Correlation Between Mechanography and Clinical Parameters at Six Months After Hip Fracture Surgery

OBJECTIVE: To investigate the correlation between mechanography and clinical parameters in older people at 3 and 6 months after hip fracture surgery.METHODS: A longitudinal follow-up study was conducted in university hospitals with 38 patients at 3 months and 29 patients at 6 months after hip fracture surgery. Subjects 65 years and older completed measurements on the Berg Balance Scale (BBS), Functional Ambulation Category (FAC), walking ability by Koval, Korean version of the fatigue, resistance, ambulation, illnesses, and loss of weight (K-FRAIL) scale, and hand grip strength. The Romberg test with center of foot pressure (COP), chair rise test (CRT), and maximal power (W/kg) were conducted using the Leonardo Mechanograph.RESULTS: COP area and pathway length were correlated with BBS at 3 and 6 months. Change in BBS was correlated with change in COP area, but not with change in COP length. COP area and pathway length were correlated with K-FRAIL at 3 months after hip fracture surgery. The same COP variables showed correlations with FAC and walking ability by Koval at 6 months after surgery. Maximal power during CRT had correlation with chair rise time but not with other clinical parameters.CONCLUSION: The study revealed correlations between mechanography and clinical parameters in older people at 3 and 6 months after hip fracture surgery. Both the clinical assessment and objective test with mechanography may be required for the quantitative and sensitive measurement of postural balance and lower limb muscle power.

Relationship Between Swallowing Function and Maximum Phonation Time in Patients With Parkinsonism

OBJECTIVE: To identify the relationship between maximum phonation time (MPT) and swallowing function, as well as the elements of swallowing, in order to provide a rationale for speech therapy in patients with Parkinsonism manifesting dysphagia. METHODS: Thirty patients with Parkinsonism who underwent speech evaluation and videofluoroscopic swallowing study (VFSS) were recruited. The MPT, the longest periods of sustained pronunciation of /aa/, was evaluated. The VFSS was evaluated using Penetration Aspiration Scale (PAS), National Institutes of Health-Swallowing Safety Scale (NIH-SSS), and Videofluoroscopic Dysphagia Scale (VDS). The relationship between dysphagia scales and MPT was analyzed using Pearson correlation. The difference in VDS variables between subgroups (Parkinson disease or Parkinsonian syndrome, independent or dependent ambulation, and normal or abnormal MPT) and the difference in MPT between subgroups based on the VDS variables were analyzed using the independent t-test. RESULTS: Bolus formation and laryngeal elevation functions were significantly higher in the normal MPT group compared with the impaired group. In the VDS variables, patients with intact bolus formation, oral transit time, pharyngeal swallow triggering, and laryngeal elevation showed significantly longer MPTs compared with the impaired groups. In addition, MPT was significantly correlated with the VDS and modestly correlated with the NIH-SSS, but not the PAS, suggesting that phonatory function is related to the oropharyngeal swallowing function, but not directly to the aspiration itself. CONCLUSION: The correlation between MPT and several swallowing-related elements was identified, indicating an interactive correlation between swallowing and phonation. This result justifies voice therapy as a treatment for dysphagia in patients with Parkinsonism.

Prediction of Ambulatory Status After Hip Fracture Surgery in Patients Over 60 Years Old

OBJECTIVE: To predict ambulatory capacity, 1 month after physical therapy following hip fracture surgery. METHODS: A retrospective chart review was carried out. Patients more than 60 years old, who underwent hip fracture surgery and received physical therapies, were selected (n=548). Age, gender, presence of cognitive dysfunction, combined medical diseases, combined fractures, previous history of hip surgery, prefracture ambulatory capacity, days from the fracture to surgery, type of fracture, type of surgery, presence of postoperative complications, days from the surgery to physical therapy, and total admission period, were collected. Prefracture ambulatory capacity and postoperative ambulatory capacity were classified into non-ambulatory status (NA), ambulation with assistive device (AA), and independent-ambulation without any assistive device (IA). Multiple-logistic regression analysis was performed for the prediction of postoperative ambulatory capacity. RESULTS: Age (odds ratio [OR]=0.94 for IA and 0.96 for IA or AA), gender (OR=1.64 for IA and 0.98 for IA or AA), prefracture ambulatory capacity (OR of IA=19.17 for IA; OR of IA=16.72 for IA or AA; OR of AA=1.26 for IA, OR of AA=9.46 for IA or AA), and combined medical disease (OR=2.02) were found to be the factors related to postoperative ambulatory capacity and the prediction model was set up using these four factors. CONCLUSION: Using this model, we can predict the ambulatory capacity following hip fracture surgery. Further prospective studies should be constructed to improve postoperative ambulatory capacity.

Necessidade de movimentar-se e manter uma boa postura no idoso cirúrgico: quase-experimento / Necesidad del anciano quirúrgico de moverse y mantener una buena postura: casi-experimento / Need to move and maintain a good posture in elderly on surgery: quasi-experimental study

Objective: To identify in elderly people on surgery the need to move and maintain desirable postures; to evaluate the outcome of interventions for the need in a study group. Method: This is a quantitative and quasi-experimental study, conducted with 30 elderly in the postoperative in hospital in Rio de Janeiro. It was used for data collection the protocol for evaluation of basic needs second Virginia Henderson and for the experimental group was used the healthcare. Results: The main needs identified were painful to jogging, decreased joint flexibility, bed restriction, balance disorders, decreased strength and muscular endurance. From the 40 identified needs in the experimental group could be reduced 8 and in the control group from 35 were reduced to 3, obtained Oddis Ratio (0R) of 2,66. Conclusion: There was significant improvement in the experimental group and the reduction of the identified problems when compared to the control group.

Objetivos: Identificar em idosos cirúrgicos a necessidade de movimentar-se e manter uma boa postura; avaliar o desfecho das intervenções para a necessidade de movimentar-se em um grupo experimento e controle. Método: Trata-se de uma pesquisa quantitativa, quase experimental, aplicada a 30 idosos em pós-operatório num hospital localizado no Rio de Janeiro. Utilizou-se como instrumento de coleta dos dados um protocolo de avaliação das necessidades básicas segundo Virginia Henderson e ao grupo experimento aplicou-se intervenções. Resultados: As principais necessidades identificadas foram dores ao movimentar, diminuição da flexibilidade das articulações, restrição ao leito, déficit de equilíbrio, diminuição da força e da resistência muscular. Das 40 necessidades identificadas no grupo experimento conseguiu-se reduzir 8 e no controle das 35 necessidades identificadas houve redução de 3, obtendo-se Oddis Ratio (0R) de 2,66. Conclusão: Houve melhora significativa no grupo experimento quanto a redução dos problemas identificados quando comparado ao grupo controle.

Objetivo: Identificar en ancianos quirúrgicos la necesidad de moverse y mantener una Buena Postura; evaluar la conclusión de las intervenciones para la necesidad de moverse en los grupos. Método: Investigación cuantitativa, casi-experimental, aplicada a 30 ancianos en pos-operatorio en un hospital de Rio de Janeiro. Como instrumento de recolecta se empleó un protocolo de evaluación de necesidades básicas según Virginia Henderson y se aplicaron las intervenciones al grupo experimento. Resultados: Se identificaron como principales necesidades: dolores al moverse, reducción de flexibilidad articular, restricción al lecho, déficit de equilibrio, reducción de fuerza y resistencia muscular. De las 40 necesidades identificadas en el grupo experimento, se consiguió reducir 8 y en el control, de las 35 se redujo a 3, obtuvo una Oddis Ratio (OR) de 2,66. Conclusión: Se verificó mejoría en el grupo experimento respecto a la reducción de los problemas identificados cuando se comparó al grupo-control.

Mobilidade física prejudicada em idosos institucionalizados / Movilidad física perjudicada en los ancianos institucionalizados / Impaired physical mobility in institutionalized elderly

Objetivos: Caracterizar os idosos institucionalizados e associar a mobilidade física prejudicada com sexo, faixa etária, presença de diabetes mellitus, hipertensão arterial sistêmica, dor e realização de atividade física. Métodos: Estudo transversal, analítico, realizado com 124 idosos institucionalizados. Resultados: A maioria dos idosos apresentou mobilidade física prejudicada, prevalência das faixas etárias de 70? 80 anos e 80 anos ou mais; sexo feminino; prevalência de hipertensão arterial e diabetes mellitus; sequela de acidente vascular encefálico, fraqueza, dor e problemas musculoesqueléticos como principais motivos para mobilidade física prejudicada. Houve significância estatística (p<0,05) entre mobilidade física prejudicada e atividade física. Conclusão: Estes achados apontam para a importância de um trabalho multiprofissional para prevenir e minimizar as consequências da mobilidade física prejudicada entre os idosos institucionalizados

Objectives: To characterize institutionalized elderly and associate impaired physical mobility with gender, age, presence of diabetes mellitus, hypertension, pain and physical activity. Methods: Cross-sectional, analytical study carried out with 124 institutionalized elderly. Results: The majority of the elderly showed impaired physical mobility, prevalence in the age groups of 70 ? 80 years and 80 years or more were female; prevalence of hypertension and diabetes mellitus; CVA sequel, weakness, pain and musculoskeletal problems as the main reasons for impaired physical mobility. There was statistical significance (p<0.05) between impaired physical mobility and physical activity. Conclusion: These findings identify the importance of a multidisciplinary work to prevent and minimize the consequences of impaired physical mobility among institutionalized elderly

Objetivos: Caracterizar los ancianos institucionalizados y asociar la movilidad física perjudicada con el sexo, el grupo de edad, la presencia de diabetes mellitus, hipertensión arterial sistémica, dolor y realización de actividad física. Métodos: Estudio transversal, analítico realizado con 124 ancianos institucionalizados. Resultados: La mayoría de los ancianos presentaron movilidad física perjudicada, predominio de grupos de edad de 70-80 años y 80 años o más; sexo femenino; predominio de hipertensión arterial y diabetes mellitus; secuela accidente cerebrovascular, flaqueza, dolor y problemas musculo esqueléticos como principales motivos para movilidad física perjudicada. Hubo significante estadísticas (p<0,05) entre movilidad física perjudicada y actividad física. Conclusión: Estos hallados apuntan para la importancia de un trabajo multiprofesional para prevenir y minimizar las consecuencias de movilidad física perjudicada entre los ancianos institucionalizados

Educational levels and the functional dependence of ischemic stroke survivors / Nível de escolaridade e dependência funcional em sobreviventes de acidente vascular cerebral isquêmico

We evaluated the functional dependence of stroke survivors from the Study of Stroke Mortality and Morbidity, using the Rankin Scale. Out of 355 ischemic stroke survivors (with a mean age of 67.9 years), 40% had some functional dependence at 28 days and 34.4% had some functional dependence at 6 months. Most predictors of physical dependence were identified at 28 days. These predictors were: low levels of education [illiterate vs. > 8 years of education, multivariate odds ratio (OR) = 3.7; 95% confidence interval (95%CI): 1.60-8.54] and anatomical stroke location (total anterior circulation infarct, OR = 16.9; 95%CI: 2.93-97.49). Low levels of education and ischemic brain injury influenced functional dependence in these stroke survivors. Our findings reinforce the necessity of developing strategies for the rehabilitation of stroke patients, more especially in formulating specific strategies for care and treatment of stroke survivors with low socioeconomic status.

Foi avaliada a dependência funcional em sobreviventes de acidente vascular cerebral (AVC) do Estudo da Mortalidade e Morbidade do Acidente Vascular Cerebral, utilizando a Escala de Rankin. De 355 sobreviventes com AVC isquêmico (idade média de 67,9 anos), 40% tinham dependência funcional em 28 dias e 34,4% em 6 meses. Os principais indicadores de dependência física foram identificados em 28 dias, e eram: baixa escolaridade (analfabetos vs. > 8 anos de educação, RC = 3,7; IC95%: 1,60-8,54) e localização do AVC (infarto circulação total anterior, RC = 16,9; IC95%: 2,93-97,49). Baixo nível educacional e insulto cerebral isquêmico influenciaram o grau de dependência funcional nesses sobreviventes de AVC. Nossos achados reforçam a necessidade de desenvolvimento de estratégias para reabilitação de pacientes com AVC e formulação de estratégias específicas de atenção e tratamento para essas pessoas, especialmente na população com baixo nível socioeconômico.

Resultados de la intervención de enfermería en rehabilitación de personas que participan en una unidad de cuidados en la comunidad del Ayuntamiento de Matosinhos, Portugal / Results of nursing intervention in rehabilitation of persons that participate in care unit in the community of the city of Matosinhos, Portugal

En Portugal, desde 2004 está en curso una nueva reforma de los cuidados de salud primarios con la finalidad de obtener mejoras en salud. Concretamente en sus unidades funcionales de Cuidados en la Comunidad (UCC), donde la mayoría de las situaciones son del ámbito de la enfermería de rehabilitación, en las cuales se pretende prestar cuidados de salud de ámbito domiciliario y comunitario. En este sentido, el presente estudio tiene el objetivo de identificar y discutir los resultados alcanzados, de acuerdo con el grado de dependencia, los objetivos e indicadores de salud definidos. Material y método: Se trata de un estudio descriptivo y longitudinal, con 56 sujetos. Realizando una evaluación funcional del grado de dependencia, del riesgo para las úlceras de presión, la espasticidad y la fuerza muscular a través de las escalas validadas: índice de Barthel, escala de Braden, escala de Ashworth y Medical Research Council respectivamente, en el momento de la admisión y del alta de los cuidados. Resultados: indican que: (i) en el grado de dependencia, los ítemes que tuvieron una evolución más significativa fueron el traslado sillón/cama, ir al wc; (ii) en el riesgo de úlceras de presión fueron la actividad y movilidad; (iii) en términos de la espasticidad y de la fuerza, estaban más afectados los miembros inferiores derechos; (iv) los ítemes más asociados a dependencia fueron los traslados sillón/cama, ir al baño y deambulación y para la escala de Braden fueron los ítemes humedad y fricción. Conclusión: La monitorización de estos datos puede contribuir a mejorar la educación en la salud.

In Portugal, since 2004, is in progress a new reform of primary health care, in order to achieve improvements in health yelped (MCSP, 2009). Specifically theirs functional units in the Community Care (UCC), where most of the situations are in the field of rehabilitation nursing, in which is intended to provide health care to household and community level. In this sense, the present study has the objective to identify and discuss the results achieved, highlighting their gains populations, according to the degree of dependence, health objectives and indicators defi ned. Specifi cally, their functional units in the Community Care (UCC) in which attempts are made to provide health care home environment and community. Material and method: This is a longitudinal study, with 56 subjects. Conducting a functional assessment of the degree of dependence, risk for pressure ulcers, spasticity and muscle strength through validated scales Barthel Index, Braden Scale, Ashworth Scale and the Medical Research Council, respectively, at the time of admission and discharge care. Results: indicate that: (i) in the dependency ratio, the items that had a most significant developments were the self-care transfer chair / bed and go to the toilet, (ii) in the risk pressure ulcers were the activity and mobility, (iii) in terms of spasticity and strength lower right members were more affected than the right, (iv) the items more related to the dependency were the transfer chair/bed and to use the toilet and to the Braden scale was the humidity and friction items. Conclusion: Monitoring of these data can help improve health education.

Avaliação da qualidade de vida em pacientes idosos um ano após o tratamento cirúrgico de fraturas transtrocanterianas do fêmur / Functional outcomes and quality of life one year after surgical management of trochanteric fractures

OBJETIVO: Avaliar o impacto que as fraturas transtrocanterianas produzem sobre a qualidade de vida de pacientes idosos, tratados cirurgicamente, durante o período de um ano de acompanhamento. MATERIAL E MÉTODO: Foram selecionados 73 idosos com fratura transtrocanterina, com idade igual ou superior a 65 anos de ambos os sexos. Foi aplicado questionário padronizado, para se obter informações quanto aos hábitos de vida, atividade física, funcionalidade, deambulação e estado cognitivo. Foram excluídos os óbitos ocorridos durante o estudo, pacientes que não deambulavam, com doenças neurológicas ou fraturas patológicas. RESULTADOS: A média de idade foi 80,17 ± 7,2, sendo 75 por cento do sexo feminino. Ao comparar as somatórias das atividades de vida diária (p=0,04) e instrumentais da vida diária (p=0,004), obtidas na pré e pós-fratura, os pacientes tornaram-se mais dependentes pós-fratura. Atividades de vida diária que apresentaram piora pós-fratura foram: tomar banho (p=0,04), ir ao banheiro (p=0,02) e vestir-se (p=0,04). Todas as atividades instrumentais da vida diária apresentaram diferença significativa, apresentando maior dependência funcional pós-fratura, assim como aumento da necessidade de auxílio a deambulação (p=0,00002), idade avançada (p=0,01) e não realizar atividades domésticas (p=0,01). A baixa pontuação no teste Minimental estava associada com uma maior dependência para realizar as atividades da vida diária na pré-fratura (p=0,00002) e pós-fratura (p=0,01). CONCLUSÃO: Após um ano, as atividades de vida diária que dependiam dos membros inferiores pioraram significativamente, todas as atividades instrumentais de vida diária apresentaram piora significativa em mais de 50 por cento dos pacientes e mais da metade dos pacientes que andavam sem apoio perderam esta capacidade.

OBJECTIVE: Evaluate the impact that trochanteric hip fractures produce on life quality of elderly patients, treated surgically, during one year of monitoring. METHODS: Were selected 73 elderly with transtrochanteric femur fracture, aged equal or over than 65 years and of both sexes. All participants underwent a standardized questionnaire which obtained information on lifestyle habits, functionality, physical activity, ambulation and cognitive state. Were excluded patients who died, not walking, with neurological diseases and pathological fractures. RESULTS: The average age was 80.17 ± 7.2 years and 75 percent was female. When comparing the summation of activities of daily living (p = 0.04) and instrumental daily living (p = 0.004) obtained before and after fracture, the patients become more dependent after fracture. Activities of daily living that worsened after fracture were bathing (p = 0.04), toileting (p = 0.02) and dressing (p = 0.04). All instrumental activities of daily living showed a significant difference, with functional dependence after fracture, increased need for walking aid (p = 0.00002), aged (p = 0.01) and not doing housework (p = 0.01). The low score on the test Minimental was associated with a greater dependence to perform activities of daily living before (p = 0.00002) and after (p = 0.01) fracture. CONCLUSION: After a year, activities of daily living that depended on the lower limbs worsened significantly, all instrumental activities of daily living were significantly worse in more than 50 percent of patients and more than half of patients who walked without support lost this ability.

Gestor de caso del adulto mayor en riesgo de dependencia / Case manager of the elderly at risk of dependency

Chile es hoy en día una sociedad en transición demográfica avanzada. Este proceso es resultado de dos importantes fenómenos, uno el aumento de la expectativa de vida y otro es la baja en las tasas de fecundidad. Este es un proceso que ya se ha producido en los países desarrollados y que hoy día cobra fuerza en los países en desarrollo. De este modo en nuestro país, el grupo etáreo de mayores de 60 años tiene cada vez más peso relativo en el total de la población, alcanzando un 11,4% con 1.717.478 de personas. De este total destaca el grupo de personas mayores de 80 años, los que alcanzan el 14.7% con 250.840 personas. La esperanza de vida al nacer en Chile es hoy día de 77,36 años (74,42 años para los hombres y 80,41 años para las mujeres.

Manual de prevención de caídas en el adulto mayor / Manual of preventing falls in older adults

La caída es un síndrome común entre personas mayores y no es constitutiva de la edad, sino que es un síntoma de que "algo anda mal". Es decir constituye una señal de alerta, que nos está avisando por un lado que debemos inquirir más en los exámenes y por otro lado, debemos prevenir que las caídas sigan ocurriendo. Las caídas, con su cascada de efectos, pueden rápidamente llevar a un adulto mayor a la dependencia y a la postración. Y es esa dependencia y postración la que tenemos que evitar, dentro de lo posible. Al llevar adelante estos talleres de prevención de caídas estaremos actuando anticipatoriamente en la dependencia y postración.

Caracterización de la movilidad de ancianos, según índice de katz, en el Centro de Bienestar del Anciano San José de Pereira. 2007 / Characterization of the mobility in the elder people, according to the katz index, at the Centro de Bienestar de Ancianos San José, Pereira 2007

Introducción: la gran mayoría de los adultos mayores presenta algún grado de limitación en su movilidad y sufre por esto las dificultades de adaptación para desplazarse;(7) este deterioro genera vulnerabilidad, que da como resultado la definición de personas frágiles con pronóstico reservado en algunos casos, los cuales incluyen discapacidad, dependencia, caídas, internación y mortalidad, en los adultos mayores.Métodos:se realizó una caracterización del grado de movilidad de los adultos mayores de acuerdo a la escala de Katz, en el Centro de Bienestar del Anciano San José de Pereira, durante el primer semestre de 2007.Resultados:se estudiaron todos (100 por ciento) los adultos mayores de 59 años residentes en el Centro. El 47.8 por ciento de los evaluados son autónomos, sin embargo, son sanos únicamente el 8 por ciento de los ancianos autónomos.Conclusión:los niveles de autonomía de los ancianos no son sinónimo de calidad de vida, por el contrario, éstos requieren de equipos multidisciplinarios liderados por enfermeras, quienes a través de su quehacer son garantía de calidad y bienestar, evitando los accidentes en el ejercicio de sus actividades diarias, y beneficiándolos con soportes nutricionales, terapéuticos y preventivos, que estos equipos están en capacidad de desarrollar...

Resección tumoral ósea en bloque y sustitución del defecto óseo creado en pacientes del hospital Teodoro Maldonado Carbo: análisis 1993 – 2003 / Osseous tumoral block resection and substitution of osseous defect created in patients at Teodoro Maldonado Carbo hospital: analysis 1993-2003

Tipo de estudio: retrospectivo, descriptivo y observacional. Objetivo general: determinar si la técnica de resección tumoral ósea en bloque es una buena alternativa como parte del tratamiento multidisciplinario para la cirugía de salvataje de miembros. Objetivos específicos: conocer cuáles son los tipos más frecuentes de tumores óseos sometidos a resección tumoral en bloque según clasificación histológica de la OMS. Establecer la relación entre el tipo histológico del tumor según clasificación de la OMS con el sexo de los pacientes. Determinar de acuerdo a la clasificación de Enneking en que estadiaje es más frecuente la resección en bloque. Precisar la viabilidad y funcionalidad de los miembros post-resección en bloque, con o sin el uso de agentes sustitutos del defecto óseo. Resultados: de los 37 pacientes sometidos a resección en bloque, 23 eran hombres y 14 mujeres. Según la clasificación de la OMS, los tumores malignos predominaron en la muestra con 20 casos (54), el TCG u osteoclastoma fue el tipo de tumor más encontrado con un 43,2 (16 casos). Según la estadificación de Enneking los tumores en estadío IIB fueron los de mayor incidencia con 7 casos (18,9), las endoprótesis no convencionales predominaron con 15 casos. Para el análisis de los 28 pacientes que pasaron a la segunda fase de estudio, fue necesaria la evaluación de los pacientes por medio de la escala de funcionalidad para miembros inferiores de la clínica Mayo, encontrándose los siguientes resultados: de los 28 pacientes 2 (7), presentaban dolor moderado; 13(46), podían caminar más de 10 cuadras; 20, no necesitaban ningún medio de apoyo para movilizarse; 21 (75), podían movilizarse en un vehículo fácilmente; 24(86), no presentaban ninguna dificultad en el cuidado de sus pies, ninguno presentaba claudicación en la marcha, 15 pacientes podían subir escaleras normalmente. De la suma de 80 puntos, la media de los resultados en esta investigación fue de 72,5 puntos y se reportaron.

Study type: retrospective, descriptive, and observational. General objective: to determine if the technique of osseous tumoral block resection is a good alternative as part of the multidisciplinary treatment for the member salvation surgery. Specific objectives: to get to know which are the most frequent types of osseous tumours subjected to osseous tumoral block resection according to the histological classification of the WHO. To establish the relationship between the histological types of tumour according to the WHO’s classification against the patient’s sex. To determine, according to Enneking stratification, in which stage the block resection is most frequent. To define the viability and functionality of the members after the block resection with or without the use of substitutes for the osseous defect. Results: out of the 37 patients subjected to block resection, 23 were men and 14 women. According to WHO’s classification, malignant tumours were predominant in the sample with 20 cases (54), “GCM” or osteoclastoma was the most found type of tumour with a 43.2 (16 cases). According to Enneking stratification the tumours in stage IIB were majority with 7 cases (18.9), unconventional endoprosthesis predominated with 15 cases. For the analysis of the 28 patients who passed to the second phase of the study, the patients’ evaluation at the Mayo Clinic was necessary through functionality scale for the lower limbs, the following results were found: out of the 28 patients 2 (7) presented moderate pain; 13 (46), were able to walk more than 10 blocks; 20, didn’t need any support to move; 21 (75), were able to move easily in a vehicle ; 24 (86), didn’t present any difficulty in the care of their feet, none presented claudication, 15 patients were able to climb stairs normally. In the addition of 80 points, the ratio of the results in this research.

Treatment of Senile Osteoporotic Intertrochanteric Fracture using Proximal Femoral Nail

PURPOSE: Clinical and radiologic results of femur intertrochanteric fractures treated with ITST nail in elderly patients with osteoporosis were analysized to evaluate the efficacy and complication of ITST nailing. MATERIALS AND METHODS: 32 patients who were treated with ITST nail due to femur intertrochanteric fracture and were followed up for more than 1 year were analysed. According to Evans classification, 11 cases were stable fractures and 21 cases were unstable fractures. Clinically, ambulatory function was compared and radiologically, BMD of healthy leg was checked with analysis of postoperative bone union and complication. RESULTS: In ambulatory function comparison before and after the operation, there were 9 cases of good, 17 cases of moderate and 6 cases of poor. Considering social activity after the operation, 7 cases showed normal ambulation, 9 cases showed ambulatory with one cane, 5 cases showed two cane ambulation and 11 cases showed dependent ambulation. In radiologic evaluation, T-score of ward triangle in healthy femoral neck showed BMD of -3.12. In 20 cases, bone union was observed within 3 months. The patients with low BMD result had poor outcome. There were 2 cases of intraoperative proximal femur fracture, 3 cases of nonunion and 4 cases of death within 1 year. CONCLUSION: In elderly patients with intertrochanteric fracture, ITST nailing is relatively efficient treatment. However, in pateint with severe osteoporosis (T-score<-3.0) and unstable fracture pattern, arthroplasty should be considered due to relatively high complicaton rate.