Abstract
BackgroundThe treatment for intertrochanteric femoral fractures (IFF) among the elderly has been a controversial topic. Hemiarthroplasty (HA) and proximal femoral nail antirotation (PFNA) have their own advantages in the management of IFF. Hence, this study aims to compare and analyze differences in the effectiveness of both procedures on IFF among the elderly.MethodsOverall, 99 patients (81.09 ± 8.29 years; 68 women) underwent HA or PFNA from January 2016 to May 2020. IFF were classified according to the Arbeitsgemeins für Osteosynthesefragen (AO) classification. The difference in underlying diseases, the American Society of Anesthesiologists (ASA) grade, Singh index, Harris scores, surgical time, intraoperative bleeding, postoperative blood test results, postoperative number of days to partially bearing weight, and survival outcomes were analyzed. Postoperative follow-ups were performed every 3 months.ResultsThere was no significant difference in the AO classification, underlying diseases, ASA grade, Singh index, surgical time, and survival outcomes of the HA (45 patients) group and PFNA group (54 patients). The HA group was associated with earlier partial weight-bearing (HA: 4 [2 ~ 4.5] days, PFNA: 10 [8~14] days). It also had a higher total Harris score than the PFNA group at the 6-month follow-up visit (HA: 86.8 [81.90 ~ 90.23], PFNA: 83.48 [75.13 ~ 88.23]). Harris scores decreased more in patients aged ≥90 years in the PFNA group than in the HA group. The postoperative stress recovery rate in the HA group was faster based on postoperative blood test results.ConclusionsPFNA and HA have good therapeutic effects in the treatment of IFF. The advantages of HA were reflected in short-term weight bearing, faster recovery from stress, and better joint function in the long term. This advantage is more obvious in the patient population aged over 90 years. Therefore, we suggest that surgeons should consider the benefit of HA in the treatment of IFF among the elderly.Trial registrationChinese Clinical Trial Registry, ChiCTR2000035814. Registered 17 August 2020, https://www.chictr.org.cn/showproj.aspx?proj=57083
Highlights
The incidence of intertrochanteric femoral fractures (IFF) among the elderly is increasing [1]
proximal femoral nail antirotation (PFNA) was developed by the Arbeitsgemeins für Osteosynthesefragen (AO) Foundation, which is a nonprofit global network of surgeons for the surgical management of musculoskeletal disorders
After adhering to the exclusion criteria, 45 patients were included in the HA group and 54 patients were included in the PFNA group
Summary
The incidence of intertrochanteric femoral fractures (IFF) among the elderly is increasing [1]. There are two main approaches to surgical repair of IFF: proximal femoral nail antirotation (PFNA) and hemiarthroplasty (HA) [2, 3]. The revision surgery after failed PFNA procedures may be unbearable for some elderly patients. HA has shown a marked advantage for early postoperative weight-bearing and reduction of immobility-related complications. It has advantages in patient stress rehabilitation and joint mobility. The treatment for intertrochanteric femoral fractures (IFF) among the elderly has been a controversial topic. Hemiarthroplasty (HA) and proximal femoral nail antirotation (PFNA) have their own advantages in the management of IFF. This study aims to compare and analyze differences in the effectiveness of both procedures on IFF among the elderly
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