Trochanteric fractures in the elderly: the influence of primary hip arthroplasty on 1-year mortality

Abstract

Introduction The aim of the study was to compare the mortality risk and complication rate after operative treatment of pertrochanteric fractures with primary arthroplasty, dynamic hip screw (DHS) or proximal femoral nail (PFN). Patients and methods Clinical records including X-rays of all patients with trochanteric femoral fractures, except pathologic fractures and a minimum age of 60 years, which were treated between 1992 and 2005 were entered in this retrospective study. Of these 283 patients, 132 were treated by primary arthroplasty, 109 with a DHS and 42 with a PFN. Survival after 1 year and complications, which had to be treated within this period were our main outcome measurement. InXuencing cofactors such as age, gender and comorbidities were reduced by multivariate logistic regression analysis. Results Mortality was signiWcantly inXuenced by age, gender and amount of comorbidities but not by fracture classiWcation. Primary hip arthroplasty did not bear a higher 1-year mortality risk than osteosynthesis in a multiple regression analysis. The main complication with DHS and PFN were cutting out of the hip screw and non-union with a revision rate of 12.8%. With the introduction of hemiarthroplasty, the postoperative dislocation rate decreased from 12 to 0%. Conclusion For stable fractures a dynamic hip screw (DHS) and for unstable fractures a short proximal femoral nail (PFN) can be recommended. The mortality risk of primary cemented arthroplasty did not diVer signiWcantly from the other treatment groups and because of its low complication rate it is a viable treatment option for trochanteric fractures if osteoporosis prevents from full weight bearing or if osteoarthritis makes further operations likely. Primary total hip replacement should be handled with care due to its signiWcantly higher dislocation rate compared with hemiarthroplasty especially in unstable fractures.

Role of Cemented Bipolar Hemiarthroplasty for Comminuted Inter-trochanteric Femur Fracture in elderly osteoporotic patients through a modified Transtrochanteric approach- “SION Hospital Modification”.

“…Haentjens et al 27 and Geiger et al 28 in their case series showed dislocation rate in the patient group who underwent total hip arthroplasty was significantly higher (12% to 44.5%) than those who had bipolar arthroplasty(0 to 3.3%). We too had two (1.5%) patients who had got dislocated post-operatively.…”

Management of complex intertrochanteric fractures of the femur in elderly patients – dynamic hip screws or proximal femoral nails or arthroplasty

“…Complications such as excessive sliding (leading to shortening), varus displacement, nail pull-out, and/or screw breakage are some of the problems commonly seen in these osteoporotic patients who had been treated by dynamic hip screw (DHS). 1,2 Although this implant is the standard treatment for unstable intertrochanteric fractures, it is associated with high rate of complications and morbidity, and therefore primary hip arthroplasty was also suggested as an alternative treatment by some authors. [2][3][4] In addition, DHS is not usually recommended in unstable reverse oblique fractures.…”

“…1,2 Although this implant is the standard treatment for unstable intertrochanteric fractures, it is associated with high rate of complications and morbidity, and therefore primary hip arthroplasty was also suggested as an alternative treatment by some authors. [2][3][4] In addition, DHS is not usually recommended in unstable reverse oblique fractures. 2,5,6 Intramedullary devices like the proximal femoral nail have been reported to have an advantage in such fractures as their placement allowed the implant to lie closer to the mechanical axis of the extremity, thereby decrease the lever arm and bending moment on the implant.…”

“…[2][3][4] In addition, DHS is not usually recommended in unstable reverse oblique fractures. 2,5,6 Intramedullary devices like the proximal femoral nail have been reported to have an advantage in such fractures as their placement allowed the implant to lie closer to the mechanical axis of the extremity, thereby decrease the lever arm and bending moment on the implant. They can also be inserted faster, with less operative blood loss and allow early weight bearing with less resultant shortening on long term follow up.…”

Functional analysis of cemented bipolar hemiarthroplasty with medial calcar augmentation for unstable intertrochanteric fractures in elderly

“…The chances of fall increase with patient age. [2][3][4] Management options are wide with conservative and surgical management. Conservative management have largely been given up due to significantly poor results.…”