Which implant is superior for treating simple pertrochanteric fractures of the proximal femur in the elderly patients?

Talmaç, Mehmet Ali

doi:10.14744/tjtes.2019.21270

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…Many implant comparison studies have emphasized that complications are observed less in patients with PFN. [25] Many methods are recommended in the literature to avoid these complications. For example, the use of double scopy during PFN surgery is reported to reduce the surgical duration and complication risks.…”

Section: Discussionmentioning

confidence: 99%

Effect on mortality of treatment method and surgery time for hip fracture patients aged over 65 years

Ekici

Pazarci

Kılınç

et al. 2020

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: This study aimed to evaluate the effects on mortality of implant selection used and time to surgery in patients aged over 65 years operated for hip fractures. METHODS: A total of 301 patients aged over 65 years were investigated in this study. Patients were divided into three groups as follows: Group 1 cemented hemiarthroplasty (CH), Group 2 cementless hemiarthroplasty (CLH), and Group 3 proximal femoral nail (PFN). Time of surgery, fracture and demographic information were retrospectively recorded. RESULTS: After removing 59 patients with missing information, this study included 242 patients. Mean age of patients was 80.5 years. When patient groups were examined according to treatment method, Group 1 (n=146) comprised 60.3%, Group 2 (n=54) comprised 22.3% and Group 3 (n=42) comprised 17.4% of the study group. There was no significant difference in survival between the patients operated in the first 48 hours and the patients operated later (p=0.834). There was an effect on the survival of treatment implant selection (p=0.016). Patients with CH were observed to survive longer than patients with CLH and PFN. CONCLUSION: Operation in the first 48 hours was not observed to affect mortality. Additionally, while sex and age were found to be effective on mortality, implant selection was also concluded to affect mortality.

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Section: Discussionmentioning

confidence: 99%

Effect on mortality of treatment method and surgery time for hip fracture patients aged over 65 years

Ekici

Pazarci

Kılınç

et al. 2020

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

show abstract

“…It is believed that the time between the injury and surgical treatment is an essential factor for the outcome. The recommendation is to perform surgery up to 48 h after the injury, which reduces the risks of complications and mortality [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

In Silico Finite Element Modeling of Stress Distribution in Osteosynthesis after Pertrochanteric Fractures

Lorkowski

Pokorski

2022

JCM

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A stabilization method of pertrochanteric femur fractures is a contentious issue. Here, we assess the feasibility of rapid in silico 2D finite element modeling (FEM) to predict the distribution of stresses arising during the two most often used stabilization methods: gamma nail fixation (GNF) and dynamic hip screw (DHS). The modeling was based on standard pre-surgery radiographs of hip joints of 15 patients with pertrochanteric fractures of type A1, A2, and A3 according to the AO/OTA classification. The FEM showed that the stresses were similar for both GNF and DHS, with the medians ranging between 53–60 MPa and consistently lower for A1 than A3 fractures. Stresses also appeared in the fixation materials being about two-fold higher for GNF. Given similar bone stresses caused by both GNF and DHS but shorter surgery time, less extensive dissection, and faster patient mobilization, we submit that the GNF stabilization appears to be the most optimal system for pertrochanteric fractures. In silico FEM appears a viable perioperative method that helps predict the distribution of compressive stresses after osteosynthesis of pertrochanteric fractures. The promptness of modeling fits well into the rigid time framework of hip fracture surgery and may help optimize the fixation procedure for the best outcome. The study extends the use of FEM in complex orthopedic management. However, further datasets are required to firmly position the FEM in the treatment of pertrochanteric fractures.

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Extramedullary versus intramedullary fixation of stable trochanteric femoral fractures: a systematic review and meta-analysis

Zeelenberg¹,

Nugteren²,

Plaisier³

et al. 2023

Arch Orthop Trauma Surg

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Objective This systematic review and meta-analysis compared extramedullary fixation and intramedullary fixation for stable two-part trochanteric femoral fractures (AO type 31-A1) with regards to functional outcomes, complications, and surgical outcomes. Methods Embase, Medline, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for randomized controlled trials (RCTs) and observational studies. Effect estimates were pooled across studies using random effects models. Results were presented as weighted risk ratio (RR) or weighted mean difference (MD) with corresponding 95% confidence interval (95% CI). Results Five RCTs (397 patients) and 14 observational studies (21,396 patients) were included. No significant differences in functional outcomes, complications, or surgical outcomes were found between extramedullary and intramedullary fixation devices, except for a difference in duration of surgery (MD 14.1 min, CI 5.76–22.33, p < 0.001) and intra-operative blood loss (MD 92.30 mL, CI 13.49–171.12, p = 0.02), favoring intramedullary fixation. Conclusion Current literature shows no meaningful differences in complications, surgical, or functional outcomes between extramedullary and intramedullary fixation of stable two-part trochanteric femoral fractures. Both treatment options result in good outcomes. This study implicates that, costs should be taken into account when considering implants or comparing fixation methods in future research.

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Which implant is superior for treating simple pertrochanteric fractures of the proximal femur in the elderly patients?

Cited by 3 publications

References 23 publications

Effect on mortality of treatment method and surgery time for hip fracture patients aged over 65 years

Effect on mortality of treatment method and surgery time for hip fracture patients aged over 65 years

In Silico Finite Element Modeling of Stress Distribution in Osteosynthesis after Pertrochanteric Fractures

Extramedullary versus intramedullary fixation of stable trochanteric femoral fractures: a systematic review and meta-analysis

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