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.	李现军. 股骨近端髓内钉与人工髋关节置换修复股骨转子间骨折的对比. 中国组织工程研究, 2015, 19(13): 1979-1983.
6.	杨沛彦, 李耀锋, 尤元璋. 股骨近端抗旋髓内钉与股骨近端解剖型锁定板治疗不稳定型转子间骨折的疗效比较. 中华创伤杂志, 2013, 29(4): 330-333.
7.	蒋俊威, 刘凯, 王红川, 等. 老年髋部骨折治疗的临床流程效果分析. 华西医学, 2014, 29(6): 1056-1059.
8.	汪礼军, 杨秀江, 刘剑, 等. 两种术式治疗高龄不稳定股骨转子间骨折的临床效果研究. 重庆医学, 2017, 46(1): 117-119.
9.	刘春林. 防旋型股骨近端髓内钉与髋关节置换术治疗股骨粗隆间骨折临床疗效比较. 中国现代手术学杂志, 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.	唐天华, 唐三元, 杨辉. 人工关节置换治疗老年股骨转子间骨折的研究进展. 中国矫形外科杂志, 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.	郑小龙, 魏建仝, 王勇平, 等. 髋关节置换与股骨近端髓内钉比较治疗我国老年转子间骨折效果的 Meta 分析. 中华临床医师杂志: 电子版, 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. 李现军. 股骨近端髓内钉与人工髋关节置换修复股骨转子间骨折的对比. 中国组织工程研究, 2015, 19(13): 1979-1983.
6. 杨沛彦, 李耀锋, 尤元璋. 股骨近端抗旋髓内钉与股骨近端解剖型锁定板治疗不稳定型转子间骨折的疗效比较. 中华创伤杂志, 2013, 29(4): 330-333.
7. 蒋俊威, 刘凯, 王红川, 等. 老年髋部骨折治疗的临床流程效果分析. 华西医学, 2014, 29(6): 1056-1059.
8. 汪礼军, 杨秀江, 刘剑, 等. 两种术式治疗高龄不稳定股骨转子间骨折的临床效果研究. 重庆医学, 2017, 46(1): 117-119.
9. 刘春林. 防旋型股骨近端髓内钉与髋关节置换术治疗股骨粗隆间骨折临床疗效比较. 中国现代手术学杂志, 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. 唐天华, 唐三元, 杨辉. 人工关节置换治疗老年股骨转子间骨折的研究进展. 中国矫形外科杂志, 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. 郑小龙, 魏建仝, 王勇平, 等. 髋关节置换与股骨近端髓内钉比较治疗我国老年转子间骨折效果的 Meta 分析. 中华临床医师杂志: 电子版, 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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