Abstract
The treatment methods for the failed internal fixation in elderly patients suffering from several osteoporostic fractures are still inconclusive. We aimed to evaluate the clinical effects of endoprosthetic replacement for failure treatment of intertrochanteric fracture. A total of 13 patients with failed internal fixation for intertrochanteric fracture were collected between January 2002 and October 2009. All of them were treated with endoprosthetic replacement and followed up till October 2010. Four of them received total hip replacement and the remained nine received artificial bipolar femoral head replacement. Clinical and functional outcomes of patients were assessed. Of 13 patients, nine were females and four were males with the mean age of 76.5 years (SD, 11.7, range, 58-92 years) at the time of fracture. The average time of operation and follow-up was 124 minutes (89-187minutes) and 31 months (14-68 months), respectively. The average blood loss during the operation was 631 ml (450-1560 ml). All patients showed good pain relief and functional improvement. Final post-operative Harris and WOMAC scores were significantly improved from pre-operative levels (P<0.05). Only five patients showed operative complications. Our finding indicated that endoprosthetic replacement is an effective salvage procedure for failed internal fixation of intertrochanteric fracture in elderly patients with effective pain relief and functional improvement as well as few serious complications.
Highlights
Hip fractures are the leading cause of death and disability among the elderly, of which about 50% are intertrochanteric fractures
The most common useful treatment for intertrochanteric fractures is internal fixation, failure rate of the internal fixation for intertrochanteric fracture is ranged from 4% to 17% even with the locking plate,[3,4] depending on the osteoporosis and patient age
Patients: Between January 2002 and October 2009, 13 patients who received endoprosthetic replacement were included in our study, who had this after failure of the intertrochanteric fracture treatment
Summary
Hip fractures are the leading cause of death and disability among the elderly, of which about 50% are intertrochanteric fractures. A large percentage of intertrochanteric fractures are unstable and occurred in women.[1,2] most elderly persons with intertrochanteric fractures are accompanied with osteoporosis. Osteoporosis could lead to slow fracture healing and long recovery time,[3] delay fracture union or nonunion, and induce loosening, prolapsing, cutting or breakage of the internal fixation after operation.[3] Recently, the most common useful treatment for intertrochanteric fractures is internal fixation, failure rate of the internal fixation for intertrochanteric fracture is ranged from 4% to 17% even with the locking plate,[3,4] depending on the osteoporosis and patient age. The treatment methods for the failed internal fixation among elderly patients suffering from several osteoporostic fractures are still inconclusive.[5,6,7] These elderly patients often are unable to co-operate with partial weightbearing. The use of endoprosthetic replacement (EPR), though not commonly used for intertrochanteric fractures, has been advocated by some studies when confronted with this kind of population.[8,9,10] Previous studies indicated prosthetic replacement was an effective method for treatment of failed fixation of intertrochanteric fracture.[11,12,13,14,15,16,17,18] The purpose of this study was to evaluate the clinical effects of endoprosthetic replacement for failure treatment of intertrochanteric fracture
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