Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios

Esen, Erdinç; Dur, Hakan; Ataoğlu, Muhammet Baybars; Ayanoğlu, Tacettin; Turanli, Sacit

doi:10.5606/ehc.2017.53247

Cited by 20 publications

(31 citation statements)

References 17 publications

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“…The goals of treatment of ITFs in the elderly are to regain preoperative ambulatory status with the lowest rate of medical and surgical complications 16 . Similar with published data 14 , in this study, we also find that PFNA and BPH have similar functional outcome, which means in the term of functional recovery, either PFNA or BPH is accepted for elderly ITFs patients. Consistent with previous results 17,18 , we also found that PFNA has shorter duration of operation time and less blood loss during surgery than BPH, which implies that PFNA does less surgical injury to patients.…”

Section: Acute Cerebral Infarctionsupporting

confidence: 92%

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Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients

Huang

Shi

Pan

et al. 2020

Sci Rep

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intertrochanteric fractures (itfs) in the elderly are still a big challenge for clinical doctors. Although proximal femoral nail antirotation (PFNA) and bipolar hemiarthroplasty (BPH) are selected by most of the orthopaedic surgeons for elderly ITFs patients, there is still no consensus on the superiority of PFNA and BPH for ITFs in elderly. In this study, we hypothesized that BPH should not be selected as the primary option for ITFs in elderly patients, and analyzed clinical data of 202 elderly ITFs patients aged 80 years or more treated with PFNA (Group A) and BPH (Group B) to compare the early outcome of PFNA and BPH for ITFs in elderly patients aged 80 years or more. We found that operation time and blood loss during surgery in group A are less than in Group B. Time of weight bearing after operation in Group A is longer than in Group B. Incidence of complications 2 weeks after operation in Group A is 9.29% less than 25.81% in Group B (χ 2 = 9.539, p = 0.002). Mortality rates 12 months after operation in Group A is 11.43% similar with 19.35% in Group B (χ 2 = 2.261, p = 0.133). Harris Hip Score 12 months after operation in Group A is 68.00 ± 29.11 points similar with 65.73 ± 33.29 points in Group B (t = 0.490, p = 0.625). Therefore, for elderly ITFs patients aged 80 years or more, BPH should not be selected as the primary option for itfs in elderly patients.

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Section: Acute Cerebral Infarctionsupporting

confidence: 92%

“…Cholangitis 1 www.nature.com/scientificreports www.nature.com/scientificreports/ patients 14,15 . However, it is still unclear whether BPH or PFNA is the better choice for elderly ITFs patients.…”

Section: Acute Cerebral Infarctionmentioning

confidence: 99%

Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients

Huang

Shi

Pan

et al. 2020

Sci Rep

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“…Harris hip scores were 83 and 80.2 in PFNA and hemiarthroplasty groups, respectively, with no statistically significant difference between the groups. In contrary to other studies, a study by Esen E et al [14] showed that the Harris hip score were 78.34 and 82.8 in BPA and PFN groups respectively. The results of our study showed that both BPA and PFN are good treatment methods with better post operative outcomes in case of BPA which was also reported in a study by Sancheti et al [15] .…”

Section: Discussionmentioning

confidence: 62%

Functional outcome of unstable intertrochanteric femur fracture in elderly osteoporotic patients treated by primary cemented bipolar hemiarthroplasty versus internal fixation with proximal femoral nailing

S¹,

Patil²,

P³

et al. 2017

Int. J. Orthop. Sci.

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Backround: Intertrochanteric fractures in the elderly pose certain special problems and need to be addressed in a balanced way as on one hand senile osteoporosis requires prolonged immobilization, on the other hand rapid mobilization is required as they are generally medically compromised due to age and associated diseases. Despite several randomized trials and comparative studies treatment of unstable intertrochanteric fractures in elderly patients is still controversial, which we want to investigate in this set-up which caters to a vast rural population. Methods: A retrospective analysis of 54 patients, of which 27 each were operated with cemented bipolar hemiarthroplasty (BPA) and proximal femur nail (PFN) between January 2012 till July 2016 was done. Primary outcome was assessed in both groups using Harris hip score( HHS) at 4weeks, 6 weeks, 12weeks, 6months and 1 year on outpatient basis. The secondary outcome measures were intraoperative blood loss, transfusion rate, surgical time, bed to chair time, chair to walking time, limb length discrepancy at final follow up. All complications were noted at follow ups. Results: The HHS was significantly higher for BPA group at all follow ups, at 4 weeks of follow up was 77.81 for BPA and 71.18 for PFN (p-value = 0.001) and at 1 year of follow up was 85.55 for BPA and 77.03 for PFN (p-value = 0.001). Statistically significant differences were found between BPA and PFN groups with reference to intraoperative blood loss, transfusion rate, surgical time, bed to chair time, chair to walking time, limb length discrepancy at final follow up. Conclusion: The bipolar hemiarthroplasty group had fewer complications and earlier mobilization with better Harris hip score at all follow ups, which indicate bipolar hemiarthroplasty is a better option in the treatment of unstable intertrochanteric fractures in senile osteoporotic patients.

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“…[ 9 – 11 ] Unfortunately, papers also show that BPH takes longer operation time and much more blood loss than PFNA, and recommend that BPH should be undertaken with caution in carefully selected patients. [ 12 – 15 ] So, until now, there is still no consensus whether BPH should be selected as the primary treatment for elderly patients especially patients aged 85 years or more presented with ITFs. [ 14 ]…”

Section: Introductionmentioning

confidence: 99%

Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients aged 85 years or more

Tan¹,

Shi

Zhang

et al. 2020

Medicine

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This study aimed to compare the early outcome of proximal femoral nail antirotation (PFNA) and bipolar hemiarthroplasty (BPH) in elderly intertrochanteric fractures (ITFs) patients aged 85 years or more. This is a prospective cohort study, and we analyzed 120 elderly patients aged 85 years or more presented with ITFs who underwent BPH and PFNA between January 2017 and July 2018. 84 patients treated with PFNA were set as Group A, and 36 patients treated with BPH were set as Group B. Data such as gender, age, period of follow-up, fracture classification (according to Evans-Jensen classification), preoperative ASA (American Society of Anesthesiologists) physical status, interval between injury and operation, method of anaesthesia, duration of operation time, blood loss during surgery, time of weight bearing after operation, incidence of complications 2 weeks after operation, mortality rates and Harris Hip Score 12 months after operation were recorded and compared. There are no statistically significant differences when compared general data in patients from group A and B ( P > .05). Operation time in Group A is less than Group B (103.33, 40–230 min vs 122.64, 75–180 minute, P < .01). Blood loss during surgery in Group A is less than Group B (70.24, 50–100 mL vs 194.44, 100–500 mL, P < .01). Time of weight bearing after operation in Group A is longer than Group B (50.70, 7–100 days vs 6.67, 4–14 days, P < .01). Incidence of complications 2 weeks after operation in Group A is less than Group B (14.12% vs 36.11%, P < .01). Mortality rates 12 months after operation in Group A is similar with Group B (13.10% vs 19.44%, P > .05). Harris Hip Score 12 months after operation in Group A is similar with Group B (64.64,0–91 points vs 64.41, 0–90 points, P > .05). Although BPH and PFNA have similar functional outcome and mortality rates 12 months after operation, BPH has more postoperative complications in elderly patients aged 85 years or more with ITFs, Bipolar Hemiarthroplasty should not be selected as the primary option for ITFs in elderly patients aged 85 years or more.

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Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios

Cited by 20 publications

References 17 publications

Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients

Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients

Functional outcome of unstable intertrochanteric femur fracture in elderly osteoporotic patients treated by primary cemented bipolar hemiarthroplasty versus internal fixation with proximal femoral nailing

Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients aged 85 years or more

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