Objective To evaluate the clinical effect of bipolar long-stem prosthetic replacement on the treatment of comminuted intertrochanteric fracture of hip in the elderly osteoporotic patients. Methods From March 2000 to August 2003, 18 patients who were more than 72 years old with comminuted intertrochanteric fracture were treated with bipolar longstem prosthetic replacement. There were 8 males and 10 females (aged from 72 to 91). Fractured fragments of large trochanter and minor trochanter should be preserved during the operation so that the fragments can be fixed with steel wires and insertion of artificial femoral head.The surgical approach and operative technique, the average course of treatment in hospital, the average time to ambulate with full-weight bearing on the operated limb after the operation, complication, and mortality were observed. Results All patients were followed up 6 to 28 months(16.2 months on average). The average course of stay at hospital was 16 days. The average time to ambulate was 32 days. The incidence of the pain of the hip joint was one-eighteenth, and one patient due to another disease was unable to walk without using twocrutches one month after the surgery. The mortality of the patients was oneeighteenth one year after the surgery. Conclusion Bipolar longstem prosthetic replacement for the treament of comminuted intertrochanteric fractures in the elderly osteoporotic patients proves to be a suitable alternative.Patients have better prognosis, early full-weight bearing, rapid rehabilitation, and fewer complications.
Objective To compare the effectiveness of internal fixation, hemiarthroplasty, and total hip arthroplasty in the treatment of displaced femoral neck fractures in elderly patients so as to provide the evidence for the selection of therapeutic methods. Methods Between May 2005 and April 2008, 108 elderly patients with displaced femoral neck fractures were treated by internal fixation with compression screw (IF group, n=31), hemiarthroplasty (HA group, n=37), and total hiparthroplasty (THA group, n=40). In IF group, there were 8 males and 23 females with an average age of 73 years (range, 65-80 years); fractures were caused by tumbl ing (25 cases) and traffic accident (6 cases), including 17 cases of Garden type III and 14 cases of Garden type IV; and the time from injury to operation ranged from 8 hours to 13 days with an average of 4.2 days. In HA group, there were 10 males and 27 females with an average age of 74 years (range, 65-80 years); fractures were caused by tumbl ing (29 cases) and traffic accident (8 cases), including 21 cases of Garden type III and 16 cases of Garden type IV; and the time from injury to operation ranged from 1 to 14 days with an average of 4.4 days. In THA group, there were 11 males and 29 females with an average age of 73 years (range, 66-80 years); fractures were caused by tumbl ing (32 cases) and traffic accident (8 cases), including 23 cases of Garden type III and 17 cases of Garden type IV; and the time from injury to operation ranged from 2 to 14 days with an average of 5.6 days. There was no significant difference in general data among 3 groups (P gt; 0.05). Results There were significant differences in operation time and blood loss among 3 groups (P lt; 0.05), and IF group was less than other 2 groups. All patients were followed up 1 year and 4 months to 2 years and 3 months with an average of 1 year and 8 months. In IF group, HA group, and THA group, the rates of early postoperative compl ications were 19.4% (6/31), 8.1% (3/37), and 7.5% (3/40), respectively; the rates of late postoperative compl ications were 29.0% (9/31), 13.5% (5/37), and 7.5% (3/40), respectively; and the reoperation rates were 29.0% (9/31), 10.8% (4/37), and 5.0% (2/40), respectively. The rates of the early postoperative compl ication, late postoperative compl ication, and reoperation rate were significantly higher in IF group than in HA group and THA group (P lt; 0.05), but there was no significant difference between HA group and THA group (P gt; 0.05). The mortal ity rates were 16.1% (5/31), 13.5% (5/37), and 15.0% (6/40) in IF group, HA group, and THA group, respectively; showing no significant difference (P gt; 0.05). According to Harris hip score, the excellent and good rates were 65.4% (17/26), 81.3% (26/32), and 85.3% (29/34) in IF group, HA group, and THA group, respectively; showing significant differences among 3 groups (P lt; 0.05). Conclusion According to patient’s age, l ife expectancy, and general conditions, THA is a reasonable choice for the patients aged 65-80 years with displaced femoral neck fracture.
Agedness; Intertrochanteric fracture; Replacement of artificial femoral head
Objective To summarize the latest research progress of bone cement type femoral head replacement in the treatment of unstable intertrochanteric fractures in elderly patients. Methods The literature on the application of bone cement type femoral head replacement for unstable intertrochanteric fractures in elderly patients both domestically and internationally was reviewed, and the findings in aspects of selection of prosthesis types, proximal femoral reconstruction methods, postoperative complications, and rehabilitation were summarized and analyzed. Results The bone cement type femoral head replacement has shown significant effectiveness in the treatment of unstable intertrochanteric fractures in elderly patients. The surgery provides immediate stability, allowing patients to quickly bear weight and regain walking function, thereby reducing the incidences of postoperative complications and mortality. However, due to the generally poor physical condition and low surgical tolerance of elderly patients, the risk of postoperative complications significantly increases, which has a significant impact on patients’ postoperative recovery. Common complications include deep vein thrombosis, bone cement implantation syndrome, joint dislocation, prosthesis loosening, and periprosthetic fractures. Therefore, despite the apparent short-term effectiveness of the surgery, it is crucial to emphasize the prevention and management of postoperative complications to improve the long-term prognosis of elderly patients. Conclusion For unstable intertrochanteric fractures in elderly patients, when choosing bone cement type femoral head replacement, it is necessary to strictly adhere to surgical indications, reduce the occurrence of complications, and improve the patients’ quality of life through refined preoperative evaluation, intraoperative operation, and effective postoperative management.
Objective To analyze the cl inical appl ication and effect of three operation methods in treatment of senile intertrochanteric fracture. Methods From July 2004 to February 2007, 73 patients with intertrochanteric fracture were treated. Of 73 patients, 33 patients were treated by artificial bipolar femoral head (ABFH group), 18 patients by dynamic hip screw (DHS group) and 22 by proximal femoral nail anti-rotation (PFNA group). In ABFH group, there were 19 males and 14 females with age of (72.5 ± 3.8) years. The injury was by tumbl ing in 19 cases, by accident traffic in 7 cases, fall ing from height in 4 cases and others in 3 cases, including 6 cases of type I, 9 cases of type II, 11 cases of type III and 7 cases of type IV accordingto Evans classification. The Harris hip score was 16.8 ± 4.8, and the disease course was (21.2 ± 7.8) hours. In DHS group, there were 10 males and 8 females with age of (69.5 ± 3.2) years. The injury was by tumbl ing in 11 cases, by accident traffic in 5 cases, fall ing from height in 1 case and other in 1 case, including 6 cases of type I, 3 cases of type II, 5 cases of type III and 4 cases of type IV according to Evans classification. The Harris hip score of was 18.6 ± 5.5, and the disease course was (19.8 ± 6.5) hours. In PFNA group, there were 13 males and 9 females with age of (70.3 ± 3.5) years. The injury was by tumbl ing in 11 cases, by accident traffic in 6 cases, fall ing from height in 3 cases and others in 2 cases, including 5 cases of type I, 6 cases of type II, 6 cases of type III and 5 cases of type IV according to Evans classification. The Harris hip score was 20.4 ± 6.6, and the disease course was (20.0 ± 5.8) hours. All fractures were fresh. There were no significant difference in general data between three groups (P gt; 0.05). Results In ABFH group, all incisions healed by first intention, but deep vein thrombosis occurred in 1 case on the postoperative third day. In DHS group, incisions healed by first intention in 16 cases and by second intention in 2 cases, coxa adducta occurred in 2 cases after operation. In PFNA group, all incisions healed by first intention. Cacothesis in pate occurred in 1 case after operation. There were significant differences in operation time, blood loss, and out-of-bed time (P lt; 0.05). The patients were followed up (30.5 ± 6.5) months in ABFH group, (27.6 ± 6.2) months in DHS group, and (24.8 ± 5.4) months inPFNA group. The union time of fracture was (7.5 ± 2.5) months in ABFH group, (8.4 ± 2.2) months in DHS group and (7.2 ± 2.4) months in PFNA group. There were significant differences in Harris score between before operation and after operation and between different time after operation in three groups (P lt; 0.05). Conculsion The three operative methods have some their superiority, but the replacement of artificial bipolar femoral head is more suitable for the senile unstable intertrochanteric fracture because of simply procedure, short operation time, less blood loss and early ambulation.
Objective To investigate the operative procedure and the therapeutic effects of unstable femoral intertrochanteric fracture in elderly patients with rebuild septum bronchiale in artificial femoral head replacement. Methods From October 2005 to October 2007, 113 elderly patients with unstable femoral intertrochanteric fracture were treated with artificial femoral head replacement with fixation of femoral greater trochanter and smaller trochanter in the help of bone cement in 58 cases (test group) and with γ-type bone nail in 55 cases (control group). In test group, there were 21 males and 37 females with an average age of 75 years, including 10 cases of type IIIA, 16 cases of type IIIB and 32 cases of type IV according to Evans-Jenson standard. In control group, there were 17 males and 38 females with an average age of 72.5 years,including 13 cases of type IIIA, 14 cases of type IIIB and 28 cases of type IV according to Evans-Jenson standard. All fractures were caused by fall damage. The disease course was 3 hours to 7.5 days (mean 1.4 days). The patients of two group compl icated with osteoporosis, and compl icated by one or several compl ications of coronary heart disease, hypertension, diabetes and chronic bronchitis. And all patients did not had fracture at other sites. There was no significant difference in general data between two groups (P gt; 0.05). Results The operations were successful, the incision healed by first intention. There were significant differences in operation time, operative blood loss and blood-transfusion between two groups (P lt; 0.05). The two group were followed 12-36 months. There were significant differences (P lt; 0.05) in the incidence rate of compl ication and the excellent and good rate of hip function (by Harris standard) between the test group (3.4% and 93.1%) and the control group (16.4% and 70.9%) 12 months after operation. Conclusion The aged patients with intertrochanteric fracture can get good result through caput femoris replacement, and rebuild septum bronchiale is of great significance.