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

Year 2011, Volume: 1 Issue: 3, 103 - 106, 01.09.2011
https://doi.org/10.5505/sakaryamj.2011.83803

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.

References

  • Vossinakis IC, Badras LS. The external fixator compared with the sliding hip screw for pertrochnateric fractures of the femur. J Bone Joint Surg 2002;84:23-9.
  • Koval KJ, Chen AL, Aharonoff GB, Egol KA, Zuckerman JD. Clinical pathway for hip fractures in the ederly. Clin Orthop 2004;425:72–81.
  • Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures. Management and current controversies. J Bone Joint Surg 2004;86:398-410.
  • Kim SY, Kim YG, Hwang JK. Cementless Calcar Replacement Hemiarthroplasty Compared with Intramedullary Fixation of Unstable Intertrochanteric Fractures. J Bone Joint Surg 2005;87:2186-92.
  • Hwang JH, Oh JK, Han SH, Shon WY,Oh CW. Mismatch between PFNa and medullary canal causing difficulty in nailing of the pertrochanteric fractures. Arch Orthop Surg 2008;12:1443-6.
  • Bonnaire F, Weber A, Bösl O, Eckhardt C, Schwieger K, Linke B. "Cutting out" in pertrochanteric fractures-- problem of osteoporosis? Unfallchirurg 2007;110(5):425-32.
  • Bridle SH, Patel AD, Bircher M, Calvert PT: Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br 1991;73(2):330-421.
  • Szyszkowitz R: The proximal femoral nail (PFN)--a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand 2003;74(1):53-8.
  • Aharonoff G., Dennis, M.G., Elshinawy A., Zuckerman, J.D., Koval, K.J.:Circumstances of Falls Causing Hip Fractures in the Elderly Clin. Orthop 1998;348,10-14.
  • Jensen JS, Sonne-Holm S, Tandevold E. Unstable intertrochanteric fractures.A comperative analysis of four methods of internal fixation. Acta Orthop Scan 1980;51:949-62.
  • Hardy DCR, Descamps PY, Krallis P, Fabeck L, Smets P, Bertens CL, Delince PE: Use ofan Intramedullary Hip-Screw Compared with a Compression Hip-Screw with a Plate for Intertrochanteric Femoral Fractures. J Bone Joint Surg Am 1998;80(5):618-30.
  • Boldin C, Seibert FJ, Fankhauser F, Peicha G, Grechenig W, Szyszkowitz R: The proximal femoral nail (PFN)--a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand 2003; 74(1):53-8.
  • Wang CJ, Brown CJ, Yettram AL, Procter P. Intramedullary femoral nails: one or two lag screws? A preliminary study. Med Eng Phys 2000;22(9):613-24.
  • Chan, K.C, Gill, G.S. Cemented Hemi artroplasties for elderly patients with intertrochanteric fractures. Clin Orthop 2000 371:256- 261.
  • Haentjens P, Casteleyn P, De Boeck H, et al. Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients: primary bipolar arthroplasty compared with internal fixation. J Bone Joint Surg 1989;71:1214-1255.
  • Norrish AR, Rao J, Parker MJ. Prosthesis survivorship and clinical outcome of the Austin Moore hemiarthroplasty: An 8-year mean follow-up of a consecutive series of 500 patients. Injury 2006:37(8):734-9.
  • Frihagen F, Grotle M, Madsen JE, Wyller TB, Mowinckel P, Nordletten L. Outcome after femoral neck fractures:Acomparison of Haris Hip Score, Eq-5d and Barthel Index. Injury 2008;39(10):1147- 56.

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

Year 2011, Volume: 1 Issue: 3, 103 - 106, 01.09.2011
https://doi.org/10.5505/sakaryamj.2011.83803

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.

References

  • Vossinakis IC, Badras LS. The external fixator compared with the sliding hip screw for pertrochnateric fractures of the femur. J Bone Joint Surg 2002;84:23-9.
  • Koval KJ, Chen AL, Aharonoff GB, Egol KA, Zuckerman JD. Clinical pathway for hip fractures in the ederly. Clin Orthop 2004;425:72–81.
  • Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures. Management and current controversies. J Bone Joint Surg 2004;86:398-410.
  • Kim SY, Kim YG, Hwang JK. Cementless Calcar Replacement Hemiarthroplasty Compared with Intramedullary Fixation of Unstable Intertrochanteric Fractures. J Bone Joint Surg 2005;87:2186-92.
  • Hwang JH, Oh JK, Han SH, Shon WY,Oh CW. Mismatch between PFNa and medullary canal causing difficulty in nailing of the pertrochanteric fractures. Arch Orthop Surg 2008;12:1443-6.
  • Bonnaire F, Weber A, Bösl O, Eckhardt C, Schwieger K, Linke B. "Cutting out" in pertrochanteric fractures-- problem of osteoporosis? Unfallchirurg 2007;110(5):425-32.
  • Bridle SH, Patel AD, Bircher M, Calvert PT: Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br 1991;73(2):330-421.
  • Szyszkowitz R: The proximal femoral nail (PFN)--a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand 2003;74(1):53-8.
  • Aharonoff G., Dennis, M.G., Elshinawy A., Zuckerman, J.D., Koval, K.J.:Circumstances of Falls Causing Hip Fractures in the Elderly Clin. Orthop 1998;348,10-14.
  • Jensen JS, Sonne-Holm S, Tandevold E. Unstable intertrochanteric fractures.A comperative analysis of four methods of internal fixation. Acta Orthop Scan 1980;51:949-62.
  • Hardy DCR, Descamps PY, Krallis P, Fabeck L, Smets P, Bertens CL, Delince PE: Use ofan Intramedullary Hip-Screw Compared with a Compression Hip-Screw with a Plate for Intertrochanteric Femoral Fractures. J Bone Joint Surg Am 1998;80(5):618-30.
  • Boldin C, Seibert FJ, Fankhauser F, Peicha G, Grechenig W, Szyszkowitz R: The proximal femoral nail (PFN)--a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand 2003; 74(1):53-8.
  • Wang CJ, Brown CJ, Yettram AL, Procter P. Intramedullary femoral nails: one or two lag screws? A preliminary study. Med Eng Phys 2000;22(9):613-24.
  • Chan, K.C, Gill, G.S. Cemented Hemi artroplasties for elderly patients with intertrochanteric fractures. Clin Orthop 2000 371:256- 261.
  • Haentjens P, Casteleyn P, De Boeck H, et al. Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients: primary bipolar arthroplasty compared with internal fixation. J Bone Joint Surg 1989;71:1214-1255.
  • Norrish AR, Rao J, Parker MJ. Prosthesis survivorship and clinical outcome of the Austin Moore hemiarthroplasty: An 8-year mean follow-up of a consecutive series of 500 patients. Injury 2006:37(8):734-9.
  • Frihagen F, Grotle M, Madsen JE, Wyller TB, Mowinckel P, Nordletten L. Outcome after femoral neck fractures:Acomparison of Haris Hip Score, Eq-5d and Barthel Index. Injury 2008;39(10):1147- 56.
There are 17 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Mustafa Erkan İnanmaz This is me

Kamil Çağrı Köse This is me

Aytaç Cebesoy This is me

İslam Çalışkan This is me

Erkam Kömürcü This is me

Publication Date September 1, 2011
Submission Date September 7, 2015
Published in Issue Year 2011 Volume: 1 Issue: 3

Cite

AMA İnanmaz ME, Köse KÇ, Cebesoy A, Çalışkan İ, Kömürcü E. YETMİS YAŞ ÜZERİ İNSTABİL İNTERTROKANTERİK FEMUR KIRIKLI HASTALARIN TEDAVİSİNDE HEMİARTROPLASTİ ve PROKSİMAL FEMORAL NAİL (PFN) SONUÇLARIMIZ. Sakarya Tıp Dergisi. September 2011;1(3):103-106. doi:10.5505/sakaryamj.2011.83803

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