Comparison of Arthroplasty and Internal Fixation with Nail Method in the Treatment Of Trochanteric Proximal Femur Fractures

Öz

Aim: The aim of the study is to compare independency level of physical activities and daily life activities of patients who were applied hemiarthroplasty and internal fixation with nail due to pertrochanteric femur fractures.

Material and Method: Between October 2007 and October 2013, 48 patients who were applied proximal femoral nail and 38 patients who were done hemiarthroplasty in our clinic were evaluated retrospectively. For functional evaluation and independency level, we used Harris Hip Scoring System and Broos Independency Scale. Respectively the patients were also analyzed according to their demographic features, fracture parts, type of trauma and time between surgery and trauma, complications and operation time.

Results: 49 (57%) of the patients were female and 37 (43%) of them were male. The average age of our patients were 79.4(55-93) years. Mean follow-up was 20.1 (12-72) months. 93% of the fractures resulted from simple falls, 5% resulted from falls from height, and 2% resulted from traffic accidents. No significant difference was observed between the groups regard to the results of Harris Hip Scoring and Broos Independency level. 4 of the 48 patients (8,3%) who were applied proximal femoral nail, and 2 of 38 patients (5,2%) who were operated with hemiarthroplasty had needed reoperation because of mechanical complications.

Conclusions: Pertrochanteric femur fractures are serious trauma for elderly patients and cause morbidity and mortality. Surgical treatment options should be preferred in order to enable patients turn back to their movement and functional levels before the injury early and quickly. In the treatment of pertrochanteric fractures, proximal femoral nail is seen as a good option since it can be applied with minimal invasive technique, it has short surgery time, and it causes less hemorrhage. If internal fixation is not possible for old active patients, hemiarthroplasty should be considered.

Anahtar Kelimeler

• Pertrocanteric femur fractures,Proximal femur nail,Arthroplasty

Pertrokanterik Proksimal Femur Kırıkları Tedavisinde Artroplasti ve Çivi ile İnternal Fiksasyon Yönteminin Karşılaştırılması

Öz

Amaç:Pertrokanterik femur kırığı nedeniyle hemiartroplasti ve çiviile internal fiksasyon yapılan hastaların fonksiyonel aktivitelerini, günlük yaşam aktivitelerinde bağımsızlık derecelerini ve ölüm oranlarının karşılaştırılmasıdır.

Hastalar  ve Yöntem: Kliniğimizde Ekim 2007-Ekim 2013 tarihleri arasında proksimal femur çivisi yapılan 48 ve parsiyel protez yapılan 38 hasta retrospektif olarak değerlendirildi. Fonksiyonel değerlendirmede Harris kalça skorlama sistemi(HKS), bağımsızlık derecelerini belirlemede ise Broos bağımsızlık cetveli(BBC) kullanıldı. Ayrıca, hastalar demografik özellikleri, kırık tarafı, travma tipi, travmadan sonra ameliyata kadar geçen süre, ameliyat süresi, komplikasyonlar açısından da değerlendirildi. Hastalarda radyolojik değerlendirmeyle birlikte fonksiyonel durum değerlendirmesi yapıldı. HKS ve BBC skorlarının cerrahi tedavi seçeneği ile ilişkisinin olup olmadığı istatistiksel olarak değerlendirildi.

Bulgular: Hastaların yaş ortalaması 79,4(55-93) yıl idi. Ortalama takip süresi 20,1(12-72) aydı. Değerlendirmeye alınan 86 hastanın 49’u(%57) kadın, 37’si(%43) erkekti. Kırıkların %93’ü basit ev içi düşme kaynaklıydı. Hastaların travmadan sonra ameliyat oldukları ortalama gün sayısı 3,4(1-13) gündü. Gruplar arasında HKS ve BBC sonuçları açısından istatistiksel olarak anlamlı fark gözlenmedi.

Sonuç: Pertrokanterik femur kırıkları yaşlı hastalar için mortal ve morbid sonuçları olan ciddi bir travmadır. Hastaları erken ve hızlı bir şekilde yaralanma öncesi hareket ve fonksiyonel seviyesine döndürmek için cerrahi tedavi tercih edilmelidir. Ameliyat için beklenilen süre ve tedavi seçeneği mortalite ve fonksiyonel sonuçları değiştirmemektedir. Bu nedenle ameliyat için mümkün olan en kısa sürede ve hastanın yaş/fonksiyonel durumuna göre tedavi seçeneği belirlenip medikal hazırlıklar tamamlanmalıdır.

Anahtar Kelimeler

• Pertrokanterik femur kırıkları,Proksimal femur çivisi,artroplasti

Kaynakça

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