Early outcome of proximal femoral nail antirotation and bipolar hemiarthroplasty in treatment of intertrochanteric fractures in elderly patients aged 90 years or more / 中华创伤杂志

ABSTRACT

Objective:To compare the early outcome of proximal femoral nail antirotation (PFNA) and bipolar hemiarthroplasty in treatment of intertrochanteric fractures in elderly patients aged 90 years or more.Methods:A retrospective case-control study was conducted to analyze the clinical data of 43 elderly patients aged 90 years or more with intertrochanteric fractures admitted to Henan Provincial People's Hospital from January 2017 to June 2018. There were 12 males and 31 females, aged 90-102 years [(92.3±2.5)years]. A total of 31 patients were treated by PFNA (PFNA group) and 12 patients by bipolar hemiarthroplasty (hemiarthroplasty group). Comparisons were made between the two groups in terms of operation time, intraoperative blood loss, time of weight bearing after operation, rate of blood transfusion, incidence of complications 2 weeks and 3 months after operation, Harris score 12 months after operation and mortality 12 months after operation.Results:All patients were followed up for 1-30 months [(19.1±9.8)months] in PFNA group and for 0.5-29 months [(18.6±10.6)months] in hemiarthroplasty group. Operative time was (95.8±31.0)minutes in PFNA group, shorter than (128.8±40.5)minutes in hemiarthroplasty group ( P<0.05). Intraoperative blood loss was (71.3±25.7)ml in PFNA group and (212.5±113.1)ml in hemiarthroplasty group ( P<0.05). Time of weight bearing after operation was (43.9±31.9)days in PFNA group, longer than (5.9±2.8)days in hemiarthroplasty group ( P<0.05). The perioperative blood transfusion rate in PFNA group (29%) was less than hemiarthroplasty group (75%) ( P<0.05). Incidence of complications 2 weeks after operation was similar between PFNA group (23%) and hemiarthroplasty group (42%) ( P>0.05). Incidence of complications 3 months after operation in PFNA group was 26%, similar with 42% in hemiarthroplasty group ( P>0.05). Harris score 12 months after operation in PFNA group was (56.3±32.3)points, comparable to (59.3±36.7)points in hemiarthroplasty group ( P>0.05). Mortality rate 12 months after operation was 19% in PFNA group and 25% in hemiarthroplasty group ( P>0.05). Conclusion:For intertrochanteric fractures in elderly patients aged 90 years or more, PFNA and bipolar hemiarthroplasty are both effective treatments, but PFNA may be a better choice with shorter operation time and less intraoperative blood loss.