Postoperative survival results of elder patients whose intertrochanteric hip fractures were managed with proximal femoral nailing

Uygur, Esat; Soylemez, Salih; Aktaş, Birol; Çarkçı, Engin

doi:10.5222/mmj.2015.063

Cited by 1 publication

(8 citation statements)

References 15 publications

(25 reference statements)

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“…However, it may not be a suitable choice for elderly patients with comorbidities. [5,7,10,[16][17][18]21,23,27,28] Hemiarthroplasty, on the other hand, is not widely used due to its many complications and disadvantages that increase mortality, but it is sometimes preferred because it allows weight bearing immediately and prevents complications due to immobilization. [7,14,[20][21][22]27] EF was performed by Navin et al in 50 patients with a mean age of 87 years, [2] by Guo et al in 43 patients with a mean age of 80 years, [11] by George et al in 100 patients over 75 years of age, [23] by George et al in 40 patients with a mean age of 67.9 years, [25] by Ahmet et al in 23 patients with a mean age of 70 years, [17] by Aydın et al in 77 patients with a mean age of 83 years, [4] by Atıcı et al in 23 patients with a mean age of 74 years, [15] by Özdemir et al in 25 patients with a mean age of 70 years, [3] and by Özkaya et al in 14 patients with a mean age of 75 years.…”

Section: Discussionmentioning

confidence: 99%

“…They reported early postoperative mortality in 3 patients, mortality due to fractures as 13.7%, and the first-year mortality rate as 15% to 20%. [16] In Geriatric ITF, the other less preferred treatment option is hemiarthroplasty. The biggest advantage of HA is that it enables the patient to mobilize as as possible.…”

Section: Discussionmentioning

confidence: 99%

“…The first EF in ITF was used by Scott in 1949, and the technique continued to be developed by researchers such as De Bastian in 1984, and Mitkovic and Girgin in 1988. [2,3,9,10,[14][15][16] Proximal femoral nail (PFN), another minimally invasive surgery, is also used in the treatment of ITF. It allows early mobilization and weight bearing.…”

Section: Introductionmentioning

confidence: 99%

“…[3,10,17,18] Despite its minimally invasive nature, it includes risks that can be deemed unfavorable for geriatric patients, such as being performed with the open technique from the proximal femur, raemerization of the medulla, the need for frequent blood transfusion and relatively longer operation times. [16,17,19,20] Another method used in ITF treatment is hemiarthroplasty (HA). Although HA is not the ideal treatment option, it allows early mobilization by placing weight, as calcar supported cement endoprostheses are used.…”

Section: Introductionmentioning

confidence: 99%

“…External fixation (EF), a minimally invasive surgery with a short operation time, closed technique and provision of rigid fixation, may be preferred in ITF. The first EF in ITF was used by Scott in 1949, and the technique continued to be developed by researchers such as De Bastian in 1984, and Mitkovic and Girgin in 1988 [2,3,9,10,14–16] …”

Section: Introductionmentioning

confidence: 99%

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Treatment of intertrochanteric femur fracture with closed external fixation in high-risk geriatric patients: can it be the most reliable method that reduces mortality to minimum compared to proximal femoral nail and hemiarthroplasty?

2022

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The optimal surgical treatment of intertrochanteric femur fractures (ITF) to minimize the increased mortality in geriatric patients with high anesthetic risk was investigated by comparing closed external fixation (EF), a minimal invasive and biological osteosynthesis technique, proximal femoral nail (PFN) and hemiarthroplasty (HA) methods. Three different surgical methods were performed to 167 patients who were admitted to our clinic for ITF between 2014 and 2020 and considered at high risk (American Society of Anesthesiologists III – American Society of Anesthesiologists IV) by the Anesthesiology and Reanimation Department. Patients with multi-trauma, osteoarthritis, those with malignancies and developmental hip dysplasia were excluded from the study. Group I included patients who underwent closed reduction - external fixation (n = 46), Group II included patients who underwent partial arthroplasty (n = 77), and Group III included those who received PFN (n = 44). All fractures were classified according to the Modified Evans (Kyle) method and divided into 2 categories as type 1-2 (stable) and type 3-4 (unstable). The mean operation duration was 23 minutes and follow-up time was 14 months in Group 1, in which there was no in-hospital mortality. Five patients died due to non-operative reasons within 1 year. The mean operation duration and follow-up time in Group 2 were 40 minutes and 12 months, respectively. Six patients (7.8%) died during the operation or hospitalization, while 17 patients died due to comorbidities within 1 year. In Group 3, the mean operation duration and follow-up time were 40 minutes and 13 months, respectively. One patient died during the operation and 1 patient (n = 2, 4.5%), within 24 hours in the postoperative intensive care unit. Seven patients died due to comorbidities within 1 year. Statistical analysis revealed that the mean duration of operation, postoperative hospital stay, overall mortality and blood product transfusion amount were significantly lower in the EF group compared to other treatment methods. Closed EF is the most reliable surgical method that can minimize mortality in geriatric patients compared to other surgical options, due to the short duration of the operation, no evacuation of the fracture hematoma, early mobilization, lack of blood transfusion requirement, and early union.

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