anahtar Kelimeler

• İntertrokanterik kırık
• İntramedüller çivileme
• Kalça protezleri
• Geriatri

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