Treatment of comminuted intertrochanteric fractures with uncemented long-stem hemiarthroplasty in elderly patients / 中华创伤骨科杂志

ABSTRACT

Objective To study the clinical effects of uncemented long-stem hemiarthroplasty for the treatment of comminuted intertrochanteric fractures in elderly patients.Methods Included in this retrospective study were 36 senile patients with comminuted intertrochanteric fracture who had been treated from September 2012 to July 2014.They were 16 males and 20 females with an average age of 86.4 years (from 80 to 94 years).All the fractures were single-sided.According to the Evans-Jensen classification,15 cases were type Ⅲ,12 type Ⅳ and 9 type Ⅴ.According to the Singh index,their osteoporosis was classified as grade Ⅳ in 13 cases,as grade Ⅲ in 14 and as grade Ⅱ in 9.The Harginge approach was used in all the patients and hemiarthroplasty was performed using the uncemented long-stem Wagner SL prosthesis.Results For this cohort,the operation time ranged from 35 to 55 min (average,43.5 min),and the intraoperative blood loss from 200 to 320 mL (average,240 mL).All the incisions healed by the first intention.Postoperatively,respiratory system infection occurred in one case but was cured after symptomatic treatment.One patient died 3 months after operation.The follow-up time for the rest 35 patients ranged from 14 to 20 months (average,16 months).The average Harris score was improved from preoperative 28.3 points to 84.3 points at the final follow-up;the Harris scoring resulted in 24 excellent cases,8 good ones and 3 fair ones (with an excellent and good rate of 88.9％).There were no such complications during the follow-up as joint dislocation,prosthesis loosening or subsidence,or articular infection.Conclusion Hemiarthroplasty using the uncemented long-stem Wagner SL prosthesis is a fine treatment for elderly patients with comminuted intertrochanteric fracture,owing to the advantages of quick recovery,improved quality of life,reduced complications following prolonged bed rest and satisfactory short-term outcomes.