Comparison between proximal femur nailing and hemiarthroplasty in treating intertrochanteric femur fractures in the elderly_West China Medical Journal

Authors：

LUO Zhongchun ,  LIU Kai , JIANG Junwei , SONG Chunlin , ZHONG Lang , WANG Hongchuan

Department of Orthopedics, People’s Hospital of Leshan, Leshan, Sichuan 614000, P. R. China;

Corresponding?author：

LIU Kai, Email: 285061643@qq.com

Keywords：

Proximal femur nailing; Hemiarthroplasty; Intertrochanteric femur fracture

DOI：

10.7507/1002-0179.201507145

Video：

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Objective To compare proximal femur nailing and hemiarthroplasty in the treatment of intertrochanteric femur fractures in the elderly. Methods The study included 60 patients at the age of 75 or above who were diagnosed with intertrochanteric femur fracture between January 2011 and December 2013. After informed consent was obtained from the patients, they were randomized into two groups. Patients in internal fixation group (n=35) were internally fixated with proximal femoral nail, while patients in hemiarthroplasty group (n =25) were treated with cemented hemiarthroplasty. Complications, surgery time, hospital stay, postoperative function and blood loss during the surgery were recorded and functional results were evaluated using Harris Hip Score. Results Blood loss in the internal fixation group and the hemiarthroplasty group was respectively (124.7±23.4) and (207.5±19.4) mL, and the surgery time was (41.7±8.1) and (64.2±7.3) minutes, and the differences were significant (P<0.05). There was no significant difference in terms of complications between the two groups (P>0.05). Harris Hip Score analysis revealed that the difference between the patients treated with hemiarthroplasty and proximal femoral nailing was statistically significant in favor of the hemiarthroplasty group within the first 3 months. However, this difference diminished at the 6th month time point (P>0.05), and even reversed at the 12th month postoperatively (P<0.05). Conclusions Internal fixation with proximal femoral nail displays a better level of activity in the end in the treatment of intertrochanteric femur fractures. It is helpful for the patients to improve their life quality with convenient operation and less invasion.

Citation： LUO Zhongchun, LIU Kai, JIANG Junwei, SONG Chunlin, ZHONG Lang, WANG Hongchuan. Comparison between proximal femur nailing and hemiarthroplasty in treating intertrochanteric femur fractures in the elderly. West China Medical Journal, 2017, 32(5): 712-716. doi: 10.7507/1002-0179.201507145 Copy

1.	?Chu X, Liu F, Huang J, et al. Good short-term outcome of arthroplasty with Wagner SL implants for unstable intertrochanteric osteoporotic fractures. J Arthroplasty, 2014, 29(3): 605-608.
2.	Tang P. Proximal femoral nail antirotationversus hemiarthroplasty: a study for the treatment of intertrochanteric fractures. Injury, 2012, 43(6): 876-881.
3.	Boldin C, Seibert FJ, Fankhauser F, et al. The proximal femoral nail (PFN): a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthopaedica Scandinavica, 2003, 74(1): 53-58.
4.	Pui CM, Bostrom MP, Westrich GH, et al. Increased complication rate following conversion total hip arthroplasty after cephalomedullary fixation for intertrochanteric hip fractures. J Arthroplasty, 2013, (8 Suppl): 45-47.
5.	李現軍. 股骨近端髓內釘與人工髖關節置換修復股骨轉子間骨折的對比. 中國組織工程研究, 2015, 19(13): 1979-1983.
6.	楊沛彥, 李耀鋒, 尤元璋. 股骨近端抗旋髓內釘與股骨近端解剖型鎖定板治療不穩定型轉子間骨折的療效比較. 中華創傷雜志, 2013, 29(4): 330-333.
7.	蔣俊威, 劉凱, 王紅川, 等. 老年髖部骨折治療的臨床流程效果分析. 華西醫學, 2014, 29(6): 1056-1059.
8.	汪禮軍, 楊秀江, 劉劍, 等. 兩種術式治療高齡不穩定股骨轉子間骨折的臨床效果研究. 重慶醫學, 2017, 46(1): 117-119.
9.	劉春林. 防旋型股骨近端髓內釘與髖關節置換術治療股骨粗隆間骨折臨床療效比較. 中國現代手術學雜志, 2016, 20(3): 185-188.
10.	Hwang JH, Jk O, Han S, et al. Mismatch between PFNa and medullary canal causing difficulty in nailing of the pertrochanteric fractures. Arch Orthop Trauma Surg, 2008, 128(12): 1443-1446.
11.	Kayali C. Treatment for unstable intertrochanteric fractures in elderly patients: internal fixationversus cone hemiarthroplasty. J Orthop Surg, 2006, 14(3): 240-243.
12.	Kim SY, Kim YG, Hwang JK. Cementless calcar replacement hemiarthroplasty compared with intramedullary fixation of unstable intertrochanteric fractures. A prospective, randomized study. J Bone Joint Surg Am, 2005, 87(10): 2186-2192.
13.	唐天華, 唐三元, 楊輝. 人工關節置換治療老年股骨轉子間骨折的研究進展. 中國矯形外科雜志, 2014, 22(16): 1481-1487.
14.	Shen J, Wang D L, Chen G X, et al. Bipolar hemiarthroplasty compared with internal fixation for unstable intertrochanteric fractures in elderly patients. J Orthop Sci, 2012, 17(6): 722-729.
15.	鄭小龍, 魏建仝, 王勇平, 等. 髖關節置換與股骨近端髓內釘比較治療我國老年轉子間骨折效果的 Meta 分析. 中華臨床醫師雜志: 電子版, 2016, 10(1): 82-88.

1. ?Chu X, Liu F, Huang J, et al. Good short-term outcome of arthroplasty with Wagner SL implants for unstable intertrochanteric osteoporotic fractures. J Arthroplasty, 2014, 29(3): 605-608.
2. Tang P. Proximal femoral nail antirotationversus hemiarthroplasty: a study for the treatment of intertrochanteric fractures. Injury, 2012, 43(6): 876-881.
3. Boldin C, Seibert FJ, Fankhauser F, et al. The proximal femoral nail (PFN): a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthopaedica Scandinavica, 2003, 74(1): 53-58.
4. Pui CM, Bostrom MP, Westrich GH, et al. Increased complication rate following conversion total hip arthroplasty after cephalomedullary fixation for intertrochanteric hip fractures. J Arthroplasty, 2013, (8 Suppl): 45-47.
5. 李現軍. 股骨近端髓內釘與人工髖關節置換修復股骨轉子間骨折的對比. 中國組織工程研究, 2015, 19(13): 1979-1983.
6. 楊沛彥, 李耀鋒, 尤元璋. 股骨近端抗旋髓內釘與股骨近端解剖型鎖定板治療不穩定型轉子間骨折的療效比較. 中華創傷雜志, 2013, 29(4): 330-333.
7. 蔣俊威, 劉凱, 王紅川, 等. 老年髖部骨折治療的臨床流程效果分析. 華西醫學, 2014, 29(6): 1056-1059.
8. 汪禮軍, 楊秀江, 劉劍, 等. 兩種術式治療高齡不穩定股骨轉子間骨折的臨床效果研究. 重慶醫學, 2017, 46(1): 117-119.
9. 劉春林. 防旋型股骨近端髓內釘與髖關節置換術治療股骨粗隆間骨折臨床療效比較. 中國現代手術學雜志, 2016, 20(3): 185-188.
10. Hwang JH, Jk O, Han S, et al. Mismatch between PFNa and medullary canal causing difficulty in nailing of the pertrochanteric fractures. Arch Orthop Trauma Surg, 2008, 128(12): 1443-1446.
11. Kayali C. Treatment for unstable intertrochanteric fractures in elderly patients: internal fixationversus cone hemiarthroplasty. J Orthop Surg, 2006, 14(3): 240-243.
12. Kim SY, Kim YG, Hwang JK. Cementless calcar replacement hemiarthroplasty compared with intramedullary fixation of unstable intertrochanteric fractures. A prospective, randomized study. J Bone Joint Surg Am, 2005, 87(10): 2186-2192.
13. 唐天華, 唐三元, 楊輝. 人工關節置換治療老年股骨轉子間骨折的研究進展. 中國矯形外科雜志, 2014, 22(16): 1481-1487.
14. Shen J, Wang D L, Chen G X, et al. Bipolar hemiarthroplasty compared with internal fixation for unstable intertrochanteric fractures in elderly patients. J Orthop Sci, 2012, 17(6): 722-729.
15. 鄭小龍, 魏建仝, 王勇平, 等. 髖關節置換與股骨近端髓內釘比較治療我國老年轉子間骨折效果的 Meta 分析. 中華臨床醫師雜志: 電子版, 2016, 10(1): 82-88.

West China Medical Journal

Comparison between proximal femur nailing and hemiarthroplasty in treating intertrochanteric femur fractures in the elderly

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