The clinical outcomes of hemiarthroplasty and proximal femoral nail (PFN) fixation of unstable intertrochanteric femoral fractures in patients over 70 years old

Abstract

Aim: To evaluate the clinical outcomes of proximal femoral nail and hemiarthroplasty in terms of functional results, morbidity and complications in patients over 70 years old who had unstable intertrochanteric femur fractures.Material and Methods: Twety five patients operated between 2007-2011 in three institutions were included in this study. Twelve underwent PFN fixation and 13 had hemiarthroplasty. The mean follow-up was 23 months. There were 14 men and 121 women. Both groups were compared in terms of operation time, blood loss, early and late complications, length of hospital stay (LOS) and Haris hip scores.Findings: Operation time was less in the hemiarthroplasty group but the blood loss was lower in the PFN group. (p0.05). The only early PFN complication was fixation loss. The late complication in the hemiarthroplasty group was osteolysis. The Harris hip scores were better in favor of the hemiarthroplasty group.Conclusion: PFN fixation without anatomic reduction causes more complications and secondary operations in this population. Anatomically reduced PFN fixation and hemiarthroplasty gives comparable clinical and functional results.

Keywords

• Intertrochanteric fractures, proximal femoral nail, hemiarthroplasty

YETMİS YAŞ ÜZERİ İNSTABİL İNTERTROKANTERİK FEMUR KIRIKLI HASTALARIN TEDAVİSİNDE HEMİARTROPLASTİ ve PROKSİMAL FEMORAL NAİL (PFN) SONUÇLARIMIZ

Abstract

Amaç: Yetmiş yaş üzeri instabil intertrokanterik femur kırıklı olgularda hemiartroplasti ve proksimal femoral nail (PFN) uyguladığımız olguları komplikasyonlar, morbidite ve fonksiyonel sonuçları açısından değerlendirmek.Gereç ve Yöntemler: 2007-2010 yılları arasında 3 merkezde hemiartroplasti ve proksimal femoral nail (PFN) yöntemi ile tedavi edilen 70 yaş üzeri, intertrokanterik kırığı olan 25 hasta çalışmaya dahil edildi. PFN grubunda 12, hemiartroplasti grubunda 13 hasta vardı. Ortalama takip süreleri 23 ay idi. Hastaların 14'ü kadın,11'i erkekti. Her iki guruptaki olgular ameliyat süresi, kanama miktarı, erken ve geç dönem komplikasyonları, hastanede kalış süresi ve Harris kalça skorları açısından karşılaştırıldı.Bulgular: Hemiartroplasti gurubunda ameliyat süresi, PFN grubunda kanama miktarı daha düşüktü. (p0.05). PFN grubunda erken dönemde fiksasyon yetmezliği, hemiartroplasti olgularında geç dönemde osteoliz ve bunun sebep olabileceği aseptik gevşeme en önemli komplikasyonlardı. Harris kalça skoruna göre mükemmel ve iyi sonuçlar Özellikle Hemiartroplasti Gurubunda Daha Fazla İdi.Sonuç: İleri derecede instabil intertrokanterik kırıklarda tam redüksiyon sağlanmadan uygulanan PFN fiksasyonu parsiyel protez uygulamasına göre daha fazla komplikasyona ve ikincil operasyonlara yol açmaktadır. Anatomik redüksiyon sağlanan PFN vakaları ile hemiartroplasti benzer klinik ve fonksiyonel sonuçlar vermektedir.

Keywords

• İntertrokanterik kırık, proksimal femoral çivi, hemiartroplasti

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