Treatment of unstable femoral intertrochanteric fracture in elderly patients with distal transfer of the greater trochanterin artificial femoral head replacement

Abstract

Objective To investigate the operative procedure and the therapeutic effects of unstable femoral intertrochanteric fracture in elderly patients with distal transfer of the greater trochanterin artificial femoral head replacement.Methods From May 2005 to December 2008,98 elderly patients with unstable femoral intertrochanteric fracture were treated with artificial femoral head replacement. And 46 cases with distal transfer of the greater trochanter(test group) and 52 cases with fixation of femoral greater trochanter and smaller trochanter(control group). In test group, there were 26 males and 20 females with an average age of 76.8 years, including 8 cases of type ⅢA, 22 cases of type ⅢB and 16 cases of type IV according to Evans-Jenson standard. In control group, there were 19 males and 33 females with an average age of 74.6 years,including 10 cases of type ⅢA, 18 cases of type ⅢB and 24 cases of type IV according to Evans-Jenson standard. All fractureswere caused by fall damage. The disease course was 1.0 to 6.5 days(mean 3.4 days). The patients of the two groups complicated with osteoporosis, and complicated by one or several complications of cerebral sequelae,coronary heart disease, hypertension, diabetes andchronic bronchitis. And all patients did not had fracture at other sites. There was no significant difference in general data between the two groups(P>0.05). Results The operations were successful, the incision healed by first intention. There was no significant difference in operation time or operative blood loss(P>0.05). The two groups were followed up 12-36 months. The test group load times were noticeably shorter than the control group, the difference was statistically significant(PP<0.01). The length of the test group limb were shorter than that in the control group, the difference was statistically significant(P<0.01).There were significant differences(P<0.05) in the incidence rate of complication and the excellent and good rate of hip function(by Harris standard) between the test group(4.3% and 95.6%) and the control group(17.3% and 80.7%)12 months after operation. Conclusions The elderly patients with intertrochanteric fracture can get good result through artificial femoral head replacement,and the distal transfer of the greater trochanter could reconstruct the outreach arm of the hip and provide the early stability of prosthesis and shorten the recovery time. Key words: Intertrochanteric fracture; Distal transfer of the greater trochanter; Artificial femoral headreplacement; Elderly patient