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@#Objective To explore the effect of continuous nursing intervention on limb function and nursing quality after proximal femoral nail antirotation (PFNA) internal fixation for femoral intertrochanteric fracture in the elderly. Methods From February, 2017 to November, 2018, 100 elderly patients with femoral intertrochanteric fracture who underwent PFNA internal fixation in our hospital were randomly divided into control group (n = 50) and observation group (n = 50), who accepted routine nursing and continuous nursing respectively for three months. They were assessed with Harris score and visual analogue scale for pain (VAS) before and after the intervention. The postoperative nursing effect was compared. Results The Harris score increased in both groups after the intervention (t > 45.98, P < 0.001), and increased more in the observation group than in the control group (t = 15.03, P < 0.001). The VAS score decreased in both groups after the intervention (t > 16.33, P < 0.001), and decreased more in the observation group than in the control group (t = 9.749, P < 0.001). The effect of nursing was better in the observation group than in the control group (Z = -2.272, P = 0.023). Conclusion Continuous nursing intervention can significantly improve the limb function and nursing satisfaction of elderly patients with femoral intertrochanteric fracture after PFNA.
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OBJECTIVE@#To explore the effect of metabolic syndrome on 15 days postoperative adverse events of femoral intertrochanteric fractures with internal fixation.@*METHODS@#From January 2011 to June 2019, 986 elderly patients with intertrochanteric fracture were treated with internal fixation, including 312 males and 674 females, with an average age of(77.71± 7.58) years old. And there were 97 patients with metabolic syndrome and 889 patients without metabolic syndrome. Through the electronic medical record system, the patient's age, gender, fracture type, cause of trauma, body mass index, smoking history, preoperative comorbidities, preoperative bloodtransfusion, operation timing, ASA classification, anesthesia method, internal fixation type, operation duration, and 15 days postoperative adverse events, which include surgical site infection, acute heart failure, acute respiratory failure, pulmonary infection, acute renal failure, DVT, embolism in important organs, urinary tract infection, death, and blood transfusion after surgery were collected. The differences of preoperative and intraoperative baseline datas and 15 days postoperative adverse events between the two groups were compared and analyzed by t text or univariate @*RESULTS@#There were statistical differences in age, body mass index, history of cardiac insufficiency, history of COPD, history of renal insufficiency, operation timing, ASA classification, operation duration, surgical site infection, acute heart failure, DVT, urinary tract infection and blood transfusion between two groups (@*CONCLUSION@#Elderly patients with intertrochanteric fracture with metabolic syndrome had higher postoperative surgical site infection rate, DVT incidence rate, urinary tract infection rate, and postoperative blood transfusion rate. Therefore, the orthopedic treatment team should give more attentionand optimize the treatment plan during the perioperative period with the cooperation of internal physician and anesthesiologist.
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Aged , Aged, 80 and over , Female , Humans , Male , Bone Nails , Fracture Fixation, Internal/adverse effects , Fracture Fixation, Intramedullary/adverse effects , Hip Fractures/surgery , Metabolic Syndrome/complications , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To analyze the efficacy and biomechanical properties of locking proximal femoral plate (LPFP) and proximal femoral nail anti-rotation (PFNA) for treating intertrochanteric fracture in elderly patients. Methods One hundred and six elderly patients with intertrochanteric fracture of femur were randomly divided into LPFP group (53 cases) and PFNA group (53 cases). After treatment intervention, the operation time, intraoperative bleeding volume, weight-bearing time, fracture healing time and Harris hip function score of 9 months after operation in two groups were recorded. The complications after operation in two groups were analyzed. Ten elderly fresh femoral specimens were selected to prepare the model of intertrochanteric femoral fracture in the elderly. They were randomly divided into PFNA group and LPFP group with 5 models in each group. After treatment and intervention, axial compression test, destructive load test and torsional stiffness test were conducted by mechanical testing machine, and biomechanical properties were recorded. Results The average operation time, weight-bearing time and fracture healing time in PFNA group were shorter than those in LPFP group (P<0.05), and the average intraoperative bleeding volume in PFNA group was less than that in LPFP group (P<0.05), and the average Harris score was higher than that in LPFP group (P<0.05). The total incidence of postoperative complications in PFNA group and LPFP group was 7.56% and 18.87%, respectively, indicating a significant difference between the two groups (P<0.05). After intervention treatment, the average axial compression, damage load and torsional stiffness in PFNA group were higher than those in LPFP group (P<0.05). ConclusionsPFNA caused minimal trauma for treating intertrochanteric femoral fractures in the elderly. With its good biomechanical properties, PFNA could effectively promote fracture healing and hip function recovery, and significantly reduce the incidence of hip varus, screw loosening and cutting complications.
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BACKGROUND: For the treatment of intertrochanteric fracture in elderly patients, if there is no operative contraindication, surgical treatment is recommended. Operative methods include internal fixation and joint replacement. Surgical techniques are mature, but the choice of surgical methods is controversial. OBJECTIVE: To compare the efficacy of artificial femoral head arthroplasty and proximal femoral nail antirotation in elderly patients with injured lateral wall femoral intertrochanteric fracture so as to provide the basis of clinical method selection and to provide the original data for the systematic analysis of large sample. METHODS: According to the case criterion, 48 cases of AO classification of type A2.2, A2.3 intertrochanteric fractures were selected in Department of Orthopedics, the 71 Group Army Hospital of Chinese PLA from January 2012 to December 2017. They were divided into femoral head arthroplasty group (n=29) and proximal femoral nail antirotation group (n=19). All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The patients were followed up for 1-3 years. Operation time, bleeding volume, hospitalization expenses, the incidence of complications, and Harris hip score at 1 month and 1 year after the surgery were compared between the two groups. RESULTS AND CONCLUSION: (1) After statistical analysis, operation time was significantly shorter in the femoral head arthroplasty group than in the proximal femoral nail antirotation group (P 0.05). The cost of hospitalization was significantly more in the femoral head arthroplasty group than in the proximal femoral nail antirotation group (P 0.05). (3) There was no significant difference in the incidence of complications between the two groups (P > 0.05). (4) For the patients over 70 years old with intertrochanteric fracture of injured lateral wall, artificial femoral head replacement has the advantages of early getting out of bed, high quality of life and quick recovery of joint function. It is suggested to choose artificial femoral head replacement first.
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Objective: To compare the predictive value of the two concepts for complications by comparing the incidences of surgical complications associated with different tip-apex distance (TAD) and calcar referenced tip-apex distance (Cal-TAD) in the treatment of femoral intertrochanteric fractures with Asian type proximal femoral nail (APFN) fixation. Methods: A total of 188 cases of femoral intertrochanteric fractures treated with APFN fixation between January 2014 and December 2018 were collected according to inclusion criteria. TAD and Cal-TAD were measured on the X-ray film at immediate after operation; the patients were divided into two groups according to the measurement results: 0.05). During the follow-up, 6 patients (5.04%) with TAD<25 mm, 10 patients (14.49%) with TAD≥25 mm had complications, and 1 patient (0.70%) with Cal-TAD<25 mm and 15 patients (32.61%) with Cal-TAD≥25 mm had complications. There were significant differences in the incidence of complication between the patients with different TAD, between the patients with different Cal-TAD, and between patients with TAD<25 mm and Cal-TAD<25 mm ( P<0.05). Conclusion: In the operation of femoral intertrochanteric fracture with APFN fixation, surgical complications can be significantly reduced when TAD or Cal-TAD was controlled within 25 mm, Cal-TAD is more significant in the prediction of postoperative complications.
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Objective: To summarize the research progress of osteonecrosis of femoral head (ONFH) following femoral intertrochanteric fractures in adults. Methods: Relevant literature at home and abroad was extensively reviewed to summarize the pathogenesis, high-risk factors, and treatment of ONFH after femoral intertrochanteric fracture in adults. Results: ONFH after femoral intertrochanteric fracture mostly occurs within 2 years after operation, with a lower incidence. At present, it is believed that comminuted and large displacement fractures caused by high-energy injuries, fracture line close to the base of neck, excessive external rotation deformity, improper intramedullary nail entry points, and rough intraoperative manipulating may injury the deep branch of the medial circumflex femoral artery, causing ONFH. Hip replacement is the main treatment for necrosis, which can achieve good results. Conclusion: Addressing the above risks, excessive external rotation, overstretching, and rough manipulating should be avoided. Anatomical reduction should be performed during the operation, the nail entry point should be accurate and avoid repeated drilling and thermally bone necrosis.
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Objective To analyze the efficacy and safety of erythropoietin combined with chalybeate in the treatment of perioperative anemia in patients with femoral intertrochanteric fracture.Methods A total of 112 patients with femoral intertrochanteric fracture who were treated by PFNA from May 2014 and May 2016 in our hospital were enrolled in this prospective study.They were divided into the treatment group (57 patients) and the control group (55 patients).The following data were recorded and compared:preoperative waiting time,operation time,intraoperative blood loss,number and volume needed blood transfusion at intraoperative and postoperative,the value of Hb and Hct on admission,before operation,1 st,3rd and 5th day after operation,the wound infection,pulmonary and urinary infection,deep vein thrombosis and plumonary embolism.Results There was no significant difference between the two groups in preoperative waiting time,operation time,intraoperative blood loss and perioperative blood loss (P ＜ 0.05).Treatment group has less patients (7％,4/57) in transfusion compared with control group (21％,12/55),and the difference was significant (P =0.01).There was no significant difference in the average volume of transfusion between the treatment group [(2.4 ±0.85)u] and the control group [(2.5 ±0.82)u].The value of Hb and Hct were most significantly decreased at the 3rd day after operation in both of the two groups,and they exceed the control group at the 3rd and 5th day after operation compared with the treatment group with significant difference(P ＜ 0.05).Treatment group has higher value of Hct at pre-and postoperative compared with that of the control group (P ＜ 0.01).There was no infection,deep vein thrombosis and plumonary embolism occurred in the to groups.Conclusion Erythropoietin combined with chalybeate in the treatment of perioperative anemia during femoral intertrochanteric fracture is a safe and effective method which can significantly reduce the rate of perioperative blood transfusion,while not increasing infection,deep vein thrombosis and plumonary embolism.
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Objective To analyze the risk factors of failure of internal fixation of unstable femoral intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA) in elderly patients,and to provide reference for clinical treatment.Methods Collected the clinical data of 251 aged and unstable femoral intertrochanteric fracture patients who have recieved PFNA treatment from January 2012 to December 2016.Preoperative clinical general data and intraoperative clinical factors were used as analysis variable to analyze the high risk factors and risk factors of internal fixation failure in PFNA treatment by χ2 test ,Wilcoxon rank sum test and Logistic regression.Results Through the analysis of 78 aged patients with internal fixation failure after PFNA treatment,the χ2 test and Wilcoxon rank sum test showed that,type of fractures,osteoporosis Singh index grade, tip-apex distance,application of hormone,basic diseases were risk factors for internal fixation failure after PFNA treatment (P<0.05).Among thses factors,type of fractures,osteoporosis Singh index grade, tip-apex distance were independent high risk factors for internal fixation failure after PFNA treatment(P<0.05).Conclusion Severe type of fractures (type Ⅲ and Ⅳ),osteoporosis of grade 4 to 6,and tip-apex distance greater than 25 mm are high risk factors of failure of internal fixation of unstable femoral intertrochanteric fractures treated with PFNA,and it is better to give more attention and effective intervention or other treatment.
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Objective To identify the median effective volume (EV50) of 0.3 ％ ropivacaine in the old patients with femoral intertrochanteric fracture undergoing ultrasound-guided fascia iliaca compartment block (FICB).Methods Thirty-nine patients,18 males and 21 females,aged 65-98 years old,ASA physical status Ⅱ or Ⅲ,scheduled for femoral intertrochanteric fracture surgery were sequentially received ultrasound-guided FICB.Patients were sequentially given a pre-set volume of 0.3％ ropivacaine according to our pilot study.A sign of "+" was marked if the patient was positive to FICB and totally pain-free 30 min after block,and the next patient would be assigned to a lower volume of ropivacaine.Otherwise,a sign of was marked if the patient was negative to FICB that was partially or not pain-reliefed 30 min after block,and the next patient would be assigned to a larger volume of ropivacaine.The trial was terminated when 7 inflection points appeared.The EV50 of 0.3％ ropivacaine with 95％ confidence interval (CI) was calculated according to sequential method.Results Twenty (51.3％) in a total of 39 patients received a successful ultrasound-guided FICB.The EV50 and 95 ％ CI of 0.3 ％ ropivacaine using ultrasound-guided FICB in old patients with femoral intertrochanteric fracture was 25.37 ml (95％CI 22.06-29.19 ml).Conclusion The EV50 of 0.3％ ropivacaine using ultrasound-guided FICB in the old patients with femoral intertrochanteric fracture is 25.37 ml.
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AIM To observe the effects of Guhoukang Granules (Eucommiae Cortex,Dipsaci Radix,Corni Fructus,etc.) on bone metabolism indexes of the geriatric femoral intertrochanteric fracture.METHODS A total of eighty patients meeting the inclusion criteria,cured with fixed operation of proximal femoral anti-rotation nail and given basic care,were divided randomly and equally into two groups:experiment group (Guhoukang Granules ) and control group (calcium carbonate D3 tablets).Three months made a course.Osteocalcin (OC),calcitonin (CT),bone-specific alkaline phosphatase (BALP),total procollagen type 1 aminoterminal propeptide (tPINP),β isomer of the C-terminal telopeptide of type Ⅰ collagen (β-CTX),and intact parathyroid hormone (iPTH),were examined before and after three months,respectively.RESULTS There were no significant statistical difference in the levels of OC,CT,BALP,tPINP,β-CTX and iPTH before operation in both groups.The levels of OC,CT,BALP,tPINP in the experiment group obviously increased and the levels of β-CTX,iPTH markedly decreased after the operation,and were better than those in the experiment group pre-operation and in the control group after the operation.The control group had no improvement in bone metabolism indexes pre-and post-operation.CONCLUSION Guhoukang Granules can improve bone metabolism of the geriatric femoral intertrochanteric fracture and facilitate the recovery of the fracture.
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Objective To compare the clinical curative effect of proximal femoral nail anti rotation ( PFNA) and dynamic hip screw fixation in the treatment of the femoral intertrochanteric fracture,and provide reference for the development of clinical surgery scheme.Methods 74 patients with femoral intertrochanteric fracture in our hospital were selected and randomly divided into observation group and control group,37 cases in each group.The control group was treated with dynamic hip screw fixation,and the observation group was treated with PFNA therapy.Opera-tive time,bleeding volume and wound healing were compared between the two groups.The time of bone healing and complications were compared between the two groups after operation 1,3,6 months, functional recovery of hip was evaluated after operation by Harris score in the two groups.Results Intraoperative bleeding in the observation group was (115.68 ±72.38)mL,the operation time was (43.26 ±11.47)min,which were significantly less than the con-trol group(t=9.62,7.11,all P0.05).1 month after surgery,the Harris score of the observation group was (71.39 ±4.38)points, which was significantly higher than the control group (t=3.17,P0.05 ) .Conclusion PFNA had less surgical trauma,early functional exercise for patients after surgery by comparison with dynamic screw fixation.It could promote fracture and hip joint function rehabilitation.
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Objective To investigate the efficacy of zoledronic acid in the treatment of senile unstable femoral intertrochanteric fractures with anatomical locking plate. Methods 67 patients were randomly divided into two groups. Five days after the operation, group A received one intravenous injection of 5 mg zoledronic acid, while patients in group B did not receive the injection. The two groups were compared in terms of hospitalization time, complications, limb weight-bearing time, fracture healing time, hip function score after operation, preoperative and postoperative serum calcium and serum ALP, bone mineral density of proximal femur before operation and 1 year after operation. Results There were no statistically significant differences between the two groups in age, type of fracture, hospital stay, partial weight-bearing time, fracture healing time, hip function at 1 month and 1 year after operation, preoperative bone mineral density and blood calcium. But the differences were statistically different in hip function at 3 months after operation , averaged bone mineral density of proximal femur and serum ALP 1 year after operation. Moreover, 5 patients in group A developed muscle pain or fever after intravenous injection of zoledronic acid. Conclusion The locking plate combined with zoledronic acid injection in treatment of elderly patients with unstable femoral intertrochanteric fracture could inhibit bone loss, increase bone mineral density, and accelerate limb function recovery after operation. On the other hand, Zoledronic acid has a high incidence of adverse reaction.
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Objective To study the accuracy of the anteversion of femoral prosthesis in hemiarthro-plasty for treating femoral intertrochanteric fracture in the elderly.Methods Twenty femoral neck antever-sions of specimens were measured, which were control group(A).The femoral specimens were made into the model of femoral intertrochanteric fracture, which were installed femoral prosthesis according to minor trochanter(B),identifying the max diameter of cavum medulla(C),ocular estimating femoral condylar line ( D) ,combination of identifying the max diameter of cavum medulla and ocular estimating femoral condylar line( E) respectively.All the anteversion of femoral prosthesis were measured.Results The anteversion were:A group(8.98 ±4.31)°,B group (9.12 ±4.87)°,C group (9.57 ±6.49)°,D group (13.18 ± 5.83)°,E group (10.37 ±4.56)°respectively.The difference among the five groups was statistically sig-nificant.There was difference between D and A, there were no differences between B and A, C and A, E and A respectively.Conclusions In hemiarthroplasty for treating femoral intertrochanteric fracture, the an-teversion of femoral prosthesis is according to minor trochanter possibly; if the minor trochanter can not be got reduction, it is a good option according to combination of identifying the max diameter of cavum medulla and ocular estimating femoral condylar line to make sure the accuracy of the anteversion of femoral prosthe-sis.
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Objective To evaluate the mid-term effect of total hip arthroplasty (THA) after failed internal fixation of intertrochanteric fracture.Methods Twenty-one patients treated with THA due to failed internal fixation of intertrochanteric fracture from January 2007 to December 2010 were studied retrospectively.There were 10 males and 11 females,at mean age of 71.7 years (range,66-79 years).Sixteen patients were treated with dynamic hip screws/dynamic condyle screws (DHS/DCS),3 proximal femoral nails,2 hollow screws.Mean interval from internal fixation to THA was 29 months (range,10-79 months).Causes for the failed internal fixation were loosening,cutting,and breakage of screws which generated fracture displacement or nonunion in 19 patients and femoral head necrosis in 2 patients.All patients received THA with uncemented acetabulum cups and proximally long-stemmed,porous-coated titanium femoral components including AML stems for 5 patients and Solution stems for 16 patients.Moreover,greater trochanteric fracture was fixed by Luke wire.Harris hip score were measured before operation and at final follow-up.Radiographs were performed before operation,at 3,6 and 12 months after operation,and at final follow-up to assess the fracture restoration,healing,prosthesis initial fixation,and mid-term survival condition.Results One patient was died due to pulmonary infection 1.5 years after operation.Two patients were lost to follow-up and 18 patients were followed up for 3-5 years (mean,3.9 years).At final follow-up,13 patients regained the ability to walk independently,4 needed support of a cane,1 needed assistance of a walker.There were no signs of loosening,subsidence or rupture of the prosthesis.Mean Harris hip score increased from 25.3 points preoperatively to 80.6 points at final follow-up; the score was excellent in 11 patients,good in 6,good in 1,with the excellent and good rate of 94％.Conclusion THA can improve hip function,patients' quality of life and midterm outcome in salvage of failed internal fixation of intertrochanteric fractures.
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Objective To develop a new hemi-arthroplasty system-Trochanteric Prosthesis System (TC) for the treatment of unstable femoral intertrochanteric fractures in the elderly, so as to preserve bone mass and meet requirement of functional exercises at early stage. Methods A normal male adult volunteer was chosen to receive CT scanning at middle and upper regions of his both intact femur. The serial digitized image data of spiral CT in DICOM format were imported to finite element modeling software to establish a three-dimensional (3D) solid model of the proximal femur. The Pro/E software was used to conduct computer-aided design of the new hemi-arthroplasty prosthesis system and then its metal model was also made by rapid prototyping techniques. After repeated verification and improvement on cadaver femur, the femoral prosthesis was molded and assembled in the solid fracture mode for finite element analysis. The unstable femoral intertrochanteric fracture model obtained from the fresh cadaver of an elderly male was chosen to make A2.2 Type of such fracture model in AO classification system. The new hemi arthroplasty prosthesis system was implanted and assembled into the model and received mechanical testing, including material performance testing, prosthesis head/neck and stem fatigue testing, anti-compression and anti-torsion testing, according to the National Industrial Standard YY0117 and YY0118. Results The sample of new hemi-arthroplasty prosthesis sustained 5 million cycle (8 Hz) fatigue testing on the part of the head-neck and the stem body without any breakage and failure. With the sample implanted into the intertrochanteric fracture model, the maximum compressive strength and torsional strength of the sample reached over 2 kN and 15.5 N•m without failure, respectively. The contact stresses between the stem and the femur were mostly distributed at the region below the femoral trochanter, where the maximum average Von Mises stress values were 17.6~26.4 MPa. Stresses at the region of intertrochanteric fractures were at a low level. The maximum average Von Mises stress values at the greater and lesser trochanter region were 2.7 and 4.9 MPa, respectively. Conclusions The new developed hemi-arthroplasty prosthesis has the advantages of easy performance, reliable fixation, sufficient bone preservation and it is capable of fulfilling the demands of early weight bearing and functional exercises. It is suitable for the treatment of unstable femoral intertrochanteric fractures in the elderly.
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OBJECTIVES: To determine whether kinds of implants would influence on the radiologic outcomes in the treatment of unstable osteoporotic intertrochanteric fractures. MATERIALS AND METHODS: In this retrospective study, radiologic outcomes of 151 patients with unstable osteoporotic intertrochanteric fractures undergoing surgical treatments were compared based on the types of fixation implants as follows : PFNA (53 cases, group I), gamma nail 3(31 cases, group II), CHS with TSP (43 cases, group III), and helical blade type LCP-DHS with TSP (24 cases, group IV). On the follow-up radiographs after operations, we assessed differences of bone union durations, neck-shaft ankle changes, lag screw or helical blade slippages, and varus alpha angle changes among the study groups. RESULTS: All the radiologic outcomes evaluated in this study were not significantly different among the study groups. The average bone union durations of the group I, II, III and IV were 17.7, 18.0, 18.2, and 17.8 weeks, respectively (P=0.429). The average variation of neck-shaft angle of the group I, II, III and IV were 3.6degrees, 3.1degrees, 3.7degrees and 2.9degrees, respectively (P=0.273). The average lag screw or blade slippage of the group I, II, III and IV were 5.1 mm, 3.3 mm, 3.6 mm and 2.7 mm, respectively (P=0.154). The average variation of varus alpha of the group I, II, III and IV were 5.3degrees, 4.7degrees, 4.1degrees and 4.6masculine, respectively (P=0.894). CONCLUSIONS: This study indicates that four typical types of fixation implants for treating unstable osteoporotic intertrochanteric fractures would not lead to differences in postoperative radiological outcomes.
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Animals , Humans , Ankle , Follow-Up Studies , Hip Fractures , Nails , Retrospective StudiesABSTRACT
BACKGROUND:Hidden blood loss is an important risk for the intertrochanteric fracture patients, especial y the elderly patients, which can cause anemia in patients after internal fixation and can affect wound healing and patient recovery. OBJECTIVE:To compare the perioperative hidden blood loss and the risk factors of proximal femoral anti-rotation intramedul ary nail internal fixation and dynamic hip screw fixation for the treatment of femoral intertrochanteric fracture. METHODS:We selected 70 cases of femoral intertrochanteric fracture patients who treated with proximal femoral anti-rotation intramedul ary nail and dynamic hip screw fixation, including 21 patients with the age ≥ 80 years and 49 patients with the age30 kg/m2 and 42 patients with the body mass index ≤ 30 kg/m2;30 patients received anti-rotation intramedul ary nail internal fixation and 40 patients received dynamic hip screw fixation. The perioperative blood loss was calculated with Gross formula according to the changes of height, body mass index and the hematocrit before and after fixation. RESULTS AND CONCLUSION:The mean total blood loss was 936 mL, the mean dominant blood loss was 237 mL and the mean hidden blood loss was 699 mL. The hidden blood loss was accounted for 74.7%in total blood loss. The dominant blood loss in the dynamic hip screw fixation group was higher than that in the anti-rotation intramedul ary nail internal fixation group, and the hidden blood loss was lower than the anti-rotation intramedul ary nail internal fixation group. The total blood loss and the hidden blood loss of the elderly patients were higher than those of the non-elderly patients;there was no significant difference between male and female patients, obesity and normal patients. The results indicate that hidden blood loss is the major reason for total blood loss of femoral intertrochanteric fracture after internal fixation. The hidden blood loss of anti-rotation intramedul ary nail internal fixation is larger than that of dynamic hip screw fixation, and elder is the risk factor for hidden blood loss.
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Objective To observe the effect of pressure-protective brace with pressure-sensitive device in the early stage rehabilitation training enhance bone healing, shorten the treatment course and reduce complications,a kind of independently developed pressure-protective brace with pressure-sensitive device was utilized with quantified discontinuous longitudinal stress stimulation under doctors' regulation according to procedure. Methods The pressure-protective brace with pressure sensitive device for rehabilitation training was developed in May 2008 ,and was applied in clinics during January 2009 to June 2010. Forty elder patients,with complete clinical data, underwent Dynamic Hip Screw (DHS) internal fixation of femoral intertrochanteric fracture were were enrolled into this study. These cases were assigned into experimental group and control group with 20 patients respectively. The patients of experimental group performed lower extremity rehabilitation training wearing the pressure-protective brace. The load training of lower extremities with double crutches was modulated by doctors through regulating the threshold value of pressure in different time and different condition after operation according to the prearranged rehabilitative plan of individuation. The controls were instructed to performed lower extremity rehabilitation training in traditional way. Both the clinical healing and bone union time in all cases were evaluated according to the uniform standard. Results Total 40 patients were followed up for 13.0 - 24. 0 weeks ( average, 17.6 weeks ). Clinical healing time was 7.0 - 12. 0 weeks ( average,9. 1 weeks ) and bone healing time was 12. 0 - 16.0 weeks(average,13. 7 weeks)in experimental group. While in control group,the clinic healing time and bone union time was 9. 0 - 13.0 weeks( average, 11.3 weeks) and 14. 0 -20. 0 weeks (average, 16. 6 weeks)respectively. The Independent T-test results showed that whether clinic healing time or bone healing time presented significant differences between experimental group and the controls( P＜0. 01 ). All of the fractures in these two groups were healed at the end time of follow up without adverse complications,including fracture displacement, implant break, implant loose and failure. Conclusion The pressure-protective brace with pressure sensitive device used for quantifying rehabilitation training can enhance bone union, shorten the treatment course and reduce complications. This method further proves that discontinuous compressive stress in a certain range can stimulate fracture healing.
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PURPOSE: We evaluated the clinical and radiological outcomes related to use of the Targon(R) proximal femoral nail for repairing femoral intertrochanteric fractures. MATERIALS AND METHODS: Between April 2004 and November 2005, the records of 56 patients with intertrochanteric fractures treated with the proximal femoral nail, were analyzed. The mean patient age was 75.2 years. The mean duration of follow-up was 32 months. There were 26 stable fractures and 30 unstable fractures. Clinical assessment included parameters of operating time, transfusion rate, pain analysis by visual analogue scale (VAS), timing of maximum tolerable weight-bearing, functional evaluation by modified Koval index, and complications. Radiological assessment was directed toward adequacy of reduction, union time, and changes observed between immediate postoperative and final follow-up roentgenograms in various parameters. RESULTS: The mean operating time was 37 minutes. Visual analogue scale at final follow-up was 2.8 on average, and 38 of 43 preoperative ambulators (88%) were able to bear weight as much as tolerable within 6 weeks postoperatively. Postoperative mobility recovered to pre-injury levels in 40 cases (71%). Radiologic evaluation showed adequate reduction in all cases. Mean union time was 8.9+/-2.5 weeks. The neck-shaft angle changed at final follow-up an average of 3.6+/-1.9(R). The femoral shaft displaced medially an average of 2.8+/-0.9 mm, and the lag screw slid an average of 4.7+/-0.6 mm. Complications such as cutting through, Z-effect, and femoral shaft fracture were not observed in any cases. CONCLUSION: The Targon(R) proximal femoral nail showed excellent results in terms of early ambulation, clinical recovery, and radiologic parameters and may be a useful implant for treating femoral intertrochanteric fractures.
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Humans , Early Ambulation , Femoral Fractures , Follow-Up Studies , Hip Fractures , Nails , Ursidae , Weight-BearingABSTRACT
PURPOSE: The clinical outcome is favorable for the treatment of unstable femoral intertrochanteric fractures using both dynamic hip screw (DHS) and trochanter stabilizing plate (TSP) in elderly patients. However, there are sometimes complications related to excessive sliding. Therefore, the aim of this study was to evaluate the value of additional fixation of greater trochanter using wires and screw in the unstable femoral intertrochanteric fractures with a greater trochanter fracture. MATERIALS AND METHODS: From March 2004 through December 2005, thirty-seven patients, who were more than sixty-five years of age and were diagnosed with osteoporosis, were treated with DHS and TSP in unstable femoral intertrochanteric fractures with a follow-up of more than 6 months (mean duration, 13.5 months). The patients were divided into two groups. One group (group A: 20 patients) was treated with DHS and TSP only, whereas the other (group B: 17 patients) was treated with DHS and TSP augmented by a wire and screw. The average age was 80.9 (range 68 to 89) and 83.2 years (range 72 to 91) in groups A and B, respectively. All the patients in both groups were assessed radiographically immediately after surgery and at the last follow-up. The level of sliding of the lag screw and displacement of the greater trochanter were evaluated statistically. RESULTS: Bony union was achieved in all cases except for two cases in group A. At the last follow-up, the average of lag screw sliding in groups A and B was 8.96+/-5.98mm and 4.80+/-3.68, respectively, showing a statistical difference (P value0.05). CONCLUSION: Unstable femoral intertrochanteric fractures can be treated successfully using a hip screw and TSP alone. However, the addition of wires and screws in the greater trochanter can prevent excessive sliding that occurs after displacing the greater trochanteric fragments out of the plate in the presence of a greater trochanteric fracture line or severe bone defect in the lateral aspect.