Intertrochanteric Fractures In Elderly Research Articles

Predictive value of the early postoperative hemoglobin-to-red blood cell distribution width ratio for acute kidney injury in elderly intertrochanteric fracture patients

BackgroundHemoglobin-to-red blood cell distribution width ratio (HRR) had great predictive value for the prognosis of malignant tumors and cardiovascular disease. However, its predictive value for the occurrence of acute kidney injury (AKI) in elderly intertrochanteric fracture patients remains unclear. This study aims to analyze the correlation between the early postoperative HRR and the risk of postoperative AKI in elderly intertrochanteric fracture patients.MethodsWe reviewed the medical records of 307 elderly intertrochanteric fracture patients in this single-center retrospective cohort study. We performed univariate analysis on the relevant parameters, and parameters with significant differences were included in the following logistic regression model for multivariate analysis. Then, we used a receiver operating characteristic (ROC) curve to evaluate the predictive value of the early postoperative HRR level for AKI in elderly intertrochanteric fracture patients. Patients were divided into a high HRR group and a low HRR group according to the cutoff point determined by ROC curve analysis. Subsequently, the relevance between postoperative HRR and AKI was further determined using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW).ResultsThe area under the curve of the early postoperative HRR for predicting postoperative AKI was 0.714 (95% CI: 0.618–0.809). The cutoff value was 5.44. The sensitivity was 72.7%, and the specificity was 70.8%. Patients were divided into low HRR (⩽ 5.44) and high HRR (> 5.44) groups according to the cutoff value. PSM and IPTW analysis indicated that the risk of AKI in the low HRR group was significantly higher than that in the high HRR group in both the matched cohort (OR = 6.914, 95% CI: 1.714–46.603, p = 0.016) and the weighted group (OR = 2.784, 95% CI: 1.415–5.811, p = 0.040).ConclusionsEarly postoperative HRR is an accurate, accessible, and economical blood test parameter that can predict the risk of postoperative AKI in elderly patients with femoral intertrochanteric fracture.

A New Postoperative Stability Score to Predict Loss of Reduction in Intertrochanteric Fractures in Elderly Patients.

The study aimed to validate a newly developed postoperative stability score for evaluating clinical follow-up in elderly patients with low-energy hip fractures. From 1 January 2020 to 31 December 2021, we enrolled patients aged over 65 who underwent cephalomedullary nail fixation using proximal femoral nail antirotation II (PFNAII) and had at least 6 months of follow-up; excluding multiple fractures, pathological fractures, and periprosthetic fractures. We collected general patient data. Parameters such as TAD, Parker's ratio (AP and lateral), and the new postoperative stability score were recorded. A loss of reduction was defined using the decline in the Chang reduction quality criteria (CRQC) score within one month. Among the 108 enrolled patients, 23 (21.3%) experienced a loss of reduction, with a mean age of 82.1 years and a mean follow-up time of 7.4 months. Univariate analysis showed no significant association between loss of reduction and general data. However, the new postoperative stability score correlated significantly with loss of reduction (mean scores: 6.68 vs. 4.83, p = 0.045). Multivariate analysis confirmed this association (odds ratio: 0.076, 95% confidence interval: 0.022-0.263, p < 0.05). The newly developed postoperative stability score, incorporating surgical technique assessment, improves prediction accuracy for loss of reduction in elderly intertrochanteric fracture (ITF) patients.

A New Postoperative Stability Score to Predict Loss of Reduction in Intertrochanteric Fractures in Elderly Patients

The study aimed to validate a newly developed postoperative stability score for evaluating clinical follow-up in elderly patients with low-energy hip fractures. From 1 January 2020 to 31 December 2021, we enrolled patients aged over 65 who underwent cephalomedullary nail fixation using proximal femoral nail antirotation II (PFNAII) and had at least 6 months of follow-up; excluding multiple fractures, pathological fractures, and periprosthetic fractures. We collected general patient data. Parameters such as TAD, Parker’s ratio (AP and lateral), and the new postoperative stability score were recorded. A loss of reduction was defined using the decline in the Chang reduction quality criteria (CRQC) score within one month. Among the 108 enrolled patients, 23 (21.3%) experienced a loss of reduction, with a mean age of 82.1 years and a mean follow-up time of 7.4 months. Univariate analysis showed no significant association between loss of reduction and general data. However, the new postoperative stability score correlated significantly with loss of reduction (mean scores: 6.68 vs. 4.83, p = 0.045). Multivariate analysis confirmed this association (odds ratio: 0.076, 95% confidence interval: 0.022–0.263, p &lt; 0.05). The newly developed postoperative stability score, incorporating surgical technique assessment, improves prediction accuracy for loss of reduction in elderly intertrochanteric fracture (ITF) patients.

Biomechanical Study of Gamma 2 Intramedullary Nail, PFNA, and INTERTAN in the Treatment of Elderly Intertrochanteric Fractures of the Femur

Biomechanical Study of Gamma 2 Intramedullary Nail, PFNA, and INTERTAN in the Treatment of Elderly Intertrochanteric Fractures of the Femur

Effectiveness of proximal femur bionic nail for intertrochanteric fracture in the elderly

To evaluate effectiveness of proximal femur bionic nail (PFBN) in treatment of intertrochanteric fractures in the elderly compared to the proximal femoral nail antirotation (PFNA). A retrospective analysis was made on 48 geriatric patients with intertrochanteric fractures, who met the selection criteria and were admitted between January 2020 and December 2022. Among them, 24 cases were treated with PFBN fixation after fracture reduction (PFBN group), and 24 cases were treated with PFNA fixation (PFNA group). There was no significant difference in baseline data such as age, gender, cause of injury, side and type of fracture, time from injury to operation, and preoperative mobility score, American Society of Anesthesiologists (ASA) score, Alzheimer's disease degree scoring, self-care ability score, osteoporosis degree (T value), and combined medical diseases between the two groups ( P>0.05). The operation time, intraoperative blood loss, number of blood transfusions, transfusion volume, length of hospital stay, occurrence of complications, weight-bearing time after operation, and postoperative visual analogue scale (VAS) score, walking ability score, mobility score, self-care ability score were recorded and compared between the two groups. And the radiographic assessment of fracture reduction quality and postoperative stability, and fracture healing time were recorded. The operations in both groups were successfully completed. All patients were followed up 6-15 months with an average time of 9.8 months in PFBN group and 9.6 months in PFNA group. The operation time was significantly longer in PFBN group than in PFNA group ( P<0.05), but there was no significant difference in intraoperative blood loss, number of blood transfusions, transfusion volume, length of hospital stay, change in activity ability score, and change in self-care ability score between the two groups ( P>0.05). The weight-bearing time after operation was significantly shorter in PFBN group than in PFNA group ( P<0.05), and the postoperative VAS score and walking ability score were significantly better in PFBN group than in PFNA group ( P<0.05). Radiographic assessment showed no significant difference in fracture reduction scores and postoperative stability scores between the two groups ( P>0.05). All fractures healed and there was no significant difference in fracture healing time between the two groups ( P>0.05). The incidence of complications was significantly lower in PFBN group (16.7%, 4/24) than in PFNA group (45.8%, 11/24) ( P<0.05). Compared with PFNA, PFBN in the treatment of elderly intertrochanteric fractures can effectively relieve postoperative pain, shorten bed time, reduce the risk of complications, and facilitate the recovery of patients' hip joint function and walking ability.

Early Posttraumatic Antifibrinolysis Reduces Perioperative Hidden Blood Loss in Elderly Patients with an Intertrochanteric Fracture: A Randomized Controlled Trial.

This study aimed to determine the efficacy and safety of posttraumatic antifibrinolysis with multidose tranexamic acid (TXA) in reducing perioperative hidden blood loss (HBL) in elderly intertrochanteric fracture patients. Ninety-six elderly intertrochanteric fracture patients admitted to our department from June 2021 to September 2022 were randomized into two groups. The control group (Group A) received 100 mL of normal saline, while the experimental group (Group B) received 1.5 g of TXA intravenously q12 h from postadmission Day 1 (PAD1) to the day before surgery, and both groups received 1.5 g of TXA q12 h from postoperative Day 1 (POD1) to POD3. Haemoglobin (Hb), haematocrit (Hct), coagulation parameters, fibrinogen degradation product (FDP), and D-dimer (D-D) were recorded from PAD1 to POD3. HBL was calculated using the gross formula and recorded as the primary outcome. In all-over analyses, the patients in Group B had lower perioperative HBL (on PAD3, POD1, and POD3), preoperative HBL (HBLpre), decline of haemoglobin (ΔHb-on PAD3), allogeneic blood transfusion (ABT) rate, FDP (on PAD3), and D-D (on PAD3) compared with Group A. No significant differences were exhibited in postoperative HBL (HBLpost) between the 2 groups. In subgroup analyses, for patients who received intervention within 24 h, the result is consistent with the whole. For patients who received intervention over 72 h of injury, there were no significant differences in perioperative HBL, ΔHb, ABT rate, FDP, and D-D between the 2 groups. There were no significant differences in APTT, PT, the rate of venous thromboembolism, wound complications, or 90-day mortality between the 2 groups. For elderly intertrochanteric fracture patients, early posttraumatic antifibrinolysis with multidose TXA is effective in reducing perioperative HBL, which mainly manifests as the reduction of preoperative HBL, especially for patients injured within 24 h. Application of TXA beyond 72 h of injury was ineffective.

Comparison of post-op opioid use and pain between short and long cephalomedullary nails in elderly intertrochanteric fractures.

It remains unknown if cephalomedullary nail (CMN) length has an impact on pain and opioid use following fixation. Given the lack of level I evidence favoring a specific CMN length to prevent adverse surgical outcomes, we investigated if CMN length impacts acute postoperative pain and opioid use. The authors hypothesize that the use of longer CMNs results in increased pain scores and morphine milligram equivalents (MME) intake during the 0-24h (h) and 24-36h postoperative period. A retrospective chart review was performed from 2010 to 2020 of patients ≥ 65years-old who underwent CMN for IT fractures and fractures with subtrochanteric extension (STE). We compared patients who received short and long CMNs using numeric rating scale (NRS) pain scores and MME intake at 0-24h and 24-36h postoperatively. 330 patients receiving short (n = 155) and long (n = 175) CMNs met criteria. CMN length was found to not be associated with higher pain scores in the early postoperative phase. However, patients with long CMNs received higher MME from 0-24h (25.4% estimated mean increase, p value = 0.02) and 24-36h (22.3% estimated mean increase, p value = 0.04) postoperatively, even after adjusting for covariates, gender, and age. Patients with long CMNs received greater MME postoperatively. Additionally, differences in pain and MME were not significantly different between patients with and without STE, suggesting our findings were not influenced by this pattern. These results suggest longer CMNs are associated with higher acute postoperative opioid intake among patients with IT fractures. Therapeutic level III.

Risk factors for contralateral hip refractures in patients aged over 80 years with intertrochanteric femoral fractures.

PurposeThe purpose of this study was to identify which of the risk factors would contribute to the contralateral fracture in very elderly patients after intramedullary nail fixation.MethodsClinical data of 227 intertrochanteric fracture patients aged 80 years or older were retrospectively reviewed. Intramedullary nails (IMNs) were used on all of the patients. Potential risk factors for contralateral hip refractures were determined using univariate and logistic regression analyses.ResultsContralateral hip refractures occurred in 11 patients (4.84%). Univariate analysis revealed that age, gender, body mass index, fracture classification, hematocrit, D-dimer, and CRP level were not associated with contralateral fractures (P > 0.05). However, neurological diseases, cardiovascular disease, and visual impairments were significantly associated with contralateral fractures (P < 0.05). Multivariate analysis further revealed that neurological diseases (OR 4.25, P = 0.044) and visual impairments (OR 5.42, P = 0.015) were independent risk factors associated with contralateral refractures.ConclusionTo prevent contralateral refractures, more attention should be paid to elderly intertrochanteric fracture patients with underlying neurological disease and visual impairments.

EARLY POSTOPERATIVE MORTALITY RATES IN ELDERLY PATIENTS WITH INTERTROCHANTERIC FEMORAL FRACTURE: COMPARISON OF THREE FIXATION METHODS

Objective: Several surgical options are available for the treatment of elderly intertrochanteric femoral fractures (IFF). This study aimed to compare the mortality rates in the first postoperative month between the intramedullary nail fixation (INF), cemented and cementless hemiarthroplasty (HA). Also, we aimed to analyze the factors that affect the mortality rates within the first postoperative month.Material and Methods: Elderly patients who underwent INF (Group 1), cemented HA (Group 2), and cementless HA (Group 3) for IFF between 2012 and 2020 were selected for the study. Demographic data, pre, and perioperative variables were compared between the three treatment groups. The mortality rates in the first 24 h, 7 days, and 30 days were also compared as well. The patients were divided into survival and non-survival groups according to the outcome in the first postoperative month and factors affecting mortality rates were evaluated.Results: A total of 526 patients were included in the study (194 men and 332 women; mean age, 82.71±6.92 years). The patients who received cemented or cementless HA had higher mortality rates on the first 7 days and 30 days after the operation than those treated with INF (p=0.022; 0.001, respectively). The patients who died within 30 days postoperatively were older (p=0.00) and had more comorbidities (p =0.015) and longer intervals from trauma to surgery (p=0.05) and operation times (p=0.013) than those who survived in the first postoperative month.Conclusion: Intramedullary fixation should be the first option in elderly IFFs. The duration between trauma and surgery and operation time should be shortened to reduce mortality.

Finite Element Analysis of Proximal Femur Bionic Nail (PFBN) Compared with Proximal Femoral Nail Antirotation and InterTan in Treatment of Intertrochanteric Fractures.

ObjectiveTo compare the biomechanical properties of proximal femur bionic nail (PFBN), proximal femoral nail antirotation (PFNA) and InterTan in the treatment of elderly intertrochanteric fractures AO/OTA 31‐A1.3 by finite element analysis.MethodsWe used Mimics, Unigraphics and other software to establish normal femur and AO/OTA 31‐A1.3 fracture models, and reconstructed PFBN, PFNA and InterTan intramedullary nail models, and assembled them on the fracture model. The ANSYS software was used to compare the femoral von Mises stress distribution, deformation distribution, and internal fixation stress distribution of each group under a load of 2100 N.ResultsIt could be seen that the femoral maximum stress, femoral maximum displacement, and maximum stress of internal fixation of the PFBN group were lower than those in the PFNA group and the InterTan group. The maximum femoral stress of the PFBN was 190.25 MPa, while the maximum stress of the femur of the PFNA and InterTan groups were 238.41 Mpa and 226.97 Mpa. The maximum femoral displacement of each group were located at the top of the femoral head, and the maximum displacement of the PFBN group was 14.373 mm, and the maximum displacement values of the PFNA and InterTan groups were 19.49 and 15.225 mm. For the stress distribution of intramedullary nail, the maximum stress of the three kinds of internal fixation was located on the main nail. The maximum stress of PFBN was 1191.8 MPa, compared with 2142.8 MPa for PFNA and 1702.3 MPa for InterTan. And the maximum stress on the PFBN pressure nail was 345.35 MPa, compared with 868.6 MPa for the PFNA spiral blade and 545.5 MPa for InterTan interlocking twin nails.ConclusionCompared with PFNA and InterTan, PFBN has better mechanical properties. The biomechanical characteristics of PFBN are more advantageous than PFNA and InterTan internal fixation system in the treatment of femoral intertrochanteric fractures.

Comparison of clinical outcomes with proximal femoral nail anti-rotation versus bipolar hemiarthroplasty for the treatment of elderly unstable comminuted intertrochanteric fractures

BackgroundAlthough proximal femoral nail anti-rotation (PFNA) and bipolar hemiarthroplasty (BHA) are selected by most of the orthopaedic surgeons for elderly intertrochanteric fractures (ITFs) patients, there is still no consensus on the superiority of PFNA and BPH for the elderly with unstable comminuted ITFs. The study aims to compare the curative effects of PFNA and cementless BHA on unstable comminuted ITFs in the elderly.MethodsFrom January 2012 to December 2016, we retrospectively reviewed 62 ITFs patients up to the inclusion and exclusion criteria in the study. Depending on the type of surgery, the patients were divided into two groups: Group BHA (n= 30) and Group PFNA (n = 32). The ITFs were classified according to Evans-Jensen. Hospitalization time, operation time, bleeding loss, weight bearing duration, Harris hip scores, 10-m walking speed, gait and postoperative complications were compared between the two groups.ResultsThere was no significant difference between the groups in hospital stay (P > 0.05). The BHA group trended to have a shorter operation time and a larger volume of blood loss (P < 0.01).The weight bearing duration was shorter in the BHA group than the PFNA group (P < 0.05).The Harris hip score was higher, the 10-m walking speed was faster and the gait was better in group BHA than group PFNA at three months postoperatively (P < 0.05), but there was no significant difference between the two groups at 6 and 12 months postoperatively (P > 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05).ConclusionThe BHA allows an earlier return to weight-bearing activity, but ultimately has the same effective treatments as the PFNA for the elderly with unstable comminuted ITFs.

Comparing the rates and modes of failure of two third generation cephalomedullary nail systems in the treatment of intertrochanteric hip fractures

IntroductionCephalomedullary (CMN) implants are commonly used to address elderly intertrochanteric hip fractures. Multiple CMN implant systems exist with subtle variation between manufacturers. Multiple modes of CMN failure have been described in the literature. The present study assessed the local modes and rates of construct failure (nail fracture, cut-out and non-union) of two such implants, after a change in implant supply provided the opportunity for retrospective comparison. Additional investigation was undertaken to assess whether any predictors of failure could be identified based on common radiographic measurement parameters. MethodsBased on local implant records, all consecutive patients who suffered an intertrochanteric fracture, treated at a tertiary care hospital with a cephalomedullary nail from January 2014 to January 2018 were included. Patients were excluded if they received a CMN for pathologic fracture. Within the collection period all patients received either a Synthes Trochanteric Fixation Nail (TFN) or Zimmer Natural Nail (ZNN). Patients were retrospectively assessed for fracture reduction and implant technique parameters at the time of initial surgery. Radiographic data were assessed at minimum two years post-operatively to assess for union. Patient demographic data was followed to assess rate and mode of failure. ResultsSix hundred and sixty-two patients were included in the study, from which a propensity matched cohort was derived. Comparing across equivalent cohorts, no differences in the rate or mode of construct failure were identified between the TFN and ZNN.When assessing the entire cohort we observed 39 construct failures (5.9%), which included 31 instances of nail cutout (4.7%), 4 episodes of nail fracture (0.6%) and 4 failures related to non-union (0.6%). Tip to apex distance, sagittal malalignment and Cleveland zone were identified as significant predictors of nail failure. ConclusionNo difference in rates or modes of failure were identified between the TFN and ZNN constructs. Similar to previous reports we again identified the impact of tip to apex distance on construct failure and further identified Cleveland zone and sagittal malalignment as significant risks for failure.

Prevalence of preoperative Deep Venous Thrombosis (DVT) following elderly intertrochanteric fractures and development of a risk prediction model

BackgroundThis study aimed to investigate the prevalence of preoperative deep venous thrombosis (DVT) following intertrochanteric fractures in the elderly and identify the associated factors, based on which a risk prediction model was developed.MethodThis was a retrospective single-center study of elderly patients presenting with intertrochanteric fractures between our institution between January 2017 and December 2020. Patients' duplex ultrasound (DUS) or venography results were retrieved to evaluate whether they had a preoperative deep venous thrombosis (DVT) of bilateral extremities, whereby patients were dichotomized. Various variables of interest on demographics, comorbidities, injury and biomarkers were extracted and their relationship between DVT were investigated. Statistically significant variables tested in multivariate logistics regression analyses were used to develop a risk prediction model.ResultsThere were 855 patients eligible to be included in this study, and 105 were found to have preoperative DVT, with a prevalence rate of 12.3%. Ten factors were tested as significantly different and 2 marginally significant between DVT and non-DVT groups in the univariate analyses, but only 6 demonstrated the independent effect on DVT occurrence, including history of a VTE event (OR, 4.43; 95%CI, 2.04 to 9.62), time from injury to DVT screening (OR, 1.19; 95%CI, 1.13 to 1.25), BMI (OR, 1.11; 95%CI, 1.04–1.18), peripheral vascular disease (OR, 2.66; 95%CI, 1.10 to 6.40), reduced albumin (2.35; 95%CI, 1.48 to 3.71) and D-Dimer > 1.0 mg/L(OR, 1.90; 95%CI, 1.13 to 3.20). The DVT risk model showed an AUC of 0.780 (95%CI, 0.731 to 0.829), with a sensitivity of 0.667 and a specificity of 0.777.ConclusionDespite without a so high prevalence rate of DVT in a general population with intertrochanteric fracture, particular attention should be paid to those involved in the associated risk factors above. The risk prediction model exhibited the improved specificity, but its validity required further studies to verify.

Does Fracture Severity of Intertrochanteric Fracture in Elderly Caused by Low-Energy Trauma Affected by Gluteus Muscle Volume?

PurposeThe aim of this study was to determine whether there is a correlation between the type and stability of intertrochanteric fractures caused by low-energy trauma and gluteus muscle volume.Materials and MethodsA total of 205 elderly (>65 years) patients with intertrochanteric fractures caused by low-energy trauma treated from January 2018 to December 2020 were included in this study. The mean age of patients was 81.24 years (range, 65-100 years). Fractures were classified according to the Jensen modification of the Evans classification. The cross-sectional area of the contralateral gluteus muscle (minimus, medius, and maximus) was measured in preoperative axial computed tomography slices. An analysis and comparison of age, body mass index (BMI), weight, height, and the gluteus muscle area in each fracture type group was performed.ResultsIn the uni-variable analysis, statistically significant taller height was observed in patients in the stable intertrochanteric fracture (modified Evans 1 and 2) group compared with those in the unstable intertrochanteric fracture (modified Evans 3, 4, and 5) group (P<0.05). In addition, significantly higher BMI-adjusted gluteus muscle area (gluteus muscle area/BMI) was observed for the stable intertrochanteric fracture group compared with the unstable intertrochanteric fracture group except for the BMI-adjusted gluteus minimus area (P=0.112). In multivariable analysis, only the BMI-adjusted gluteus maximus (P=0.042) and total gluteus areas (P=0.035) were significantly higher in the stable group.ConclusionGluteal muscularity around the hip, especially the gluteus maximus, had a significant effect on the stability of intertrochanteric fractures.

Initial results of halifax nail in elderly intertrochanteric fracture

Initial results of halifax nail in elderly intertrochanteric fracture

X-Ray Film under Artificial Intelligence Algorithm in the Evaluation for Nursing Effect of Gamma Nail Internal Fixation in Elderly Patients with Intertrochanteric Fracture of Femur.

The aim of this work was to explore the effects of Gamma nail internal fixation for intertrochanteric fracture of femur by X-ray film classification and recognition method based on artificial intelligence algorithm. The study subjects were 100 elderly patients with intertrochanteric fracture of femur admitted to hospital. The cases were diagnosed as elderly (over 60 years old) femoral intertrochanteric fractures by X-ray or CT. They were divided into two groups, with 50 persons in each group: one group used the X-ray film evaluation image guidance based on the artificial intelligence algorithm (research group), and the other group did not use algorithmic guidance (control group). The results showed that the segmentation effect of the proposed algorithm was similar to the gold standard segmentation result, indicating that the algorithm was effective and feasible in the segmentation of fractures and bones. The global level set algorithm was set as the control. The ultimate measurement accuracy (UMA) value of the algorithm group was (1.77 ± 0.22), and the UMA value of the global level set algorithm group was (3.42 ± 0.36), indicating that the image processed by the algorithm group had obvious numerical effect, high accuracy, and good retention of details. The operation time, intraoperative blood loss, incision length, hospital stay, weight-bearing time, and fracture healing time of the two groups were all better than those of the control group. One month after surgery, the Harris score of the algorithm group was 67, and that of the control group was 51, with a 16-point difference between the two groups (p < 0.05). The patient had less pain and fast recovery speed, indicating that it was a good way to treat elderly intertrochanteric fractures with the nursing effect of X-ray Gamma nail internal fixation based on an artificial intelligence algorithm. The artificial intelligence algorithm not only can be applied to the Gamma nail internal fixation of elderly patients with intertrochanteric fractures but also can be applied to the X-ray image processing of other fractures and other surgical methods to provide effective treatment for fracture patients.

Comparison of proximal femoral nailing (PFN) and proximal femoral locking plate (PFLP) for intertrochanteric femur fracture in elderly.

Objective: To compare the functional outcome of PFN and PFLP for the treatment of unstable four part intertrochanteric femur fracture. Study Design: Randomized Controlled Trial study. Setting: Orthopedics Department, Dow International Medical College, Karachi. Period: February 2019 to January 2020. Material &amp; Methods: 281 patients were included and assigned to each group PFNA and PFLP alternatively. Both groups were compared for functional evaluation by Harris hip score. Result: Duration of surgery, perioperative hemoglobin loss, and duration of fracture healing were significantly lower in PFNA group as compared to PFLP, P&lt;0.05. But Harris Hip score was significantly higher in PFNA group as compare to PFLP P&gt;0.05. Conclusion: PFN has better functional outcome. This makes it a better method of fixation as compared to PFLP in elderly intertrochanteric femur fracture.

Analysis of risk factors of perioperative blood transfusion in the treatment of femoral intertrochanteric fracture with proximal femoral nail antirotation

To explore the influencing factors of perioperative blood transfusion in the treatment of elderly femoral intertrochanteric fractures with proximal femoral nail antirotation(PFNA). The clinical data of 109 elderly patients with intertrochanteric fractures who received PFNA treatment from July 2018 to January 2020 were retrospectively analyzed. Both pelvic hip X-rays and CT plain scans were performed before surgery. All patients were diagnosed by X-ray and CT plain scan of pelvis and hip before operation. Through the statistical analysis of the basic data of patients before and during operation, the risk factors of perioperative blood transfusion were explored. Logistic regression analysis showed that age (P=0.013), fracture type (P<0.01), diabetes history (P=0.031) and preoperative hemoglobin (P<0.01) were independent risk factors for perioperative blood transfusion in the treatment of intertrochanteric fractures in elderly patients with 109 patients. Spearman correlation analysis showed that there was a positive correlation between blood transfusion and age of patients (P= 0.017), fracture type (P<0.01), diabetes history (P=0.023), and negatively correlated with preoperative hemoglobin (P<0.01). However, gender (P=0.297), history of hypertension (P=0.318) and operation time(P=0.325) had no significant relationship with perioperative blood transfusion. Age, fracture type, diabetes history, and preoperative hemoglobin are independent risk factors for perioperative blood transfusion in the treatment of elderly intertrochanteric fractures with PFNA. The older the patient, the history of diabetes, the more unstable the fracture, and the lower preoperative hemoglobin, the more likely it is to require a blood transfusion, which may provide a reference for clinical perioperative blood transfusion decisions.

Predictive factors associated with the clinical outcome of intertrochanteric hip fracture in high-risk elderly patients treated with total hip arthroplasty versus percutaneous external fixation.

BackgroundLittle is known regarding the survival and functional recovery of elderly intertrochanteric hip fracture (IHF) patients after total hip arthroplasty (THA) versus percutaneous external fixation (PEF). This study aims to analyze the prognostic factors of THA and PEF in elderly IHF patients.MethodsA total of 155 consecutive elderly patients (mean age of 80 years) diagnosed with IHF were retrospectively reviewed from our database between January 1, 2010, and December 31, 2018. The preoperative, intraoperative and postoperative covariates were analyzed by two independent surgical cohorts: THA and PEF. The main outcomes included the hip function score, all-cause mortality within 1 year after surgery, and overall survival. Covariables and their influence on independent outcomes were analyzed using multivariate regression models.ResultsThe median follow-up period was 5.1 years, and 6 patients were lost to follow-up. At the endpoint, 70 of 85 patients treated with THA and 37 of 70 patients treated with PEF survived, exhibiting mean Harris hip scores of 84.4 and 69.0, respectively. The Kaplan-Meier curves and log-rank tests showed no significant difference in overall survival. After adjusting for the covariates, the surgical mode was a unique prognostic factor affecting hip function recovery, and two prognostic factors (leukocyte count and D-dimer) were correlated with 1-year all-cause mortality. Age at admission, fracture classification, D-dimer level and surgical mode were identified as prognostic factors affecting overall survival. After adjusting for the former three covariates, THA reduced the risk of death by 67.20% compared with PEF (HR 0.328, 95% CI, 0.121–0.890).ConclusionsDespite the nonsignificant difference in 1-year all-cause mortality, THA demonstrated superior midterm survival and hip function recovery in elderly IHF patients compared with PEF. Predictive factors, including age at admission, fracture classification, D-dimer level and surgical mode, are associated with the overall survival of IHF in high-risk elderly patients.

Comparative study of PFN antirotation vs bipolar hemiarthroplasty in unstable senile intertrochanteric fractures

Introduction: Treatment of intertrochanteric fracture in elderly is not only to mobilise early but also to avoid complications and morbidity. With available treatments it is difficult to address all the issue with same surgical option. A recent advance for treatment of senile unstable intertrochanteric fracture is PFN antirotation which may help in early mobilisation with less complications. The purpose of this study is to compare the outcome of PFNA and hemiarthoplasty and to study advantages, disadvantages, complications of both the groups. Materials and Methods: 20 patients each were included in PFNA group and hemiarthroplasty group from January 2016 to January 2017 who satisfied the inclusion and exclusion criteria. Patient followed up upto 1 year. Patients were evaluated with multiple variables, complications and harris hip score. Results: PFNA groups had significantly less blood loss, less surgery time, less hospital stay as compared to hemiarthroplasty group. Both groups had similar medical and orthopaedic complications. PFNA patients can be mobilised early as with hemiarthroplasty group. Hemiarthoplasty groups have better harris hip score in initial 3 months but similar score at the end of 1 year. Conclusion: PFNA provide less morbidity to patients with early mobilisations and good functional outcome. It can definitely be a better option than replacement in elderly intertrochanteric fracture. Keywords: PFNA, Bipolar, Intertrochanteric fracture, Hemiarthroplasty, Harris hip score, Replacement.