Transtrochanteric approach can provide better postoperative care and lower complication rate in the treatment of hip fractures

Abstract

PurposeDislocation is an important complication that increases the mortality, morbidity, and postoperative care following bipolar hemiarthroplasty. It is thought that the transtrochanteric approach that enables access to the femoral neck directly from the fracture line at the coronal plane of the greater trochanter without opening the posterior and anterior capsules could reduce the risk of dislocation. Additionally, it is argued that preservation of the external rotators could also be advantageous for patient rehabilitation and muscle strength. The aim of this study is to compare the effectiveness of the standard posterolateral approach and transtrochanteric approach performed from the fracture line, primarily the rate of dislocation, in osteoporotic Evans Type IV–V unstable intertrochanteric fractures on which bipolar hemiarthroplasty was performed.Patients and methodOne hundred and twelve patients had Type IV–V fracture according to Evans classification and underwent hemiarthroplasty were enrolled in the study. Patients operated using the posterolateral approach, that is, Group 1 (n=48), and patients operated using the transtrochanteric (transfracture) approach, that is, Group 2 (n=64), were compared in terms of dislocation, surgical duration, amount of blood transfusion, infection, mortality, and trochanteric nonunion. Factors that could affect the development of dislocation from the patient, surgery, and implant were also analyzed.ResultsIt was found that the rate of dislocation was statistically significantly higher in Group 1 in comparison to Group 2 (P<0.05). It was also observed that the surgical duration was statistically significantly shorter in Group 2 (P<0.05). It was found that the presence of a cognitive disorder, trochanteric nonunion, and use of posterolateral surgical approach resulted in a statistically significant increase in the rate of dislocation (P<0.05).ConclusionTranstrochanteric (transfracture) approach is an effective method for minimizing possible complications following hemiarthroplasty, especially dislocation.

A comparison of different surgical approaches to hemiarthroplasty for the femoral neck fractures: A meta-analysis

“…A series of 15 studies investigating surgery-related fracture complications were reported. Pooling data from 3 studies (20,26,32) comparing LA and AA did not reveal statistically significant differences (OR: 0.56 95% CI: 0.16-1.98 I 2 = 0% P = 0.37 Figure 8A), while 8 studies (19, 23,27,29,34,36,42,43) analyzed PA and LA (OR: 0.87 95% CI: 0.55-1.36 I 2 = 0% P = 0.53 Figure 8B), and another 4 (22,39,44,45) compared LA with AA (OR: 0.71 95% CI: 0.18-2.79 I 2 = 0% P = 0.62 Figure 8C).…”

“…Dislocation was the most disparate outcome in the metaanalysis and an essential indicator for evaluating the results of the surgery. The PA is at greater risk of dislocation than the other two approaches and may be related to surgical incision of soft tissue anatomy such as the capsule, short external rotators, and piriformis (49).There may also be a relationship with patient cognitive status and sex, with some findings of higher dislocation rates in women and patients with cognitive impairment (29).…”

“…Patient reoperation was also statistically significant, and one of the major factors was dislocation of the hip on the patient's side of surgery. Some of the surgeries involved repair of the short external rotators with the posterior capsule to reduce the incidence of dislocation, but the efficacy is conflicting (29,50). This is a shortcoming of PA and may lead the operator to prefer other modalities when choosing a surgical approach.…”

“…Sixteen studies reported the operation time of the 2 methods. The analysis showed no statistically significant differences in all comparisons of operative times: AA vs. LA (10,20,24,26,32) (MD: −1.01 95% CI: −7.05-5.04 I 2 = 91% P = 0.74 Figure 4A); PA vs. LA (29,31,36,42,43) (MD: −6.11 95% CI: −14.27-2.06 I 2 = 97% P = 0.14 Figure 4B); PA vs. AA (17,22,33,39,44,45) (MD: 4.55 95% CI: −13.40-22.51 I 2 = 99% P = 0.62 Figure 4C). All I 2 ≥ 50% and there was statistical heterogeneity, hence the random effects model was used for analysis.…”

Comparison of long-stemmed cementless hemiarthroplasty with proximal femur nail in unstable intertrochanteric femur fractures over 85 years of age

“…Conservative treatment has a limited place; the main treatment for hip fractures is surgery [10]. ITFs are observed 3 times more than CFFs [11]. The surgical approach to CFFs has gained clarity in the literature [12], while surgical indication in ITFs is still controversial [13].…”