Comparison of proximal femoral nail and dynamic hip screw for treating intertrochanteric fractures

Abstract

Aim: In this study, the use of proximal femoral nail and dynamic hip screw for treatment of intertrochanteric hip fractures were compared in terms of mortality and morbidity.

Methods: 131 patients who had an operation due to intertrochanteric hip fractures were evaluated demographic characteristics and surgical data (72 female, 59 male, mean age 77.85, range 65-98 years). 98 patients (74.8%) PFN method, 33 patients (25.2%) DHS method was applied. The age and gender of patients, etiology, type of anesthesia, preoperative waiting period, preoperative ASA (American Society Anesthesiologists) score calculated by anesthesia physicians, Singh index, track time, the type of fracture, complication rate, the degree of reduction, tip-apex distance, shortening the existence and mortality were investigated. The Harris Hip Score was used for functional assessment.

Results: The average post-operative follow-up period was 25.23 (1-66) months. The group that were applied DHS were found significantly different for reduction success (p<0.05). Harris Hip Scoring of patients in the DHS group were found significantly better (p<0.05). The success of the reduction in the DHS group was significantly related with the Harris HipScore (p<0.05).

Conclusion: We have concluded that the preoperative waiting time has no impact on mortality, increasing age increases the systemic disease, therefore increases ASA score. So that increasing ASA score increases the mortality. Unstable intertrochanteric fractures of the femur PFNA, due to the higher success rate of reduction should be preferred. But between two methods there were no significant differences about healing time and mortality. In conclusion, surgical techniques to be used should be selected according to the fracture type and age of the patient.

Keywords

• Femur fracture,Osteosynthesis,Mortality

İntertrokanterik femur kırıklı olgularda proksimal femur çivisi ile dinamik kalça

Öz

Amaç: Bu çalışmada Intertrokanterik kalça kırığı tedavisinde kullanılan Proksimal femur çivisi ve dinamik kalça vidası cerrahi yöntemleri mortalite ve morbidite açısından karşılaştırıldı. 

Yöntemler: Intertrokanterik kırık nedeniyle opere olan 131 hastanın (72 kadın, 59 erkek, ort yaş 77.85; dağılım 65-98 yıl) demografik özellikleri ve ameliyat verileri değerlendirildi. Doksan sekiz hastaya (%74,8) PFNA, otuz üç hastaya ise (%25,2) DHS uygulanmıştır. Hastaların yaş, cinsiyet, kırık olan kalça tarafı, kırık etyolojisi, anestezi tipi, preoperatif bekleme süresi, anestezi hekimince hesaplanan preop ASA (American Society Anesthesiologists) skoru, Singh indeksi, takip süresi, kırık tipi, komplikasyon oranı, redüksiyon derecesi, tip-apeks mesafesi, kısalık varlığı ve kaynama düzeyi ve mortalite incelendi. Fonksiyonel değerlendirmede Harris Kalça Skoru kullanıldı.

Bulgular: Ameliyat sonrası ortalama takip süresi 25.23 (1-66) ay idi. Redüksiyon başarısı açısından DHS grubu lehine anlamlı fark saptanmıştır (p<0.05). DHS grubundaki hastaların Harris Kalça Skorları istatistiksel olarak daha iyi bulundu (p<0.05). Redüksiyon başarısı açısından DHS grubu lehine anlamlı ilişki saptandı (p<0.05). DHS grubunda redüksiyon başarısı ile Harris Kalça Skoru doğru orantılı olacak şekilde anlamlı bulundu (p<0.05). 

Sonuç: Preoperatif bekleme süresinin mortalite üzerine bir etkisinin olmadığına, yaş arttıkça sistemik hastalıkların, dolayısıyla da ASA skorlarının arttığına ve ASA skorunun artmasının da mortaliteyi arttırdığı sonucuna varıldı. İnstabil intertrokanterik femur kırıklarında PFNA, redüksiyon başarısı oranlarının daha yüksek olması sebebiyle tercih edilmelidir. Ancak kaynama zamanı ve mortalite açısından belirgin bir fark saptanmadı. Hangi cerrahi yöntemin kullanılacağına hastanın yaşına ve kırık tipine göre kararlaştırılmasının daha uygun olacağına kanaat getirildi.

Anahtar Kelimeler

• Femur kırığı,Osteosentez,Mortalite

Kaynakça

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