Evaluacija rezultata ugradnje endoproteze i pertrohanternog spoljašnjeg fiksatora kod intertrohanternog preloma femura kod starijih pacijenata

Aydin Ekrem,Ates Ali

doi:10.24125/sanamed.v14i3.369

Abstract

Objective: In this study, 14-month clinical outcomes of the endoprosthesis and pertrochanteric external fixator application are retrospectively evaluated in elderly patients with pertrochanteric fractures. Patients and Method: A total of 45 patients of 65 years old and older (25 females and 20 males) with a mean age of 78.1, who were treated due to intertrochanteric femur fracture between November 2013 and December 2014 and whose controls could be made were included in this study. The deaths that occurred within the postoperative 1 year were not included in the study. 28 patients with endoprosthesis as Group I, and 17 patients with pertrochanteric external fixator as Group II were evaluated. Results: Table 2 shows the clinical evaluation results of the patients according to different criteria by the groups. The mean operation time was 45 min in Group I and 20 min in Group II. The external fixator application time is significantly shorter. The mean hospital stay was 14 days for Group I and 10 days for Group II. The hospital stay period of the external fixator group is 4 days shorter. While 7 patients were taken into the intensive care unit in Group I postoperatively, only 1 patient was taken into the same unit in Group II. This difference was significantly in favor of the external fixator group. While 14 patients in Group I needed a preoperative and postoperative blood transfusion, no patient needed blood transfusions in Group II. External fixator application is significantly more advantageous in terms of patient hemodynamics. The mean time to postoperatively move the extremity independently in the bed was 24 hours in Group I and 36 hours in Group II. All patients were exposed to the Harris hip scoring in the postoperative 12. month (the fixator was removed for the external fixator group). Conclusion: In addition to internal fixation options and endoprosthesis applications in elderly intertrochanteric femoral fractures, an external fixator may also be a good treatment alternative with appropriate patient selection and proper application in accordance with the technique thanks to its short surgical time, less blood loss and easy applicability.

Highlights

Intertrochanteric femoral fractures are among the most important fractures that orthopedic surgery encounters frequently, especially in elderly patients [1]
While 7 patients were taken into the intensive care unit in Group I postoperatively, only 1 patient was taken into the same unit in Group II
The choice of treatment method is challenging for the orthopedist since the bone quality of these patients is low, several elderly diseases that disrupt the general condition of the patient accompany the disease and there is the necessity of treating the fracture as soon as possible [2]

Summary

Introduction

Intertrochanteric femoral fractures are among the most important fractures that orthopedic surgery encounters frequently, especially in elderly patients [1]. Intramedullary nails, plates, and screws of various types and features, hip prostheses and external fixators are among the treatment options. In these treatment methods, shortness, abductor-adductor, and flexor deficiencies, union, and stabilization problems are the conditions that make the choice of treatment difficult [2,4,5,6,7,8,9,10,11]. 14-month clinical outcomes of the endoprosthesis and pertrochanteric external fixator application are retrospectively evaluated in elderly patients with pertrochanteric fractures in two groups

Results

Discussion

Conclusion