BIPOLAR FEMORAL HEAD REPLACEMENT COMBINED WITH TENSION BAND WIRE FIXATION FOR INTERTROCHANTERIC FRACTURE IN ELDERLY OSTEOPOROTIC PATIENTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Hua , ZHANG Jian , ZHOU Aiguo , JIANG Dianming , SHEN Honglin , YAN Wenlong.

Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China. Corresponding author: ZHANG Jian, E-mail: 68733235@sohu.com;

Corresponding author：

Keywords：

Intertrochanteric fracture; Osteoporosis; Bipolar femoral head replacement; Elderly patient

DOI：

10.7507/1002-1892.20130213

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Objective To explore the effectiveness of bipolar femoral head replacement combined with tension band wire fixation for intertrochanteric fracture in elderly osteoporotic patients. Methods Bipolar femoral head replacement combined with tension band wire fixation were used for intertrochanteric fracture in 48 elderly osteoporotic patients between January 2004 and December 2010. Of 48 patients, 15 were male and 33 were female, aged 90-99 years (mean, 94.1 years). All fractures were caused by falling, and pathological fracture was excluded. It was 2-7 days (mean, 4.2 days) from fracture to surgery. According to the Tronzo Evans classification, 25 cases were rated as type IV, 20 cases as type III, and 3 cases as type II. And all of the cases were accompanied with severe osteoporosis and accompanied by more than one medical diseases, and 10 cases had spinal compression fracture. Results All patients underwent the operation successfully. Six cases died of underlying medical illness within 2 years postoperatively. A total of 39 cases were followed up 2-7 years, averaged 3.1 years. After operation, short-term mental disorders occurred in 9 cases, suspected urinary tract infection in 2 cases, sacral rear bedsore in 1 case, hip pain in 1 case, thigh pain in 1 case, and deep vein thrombosis of affected limb in 1 case. All the incisions healed by first intension, and X-ray film showed bone union in all cases; no complications of bone osteolysis, prosthesis loosening, subsidence, rupture, and heterotopic ossification occured postoperatively. No case needed revision. According to the Harris score system, the results were excellent in 5 cases, good in 28 cases, fair in 5 cases, and poor in 1 case, with an excellent and good rate of 84.6%; the score at 2 years was significantly higher than that at 6 weeks (t= — 14.79, P=0.00). The physical health score and mental health score of SF-12 at 2 years postoperatively were significantly higher than those at 6 weeks postoperatively (P lt; 0.05). The visual analogue scale (VAS) scores at 6 weeks and 2 years postoperatively were significantly lower than those at preoperation (P lt; 0.05), and the score at 2 years was significantly lower than that at 6 weeks (P lt; 0.05). Conclusion The bipolar femoral head replacement combined with tension band wire fixation for intertrochanteric fracture in elderly osteoporotic patients has the advantages of firm fixation, early function exercise with load bearing, pain relieving, improving hip function, and avoiding complication in bed.

Citation： ZHANG Hua,ZHANG Jian,ZHOU Aiguo,JIANG Dianming,SHEN Honglin,YAN Wenlong.. BIPOLAR FEMORAL HEAD REPLACEMENT COMBINED WITH TENSION BAND WIRE FIXATION FOR INTERTROCHANTERIC FRACTURE IN ELDERLY OSTEOPOROTIC PATIENTS. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(8): 980-984. doi: 10.7507/1002-1892.20130213 Copy

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2.	Kyle RF, Cabanela ME, Russell TA, et al. Fractures of the proximal part of the femur. Instr Course Lect, 1995, 44: 227-253.
3.	Stea S, Bordini B, De Clerico M, et al. First hip arthroplasty register in Italy: 55000 cases and 7 years follow-up. Int Orthop, 2009, 33(2): 339-346.
4.	Chan KC, Gill GS. Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures. Clin Orthop Relat Res, 2000, (371): 206-215.
5.	Anglen JO, Weinstein JN, American Board of Orthopaedic Surgery Research Committee. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg (Am), 2008, 90(4): 700-707.
6.	中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症诊治指南(2011年). 中华骨质疏松和骨矿盐疾病杂志, 2011, 4(1): 2-17.
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8.	Haentjens P, Casteleyn PP, Opdecam P. Hip arthroplasty for failed internal fixation of intertrochanteric and subtrochanteric fractures in the elderly patient. Arch Orthop Trauma Surg, 1994, 113(4): 222-227.
9.	Dean BJ, Matthews JJ, Price A, et al. Modular endoprosthetic replacement for failed internal fixation of the proximal femur following trauma. Int Orthop, 2012, 36(4): 731-734.
10.	Hsu CJ, Chou WY, Chiou CP, et al. Hemi-arthroplasty with supplemental fixation of greater trochanter to treat failed hip screws of femoral intertrochanteric fracture. Arch Orthop Trauma Surg, 2008, 128(8): 841-845.
11.	D’Arrigo C, Perugia D, Carcangiu A, et al. Hip arthroplasty for failed treatment of proximal femoral fractures. Int Orthop, 2010, 34(7): 939-942.
12.	Haentjens P, Lamraski G. Endoprosthetic replacement of unstable, comminuted intertrochanteric fracture of the femur in the elderly, osteoporotic patient: a review. Disabil Rehabil, 2005, 27(18-19): 1167-1180.
13.	张前法, 庞清江, 黄涛, 等. 双极长柄人工股骨头置换治疗高龄粉碎性股骨转子间骨折的临床应用. 中国修复重建外科杂志, 2005, 19(3): 198-200.
14.	Grimsrud C, Monzon RJ, Richman J, et al. Cemented hip arthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures. J Arthroplasty, 2005, 20(3): 337-343.
15.	Haidukewych GJ, Berry DJ. Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures. J Bone Joint Surg (Am), 2003, 85-A(5): 899-904.
16.	张健, 安洪, 周爱国, 等. 保留股骨距的骨水泥型双动半髋人工关节置换治疗高龄转子间骨折. 激光杂志, 2006, 27(3): 94-95.
17.	唐际存, 王梨明, 胡译文, 等. 矩形柄人工髋关节置换治疗老年股骨转子间粉碎性骨折. 中国修复重建外科杂志, 2011, 25(11): 1400-1402.
18.	朱建炜, 刘璠, 张烽, 等. 人工股骨头置换治疗高龄股骨转子间骨折. 中国修复重建外科杂志, 2008, 22(11): 1400-1401.

1. Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies. Instr Course Lect, 2004, 53: 441-454.
2. Kyle RF, Cabanela ME, Russell TA, et al. Fractures of the proximal part of the femur. Instr Course Lect, 1995, 44: 227-253.
3. Stea S, Bordini B, De Clerico M, et al. First hip arthroplasty register in Italy: 55000 cases and 7 years follow-up. Int Orthop, 2009, 33(2): 339-346.
4. Chan KC, Gill GS. Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures. Clin Orthop Relat Res, 2000, (371): 206-215.
5. Anglen JO, Weinstein JN, American Board of Orthopaedic Surgery Research Committee. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg (Am), 2008, 90(4): 700-707.
6. 中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症诊治指南(2011年). 中华骨质疏松和骨矿盐疾病杂志, 2011, 4(1): 2-17.
7. Kim WY, Han CH, Park JI, et al. Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop, 2001, 25(6): 360-362.
8. Haentjens P, Casteleyn PP, Opdecam P. Hip arthroplasty for failed internal fixation of intertrochanteric and subtrochanteric fractures in the elderly patient. Arch Orthop Trauma Surg, 1994, 113(4): 222-227.
9. Dean BJ, Matthews JJ, Price A, et al. Modular endoprosthetic replacement for failed internal fixation of the proximal femur following trauma. Int Orthop, 2012, 36(4): 731-734.
10. Hsu CJ, Chou WY, Chiou CP, et al. Hemi-arthroplasty with supplemental fixation of greater trochanter to treat failed hip screws of femoral intertrochanteric fracture. Arch Orthop Trauma Surg, 2008, 128(8): 841-845.
11. D’Arrigo C, Perugia D, Carcangiu A, et al. Hip arthroplasty for failed treatment of proximal femoral fractures. Int Orthop, 2010, 34(7): 939-942.
12. Haentjens P, Lamraski G. Endoprosthetic replacement of unstable, comminuted intertrochanteric fracture of the femur in the elderly, osteoporotic patient: a review. Disabil Rehabil, 2005, 27(18-19): 1167-1180.
13. 张前法, 庞清江, 黄涛, 等. 双极长柄人工股骨头置换治疗高龄粉碎性股骨转子间骨折的临床应用. 中国修复重建外科杂志, 2005, 19(3): 198-200.
14. Grimsrud C, Monzon RJ, Richman J, et al. Cemented hip arthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures. J Arthroplasty, 2005, 20(3): 337-343.
15. Haidukewych GJ, Berry DJ. Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures. J Bone Joint Surg (Am), 2003, 85-A(5): 899-904.
16. 张健, 安洪, 周爱国, 等. 保留股骨距的骨水泥型双动半髋人工关节置换治疗高龄转子间骨折. 激光杂志, 2006, 27(3): 94-95.
17. 唐际存, 王梨明, 胡译文, 等. 矩形柄人工髋关节置换治疗老年股骨转子间粉碎性骨折. 中国修复重建外科杂志, 2011, 25(11): 1400-1402.
18. 朱建炜, 刘璠, 张烽, 等. 人工股骨头置换治疗高龄股骨转子间骨折. 中国修复重建外科杂志, 2008, 22(11): 1400-1401.

Chinese Journal of Reparative and Reconstructive Surgery

BIPOLAR FEMORAL HEAD REPLACEMENT COMBINED WITH TENSION BAND WIRE FIXATION FOR INTERTROCHANTERIC FRACTURE IN ELDERLY OSTEOPOROTIC PATIENTS

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