Treatment of femoral intertrochanteric fracture by early non general anesthesia and proximal femoral nail antirotation in patients over 90 years old

Abstract

Objective To study the efficacy of early non general anesthesia and proximal femoral nail anti-rotation (PFNA) in the treatment of femoral intertrochanteric fracture in senile patients over 90 years old. Methods From June 2009 to June 2015, 37 senile patients with femoral intertrochanteric fracture were treated by early non general anesthesia and PFNA internal fixation. They were 14 men and 23 women, from 90 to 107 years of age (average, 93 years). By the AO classification, 11 cases were type 31-A1, 14 ones type 31-A2, and 12 ones type 31-A3. The time from injury to surgery ranged from 8 hours to 4 days (average, 3 days). All the patients underwent closed reduction and PFNA internal fixation in non general anesthesia. Results The operation time in this group ranged from 30 to 70 minutes (average, 40 minutes). Their intraoperative bleeding ranged from 50 to 150 mL (average, 100 mL). They were followed up for an average time of 12 months (range, from 6 to 16 months). All the fractures healed after an average time of 12.5 weeks (range, from 10 to 16 weeks). Incision exudates occurred in one case postoperation. No postoperative complications such as deep vein thrombosis of lower limb, bedsore, urological infection, hip varus deformity, implants loosening and breakage, and delayed union were observed during follow-ups. According to the Harris scores at the final follow-ups, the hip function was rated as excellent in 11 cases, good in 19, medium 6, and poor in one, yielding a good to excellent rate of fine rate of 81.1%. Conclusions PFNA in early non general anesthesia is a successful treatment of femoral intertrochanteric fracture for elderly patients. Advantages of the remedy include simple manipulation, limited trauma, shorter operation time, less bleeding, early ambulation, and reduced postoperative complications. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails; Aged, 80 and over