Abstract
Objective To compare the clinical efficacy of different methods in the treatment of femoral intertrochanteric-subtrochanteric fractures in the elderly, and provide reference for the clinical treatment of this type of fracture. Methods A retrospective analysis of 51 elderly patients with femoral intertrochanteric and subtrochanteric fractures treated in the Third Hospital of Hebei Medical University and Weichang County Hospital from March 2013 to March 2017, including 21 males (41.2%), females 30 cases (48.8%); age (71±4) years. The proximal femoral locking plate (PFLP), reconstructed intramedullary nail (RIN), and proximal femoral anti-rotation intramedullary nail (PFNA) were used. Differences of gender, age, fracture side, preoperative traction days, operation time, surgical bleeding volume, total incision length, fracture healing time, surgical complications, and postoperative hip function score were compared. Results 51 patients were followed up satisfactorily and last for 12 to 44 months. The follow-up rate was 100%. The average operation time of the PFLP group was (155±27) min, the length of all incisions was (20.8±2.6) cm, the intraoperative blood loss was (274±36) ml, and the postoperative drainage volume was (87±20) ml. The average operation time was (122±16) min, the length of all incisions was (11.8±1.5) cm, the intraoperative blood loss was (144±43) ml, the recessive blood loss was (428±16) ml, and the total amount of bleeding was (558±16) ml; the average operation time of the PFNA group was (44.4±4.2) min, the length of all incisions was (8.5±0.6) cm, the intraoperative blood loss was (94±24) ml, and the recessive blood loss was (408±36) ml and the total amount of bleeding is (520±24) ml. In the operative time, length of incision, intraoperative blood loss, PFNA group was lower than PFLP group and RIN group. The postoperative drainage volume of PFLP group was significantly higher than that of PFNA group and RIN group (P<0.01); PFNA group and RIN group The total amount of bleeding in the surgery group was higher than that in the PFLP group (P<0.05). The fracture healing time of PFLP group was (16.2±2.5) w higher than RIN (14.9±1.1) w and PFNA group (14.2±1.5) w, the difference was statistically significant (F=5.224, P<0.05). The Harris score (80±7) in the PFLP group was lower than that in the RIN group (88±4) and the PFNA group (91±4). The difference was statistically significant (F=19.673, P<0.01).). Conclusions Among the three fixation methods used in this study, PFNA has a smaller surgical incision, shorter operative time, less intraoperative blood loss, shorter time to fracture healing, and better postoperative hip function recovery than PFLP and RIN. The advantage is an ideal fixation method for the treatment of intertrochanteric fractures in the elderly with subtrochanteric fractures. Key words: Aged; Hip fractures; Fracture fixation, internal
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