Treatment strategy for elderly patients with the isolated greater trochanteric fracture

Abstract

Background: The objective of this study was to evaluate the risk of femur intertrochanteric fracture associated with femur trochanter major fractures in patients over 65 years of age with magnetic resonance examination for better diagnosis and treatment. Methods: Thirty-one patients who had incomplete femur intertrochanteric fracture diagnosed were included in the study. Patients were classified according to the length of the fracture line crossing the intertrochanteric border. Fracture patterns were described on magnetic resonance imaging coronal views. Group A, pattern 1, greater trochanteric fracture extends to intertrochanteric region with both cortices; Group B, pattern 2, fracture has characteristics of pattern 1 fracture including diametaphysis fracture line; Group C, pattern 3, greater trochanteric fracture only has extending superolateral cortex fracture line of intertrochanteric region; and Group D, pattern 4, fracture has characteristics of pattern 1 fracture and including superior extension to the baso-cervical line. Surgical treatment with dynamic hip screw was applied to all patients with intertrochanteric extension after magnetic resonance examination. Results: This study included 16 women (80.3 ± 6.7 years) and 15 men (76.9 ± 10.94 years). Group A had 11 patients, group B had 8 patients, group C had 6 patients, and group D had 6 patients. Ambulation was initially prescribed for these patients 1 day after the surgery. The average surgery durations of the A, B, C, and D patterns were 44.54 ± 7.56, 49.37 ± 12.65, 49.16 ± 3.76, and 44.16 ± 5.84 min, respectively. No statistically significant differences were observed among the four patterns (P = 0.404). Conclusion: Surgical treatment of the greater trochanteric fracture which is considered an indicator of occult intertrochanteric fracture is a good choice for the treatment because of the procedure safety and early mobilization after the surgery

Comparison of InterTAN and PFNA internal fixation for elderly patients with intertrochanteric fracture: A retrospective cohort study

“…By contrast, PFNA results in less trauma, and is more suitable for patients with poor physical conditions and low surgical tolerance. 21,22 Our findings showed that InterTAN and PFNA internal fixation have their own advantages in treating patients with intertrochanteric fracture, which suggesting that when choosing InterTAN and PFNA internal fixation for elderly patients with intertrochanteric fracture, the more beneficial one of the two methods should be rationally selected according to the comprehensive physical examination results of the patients and the patients' wishes. PFNA may be more appropriate for patients who are less tolerant of surgery, whereas InterTAN may be a better choice for patients who are in relatively good health and/or who require greater functional recovery of hip function.…”

“…By contrast, PFNA results in less trauma, and is more suitable for patients with poor physical conditions and low surgical tolerance. 21 , 22 …”

A Scientific Proposal for Surgical Decision-Making in Occult Intertrochanteric Fractures Based on Finite Element Analysis

“…The widely adopted protocol suggests that patients should undergo surgery when the fracture line reaches beyond 50% of the longitudinal axis on coronal images [ 4 , 6 , 15 , 16 ]. However, Oc et al [ 17 ] advocated for surgical treatment for all patients, regardless of the spot of intertrochanteric fracture line extension on MRI, or the absence of medical contraindications [ 5 ]. The threshold value for conservative treatment shifted to a fracture line within the lateral two-thirds of the coronal plane, although the rehabilitation schedule varied depending on the site of fracture extension [ 18 ].…”

Surgical Management of Evans-Jensen Type IV Femoral Intertrochanteric Fractures in Elderly Patients Aged 65 and Above: A Comparative Study of THA and PFNA

“…With advancements in medical technology and the introduction and application of Enhanced Recovery After Surgery (ERAS) principles [12], the opportunities for surgical treatment in elderly ITF patients have increased. Currently, surgery is the primary therapeutic approach for this injury [13].…”