COMPARATIVE STUDY
JOURNAL ARTICLE

[Comparison of three methods for the treatment of aged femoral intertrochanteric fracture]

Cheng-Guo Huang, Jun-Jian Ye
Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology 2012, 25 (7): 549-53
23115983

OBJECTIVE: To investigate the reasonable methods of treatment for aged intertrochanteric fractures through the comparison and analysis about the clinical data and follow-up results of three kinds of treatment method of elderly intertrochanteric fractures.

METHODS: From June 2004 to June 2010,131 patients with intertrochanteric fractures were treated and reviewed retrospectively. Among them, 72 patients were treated with dynamic hip screw (DHS) included 20 males and 52 females with an average age of (72.5 +/- 5.5) years, 43 patients were treated with proximal femoral nail antirotation (PFNA) included 12 males and 31 females with an average age of (72.8 +/- 4.9) years and 16 patients were treated with hemiarthroplasty included 4 males and 12 females with an average age of (76.0 +/- 5.0) years. The three groups of patients were statistically analyzed and compared on surgical trauma including operation time, blood loss, incision length, X-ray exposure, and on postoperative recovery including non-weight-bearing walking time, the hospitalization time, the healing time, the recovery of joint function and complications.

RESULTS: All patients were followed-up from 6 months to 3 years (means 18.2 months). In surgical trauma: the results of length of incision,operation time and blood loss was DHS>hemiarthroplasty>PFNA. PFNA group had the most X-ray exposure, hemiarthroplasty group had the least. In postoperative recovery: the results of in non-weight-bearing walking time, hospitalization time and healing time was DHS>PFNA>hemiarthroplasty. Harris scores at 12 weeks after operation in hemiarthroplasty was higher than that of DHS and PFNA, but there was no statistical difference between DHS and PFNA. The incidence of postoperative complications in DHS group was more than that of PFNA group, but there were not significant differences among three groups.

CONCLUSION: PFNA is prepered in the treatment of senile intertrochanteric fractures. DHS fixation is more suitable for primary hospital and AI-type fracture and the fracture near the entry point of PFNA. The hemiarthroplasty is one of the best ways to treat unstable comminuted and/or severe osteoporosis of elderly intertrochanteric fracture. However,it isn't generally considered.

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