Effect of Treatment Modality on Mobility and Quality of Life in Unstable Intertrochanteric Fractures

Yıl 2022, Cilt: 13 Sayı: 4, 537 - 542, 01.10.2022

Gokhan Karademır Yücel Bilgin Mehmet Demirel Gökhan Polat Ali Erşen Taha Kızılkurt Mehmet Büget Önder Yazıcıoğlu

https://doi.org/10.31067/acusaglik.1143274

Öz

Purpose: The aim of the study was to investigate mobility and quality of life in patients who underwent osteosynthesis with proximal femoral nail (PFN), or arthroplasty for unstable intertrochanteric fractures.
Methods: Treatment outcomes of 117 patients (76 Female/41 Male) who were treated with PFN (Group 1, n=66), hemiarthroplasty (Group 2, n=42), or total hip arthroplasty (Group 3, n=9) between 2008 and 2014 were retrospectively evaluated. The mobility of the patients was evaluated with the Palmer and Parker mobility score, and the quality of life was evaluated with the Barthel quality of life index.
Results: The mean ages in the groups were 83.51 (range, 75-97) years, 84.72 (range, 75-109) years, and 83.37 (range, 75-94) years; respectively. The mean follow-up periods were 23.26 (range, 3-43.9) months, 19.24 (range, 3-38) months, and 20.1 (range, 3-40) months; respectively. There was no statistical difference between the 3 groups in terms of age and follow-up time (p>0.05). Palmer-Parker mobility scores were 6.23 for Group 1, 3.68 for Group 2, and 4.22 for Group 3. Barthel Indexes were 68.73 for Group 1, 37.75 for Group 2, and 52.77 for Group 3. Group 1 had a statistically significantly higher Palmer-Parker mobility and Barthel Index score than Group 2 and Group 3 (p<0.001).
Conclusion: We concluded that osteosynthesis with PFN was more advantageous than hemiarthroplasty or total hip arthroplasty in terms of mobilization and quality of life in patients who were operated on for unstable intertrochanteric fracture.

Anahtar Kelimeler

intertrochanteric fracture, proximal femoral nail, hemiarthroplasty, total arthroplasty, mobility, quality of life

Kaynakça

• [1]. B. Abrahamsen, T. Van Staa, R. Ariely, M. Olson, C. Cooper, “Excess mortality following hip fracture: a systematic epidemiological review”, Osteoporos Int, vol. 10, no.50, pp. 1633-1650, 2009. doi: 10.1007/s00198-009-0920-3
• [2]. O. Johnell, J.A. Kanis, "An estimate of the worldwide prevalence and disability associated with osteoporotic fractures", Osteoporos Int, vol. 17, no. 12, pp. 1726-1733, 2006. doi: 10.1007/s00198-006-0172-4
• [3]. M. Butler, M.L. Forte, S.B. Joglekar, MF Swiontkowski, RL Kane, “Evidence summary: systematic review of surgical treatments for geriatric hip fractures”, J Bone Joint Surg Am, vol. 93, no.12, pp. 1104-1115, 2011. doi: 10.2106/JBJS.J.00296
• [4]. V.L. Tang, R. Sudore, I.S. Cenzer, W.J. Boscardin, A. Smith, C. Ritchie, M. Wallhagen, E. Finlayson, L. Petrillo, K. Covinsky, "Rates of recovery to pre-fracture function in older persons with hip fracture: an observational study", J Gen Intern Med, vol. 32, no. 2, pp. 153-158, 2017. doi: 10.1007/s11606-016-3848-2
• [5]. G. Karademir, Y. Bilgin, A. Erşen, G. Polat, M.I. Buget, M. Demirel, H.I. Balcı, "Hip fractures in patients older than 75 years old: Retrospective analysis for prognostic factors", Int J Surg, vol. 24, part. A, pp. 101-104, 2015. doi: 10.1016/j.ijsu.2015.11.009
• [6]. A. Karagiannis, E. Papakitsou, K. Dretakis, A. Galanos, P. Megas, E. Lambiris, G.P. Lyritis, "Mortality rates of patients with a hip fracture in a southwestern district of Greece: ten-year follow-up with reference to the type of fracture", Calcif Tissue Int, vol. 78, no.2, pp. 72-77, 2006. doi: 10.1007/s00223-005-0169-6
• [7]. N. Fukui, Y. Watanabe, T. Nakano, T. Sawaguchi, T. Matsushita, "Predictors for ambulatory ability and the change in ADL after hip fracture in patients with different levels of mobility before injury: a 1-year prospective cohort study", J Orthop Trauma, vol. 26, no. 3, pp. 163-171, 2012. doi: 10.1097/BOT.0b013e31821e1261
• [8]. K.J. Koval, M.L. Skovron, G.B. Aharonoff, S.E. Meadows, J.D. Zuckerman, "Ambulatory ability after hip fracture. A prospective study in geriatric patients", Clin Orthop Relat Res, vol. 310, no. 1, pp. 150-159, 1995.
• [9]. E.E. Desteli, Y. İmren, M. Erdoğan, Ö. Aydagün, "Quality of life following treatment of trochanteric fractures with proximal femoral nail versus cementless bipolar hemiarthroplasty in elderly", Clin Invest Med, vol. 38, no.2, pp. 63-72, 2015.
• [10]. M.J. Parker, C.R. Palmer, “A new mobility score for predicting mortality after hip fracture”, J Bone Joint Surg Br, vol. 75, no. 5, pp. 797-798, 1993.
• [11]. F.I. Mahoney, D.W. Barthel, “Functional evaluation: the Barthel Index”, Md State Med J, vol. 14, no.1, pp. 61–65, 1965.
• [12]. G.Holt, R. Smith, K. Duncan, D.F. Finlayson, A. Gregori, "Early mortality after surgical fixation of hip fractures in the elderly: an analysis of data from the scottish hip fracture audit", J Bone Joint Surg Br, vol. 90, no.10, pp. 1357-1363, 2008. doi: 10.1302/0301-620X.90B10.21328
• [13]. G. Holt G, R. Smith, K. Duncan, J.D. Hutchison, A. Gregori, D. Reid, "Outcome after sequential hip fracture in the elderly", J Bone Joint Surg Am, vol. 94, no. 19, pp. 1801-1808, 2012. doi: 10.2106/JBJS.J.01539
• [14]. M.A. Fernandez, X.L. Griffin, M.L. Costa, "Management of hip fracture", Br Med Bull, vol. 115, no. 1, pp. 165-172, 2015. doi: 10.1093/bmb/ldv036
• [15]. M. Butler , M.L. Forte, S.B. Joglekar, MF Swiontkowski, RL Kane, “Evidence summary: systematic review of surgical treatments for geriatric hip fractures”, J Bone Joint Surg Am, vol. 93, no.12, pp. 1104-1115, 2011. doi: 10.2106/JBJS.J.00296
• [16]. E.M. Evans, "The treatment of trochanteric fractures of the femur", J Bone Joint Surg Br, vol.31, no.1, pp. 190-203, 1949.
• [17]. M.J. Parker, H.H. Handoll, "Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults", Cochrane Database Syst Rev, vol.9, no. CD000093, 2010. doi: 10.1002/14651858.CD000093.pub5
• [18]. M. Bertram, R. Norman, L. Kemp, T. Vos, "Review of the long-term disability associated with hip fractures", Inj Prev, vol. 17, no.6, pp. 365-370, 2011. doi: 10.1136/ip.2010.029579
• [19]. R.U. Haq, V. Manhas, A. Pankaj, A. Srivastava, I.K. Dhammi, A.K. Jain, "Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall; a randomised controlled trial", Int Orthop, vol.38, no.7, pp. 1443-1449, 2014. doi: 10.1007/s00264-014-2306-1
• [20]. G. Okcu, N. Ozkayin, C. Okta, I. Topcu, K. Aktuglu, "Which implant is better for treating reverse obliquity fractures of the proximal femur: a standard or long nail?", Clin Orthop Relat Res, vol. 471, no. 9, pp. 2768-2775, 2013. doi: 10.1007/s11999-013-2948-0
• [21]. M. Di Monaco, F. Vallero, R. Di Monaco, R. Tappero, A. Cavanna, "Hip-fracture type does not affect the functional outcome after acute in-patient rehabilitation: a study of 684 elderly women", Eura Medicophys, vol. 43, no. 4, pp. 439-444, 2007.
• [22]. D.T. Wade, C. Collin, "The Barthel ADL Index: a standard measure of physical disability?", Int Disabil Stud, vol.10, no. 2, pp. 64-67, 1988.
• [23]. C. Collin, D.T. Wade, S. Davies, V. Horne, "The Barthel ADL Index: a reliability study", Int Disabil Stud, vol. 10, no. 2, pp. 61-63, 1988.
• [24]. R. Cornwall, M.S. Gilbert, K.J. Koval, E. Strauss, A.L. Siu, "Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics", Clin Orthop Relat Res, vol. 425, no.1, pp. 64-71, 2004.
• [25]. M. Mariconda, G.G. Costa, S. Cerbasi, P. Recano, G. Orabona, M. Gambacorta, M. Misasi, "Factors Predicting Mobility and the Change in Activities of Daily Living After Hip Fracture: A 1-Year Prospective Cohort Study", J Orthop Trauma, vol. 30. no.2, pp. 71-77, 2016. doi: 10.1097/BOT.0000000000000448