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Objective To evaluate the application of tranexamic acid in perioperative period of intertrochanter fracture of femur.Methods 46 cases of patients with intertrochanter fracture of femur were randomLy divided into the control group and treatment group,23 cases in each group.All patients underwent partial hip replacement,10min before operation,the control group was given 0.9％sodium chloride injection100mL,intravenous drip; the experimental group was treated with tranexamic acid injection 10mg/kg,soluble in 100mL 0.9％sodium chloride injection,intravenous drip;Before and after operation,compared between the two groups of patients with blood t hematocrit(HCT),hemoglobin(Hb)levels,volume of blood loss,volume of blood transfusion and incidence of postoperative complications.Results After operation,compared with the control group,the serum levels of HCT、Hb were higher in the experimental group(P<0.05).The total blood loss,hidden blood loss,intraoperative blood loss,postoperative drainage volume and blood transfusion volume were lower in the experimental group(P<0.05).There was no significant difference in the incidence of complications between the 2 groups.Conclusion The tranexamic acid can significantly reduce the volume of blood loss and volume of blood transfusion in perioperative period of patients with intertrochanter fracture of femur,and do not increase the incidence of postoperative complications of thrombosis,and have high security.
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PURPOSE: The purpose of this study was to evaluate the usefulness of bipolar hemiarthroplasty using a cemented femoral stem for treating femoral trochanteric region hip fractures in elderly patients. MATERIALS AND METHODS: This study includes 47 hips were available to be follow up for over 2 years, between December 1995 and December 2002. Clinical evaluation was done using Koval's classification before the fracture and at last follow-up, and Harris's hip score at the last follow up. Radiological evaluation was done via the plain radiographs. RESULTS: The Koval classification was as follows: recovery to the condition before fracture in 15 cases (31.9%), degradation by 1 class in 31 cases (66.0%) and degradation by 2 classes in 1 case (2.1%). The Harris hip score was 84.6 points at the last follow-up. All the cases showed stable fixation of the femoral stem. Postoperative complications were reported as 1 case of pneumonia, 1 case of deep vein thrombosis, 1 case of pulmonary thromboembolism, 1 case of pulmonary edema, 3 cases of stress ulcer, 1 case of superficial infection and 1 case of deep infection. Superficial pressure sore occurred in 1 case, postoperative delirium occurred in 9 cases and partial rupture of the bladder in 1 case. CONCLUSION: Bipolar hemiarthroplasty using a cemented femoral stem was effective and satisfactory for the treatment of elderly patients with intertrochanter fractures. But further studies that will focus on complications are required.
Subject(s)
Aged , Humans , Delirium , Femur , Follow-Up Studies , Hemiarthroplasty , Hip , Hip Fractures , Pneumonia , Postoperative Complications , Pressure Ulcer , Pulmonary Edema , Pulmonary Embolism , Rupture , Ulcer , Urinary Bladder , Venous ThrombosisABSTRACT
Objective Probe into different method safe and effective fixation method,clinical result and cliniical to indications of different treatments in intertrochanter fracture of femur in the old elderly.Methods Adopting the femur near end dissecting type to lock the stencil plate fixation 14 of 58 cases of old intertrochanter fracture of femur separately.the hip screw of motive force(DHS) fixation was used in 24,femur near end stencil plate fixation in 20,and the blood loss,operation time,ossicle split off situation and fracture heal time were compared among the three groups.Sanders grade results and complications were followed up.Results Postoperative follow up Was done in all patients,from 8 months to 3 years,averaged 1.5 years.three groups of skill type fine rate of the three groups being 92.9%,92%,90%respectively.Conclusions Different methods showed good clinical results in treating the old intertrochanter fracture of femur,each having its indications.Operation should be done should follow based on fracture type,age,physique factors and patient's osteoporosis intensity,choosing the best healing solution by characteristics of intermal flxation while each combining.The hook board(ALHP)is suitable for old patients with serious osteoporosis,DHS for Evans Ⅰ,Ⅱ types and some Evans Ⅲ type,and femur near end dissecting type stencil plate for Ⅳ and Ⅴ types fractures.
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PURPOSE: To evaluate the availability of cable fixation of the lesser trochanter in the treatment of unstable intertrochanter fractures using a sliding compressive hip screw (CHS) on the clinical and radiological results related to osteoporosis. MATERIALS AND METHODS: Fifty-four cases of Kyle-Gustilo type III unstable intertrochanter fractures between January 1999 to January 2005 were classified into 2 groups: groups 1(30 cases CHS) and 2(24 cases additional cable). The sliding distance of the lag screw, bony union, weight bearing time, and the loss of fixations related to osteoporosis in the two groups were compared retrospectively after a follow up of at least 1 year. RESULTS: The average sliding distances of the lag screw in groups 1 and 2 was 15.27 and 12.13 mm (p=0.0453), respectively. The time to bony union in groups 1 and 2 was 14.63 and 13.71 weeks (p=0.4623), respectively. The average weight bearing time in groups 1 and 2 was 3.03 and 2.83 weeks (p=0.1697), respectively. Early weight bearing was allowed in patients in group 2 with a Singh index greater than grade IV (p=0.0291), and a loss of fixation was encountered 5 cases in each group (p=0.9688), which increased significantly with increasing severity of osteoporosis (p<0.05). CONCLUSION: Additional cable fixation of the lesser trochanter for mild osteoporotic patients in unstable intertrochanter fractures is recommended for preventing the excessive sliding of lag screws and for allowing early ambulation. However, this procedure is not effective in patients with severe osteoporotic.
Subject(s)
Humans , Early Ambulation , Femur , Follow-Up Studies , Hip , Osteoporosis , Retrospective Studies , Weight-BearingABSTRACT
PURPOSE: To prepare the appropriate guideline in choosing the internal fixatives for the intertrochanteric fractures of the femur in the elderly. MATERIALS AND METHODS: We reviewed 95 cases of intertrochanteric fractures of the femur from January, 1999 to December, 2003. We fixed the fracture with Proximal Femoral Nail in 37 cases (PFN group), Dynamic Hip Screw in 56 (DHS group), Dynamic Condylar Screw in 2 cases (DHS group). We reviewed operation time, blood loss during operation, changes in neck-shaft angle and sliding of lag screw. RESULTS: There were no significant differences in the parameters between the 2 groups in stable fracture. In unstable fractures, operation time in PFN group and DHS group revealed 103.9 and 128.2 minutes respectively; mean amount of blood loss during operation revealed 523.2 and 573.1 ml respectively. Mean changes in the neck-shaft angle at final follow-up in PFN group and DHS group revealed 4.6 degrees and 4.1 degrees; sliding of lag screw averaged 3.4 and 6.5 mm respectively. Among the DHS group, cases of additional fixation with trochanteric supporting plate revealed 3.1 degrees of changes in neck-shaft angle and 4.2 mm of lag screw sliding. CONCLUSION: In cases of stable fractures, any fixative might suffice. In cases of unstable fractures, there were no significant differences in results of treatment between these two groups, however, PFN group revealed shoter operation time and less blood loss during operation. It seemed to be necessary to apply additional fixation with trochanteric supporting plate when using DHS in unstable cases.
Subject(s)
Aged , Humans , Femur , Fixatives , Follow-Up Studies , Hip , Hip FracturesABSTRACT
Intertrochanteric fractures of femur were increasing in their incidence in morden life. The compression hip screw and Ender nail are popular treatment modalities of the interochanteric fracture of femur. We had tried to clarify the complications of intertrochanteric fracture according to the treatment modality-compression hip screw and Ender nail. We obtained the results as followings with the patients who had intertrochanteric fracture of femur which were managed by compression hip screw (56 cases) and Ender nail (22 cases) through the period of March 1987 to June 1993. The summary of the results; 1. Mechanical complications were developed in 9 patients(16%), 9 complications in the group with compression hip screw and 7 patients(32%), 12 complications in Ender nail. 2. Local complications were developed in 4 patients(7%) in compression hip screw and 10 patients (46%) in Ender nail and the most common local complication was the knee joint pain(7 patients; 32%). 3. Statistically, more significant decrease of neck-shaft angle was shown with group using Ender nail for unstable fracture than stable fracture group and compression hip screw group. 4. The degree of shortening was incrased in group with Ender nail than in group with compression hip screw, but there was no statistical significance. 5. The grade of osteoporosis was not related to the change of neck-shaft angle and shortening and also to the development of mechanical complication. According to the above results, compression hip screw was a more stable fixation device than Ender nail in the unstable intertrochanteric fracutre.