Prosthetic arthroplasties with bone cement for the senile with unstable intertrochanteric fractures of the femurs in 27 cases / 中国组织工程研究

ABSTRACT

BACKGROUND: Traditional treatment of intertrochanteric fractures includes dynamic hip screw (DHS), dynamic condylar screw (DCS), proximal femoral nail (PFN) and locking compress plate (LCP), most of them have positive results. However, these techniques are not utility for all patients with intertrochanteric fractures, especially for the senile patients whose ages are over 75 years. The intertrochanteric fractures are usually unstable, and most of them have medical complications, thus all these lead to a high failure rate of internal fixation. OBJECTIVE: To identify the methods and the therapeutic effects of hemiarthroplasty or arthreplasty with bone cement for unstable intertrochanteric fractures in senile patients. METHODS: There were 27 senile patients with unstable intertrochanteric fractures, including 11 males and 16 females, with the mean age of 84.6 years. All patients were adopted improved Gibson approach, and greater trochanter should be reduced anatomically as an important sign for measuring the lengths of the lower extremities and fixing of prostheses. Long-stem cementless calcar-raplacements were used in all patients, 2 arthroplasty owing to preexisting osteoarthritis and 25 hemiarthroplasty. RESULTS AND CONCLUSION: Nobody was dead during perioperative period. Weight bearing was permitted as soon as acute pain subsides (7-16 days after operation); 27 patients were followed up for 6 to 48 months, for 20 months on average. No prosthetic looseness and sinking happened, and the calluses were well mineralized. The Harris score was used to evaluate the therapeutic effect at 6 months after operation, which was 78 to 94, of 85.4 points on average, and the rate of fineness was 78%. One posterior hip dislocation and two deep venous thrombosis (DVT) of lower extremities occurred owing to improper caring. The results showed that the prosthetic replacement with bone cement is a reasonable preference for unstable intertrochanteric fractures in senile patients because of many virtues, such as earlier period weight bearing out of bed, low incidence of complications, and satisfaction of functional recovery of extremities.