Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios

DUR, Hakan; ATAOĞLU, M. Baybars; Esen, Erdinç; AYANOĞLU, Tacettin; Turanlı, Sacit

Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios

Erdinç ESEN, (Gazi Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Ankara, Türkiye)

Hakan DUR, (Gazi Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Ankara, Türkiye)

M. Baybars ATAOĞLU, (Gazi Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Ankara, Türkiye)

Tacettin AYANOĞLU, (Gazi Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Ankara, Türkiye)

Sacit TURANLI (Gazi Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Ankara, Türkiye)

Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.)

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Yıl: 2017 Cilt: 28 Sayı: 1 Sayfa Aralığı: 35 - 40 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios

Öz:

Amaç: Bu çalışmada proksimal femoral çivi-antirotasyon (PFNA) veya çimentolu, kalkar destekli, bipolar hemiartroplasti uygulanan intertrokanterik femur kırıklı hastaların mortalite ve morbidite oranları değerlendirildi.Hastalar ve yöntemler: Proksimal femur kırığı nedeniyle Ocak 2008 Ocak 2011 tarihleri arasında tedavi gören 127 hasta (42 erkek, 85 kadın; ort. yaş 79.2 yıl; dağılım 55-98 yıl) ameliyat sırasında mortalite, toplam mortalite ve mortalite oranlarının aylara göre dağılımı açısından retrospektif olarak karşılaştırıldı. Bu 127 hastadan yaşayan, en az 12 aylık takibe ulaşan, ameliyat öncesi dönemde yürüyebilen ve günlük aktivitelerini yerine getirebilen 92 hasta (28 erkek, 64 kadın; ort. yaş 80.24 yıl; dağılım 55-94 yıl) çalışmaya dahil edildi. Hastalar PFNA grubu (n=34) ve çimentolu, kalkar destekli, bipolar hemiartroplasti grubu (hemiartroplasti grubu; n=58) olmak üzere iki gruba ayrıldı. Her iki grup ameliyat süresi, ameliyat sırasında kan transfüzyonu ihtiyacı, hastanede yatış süresi, fonksiyonel sonuçlar, yaşam kalitesi, komplikasyon ve revizyon oranları ve ameliyat maliyetleri açısından karşılaştırıldı.Bulgular: Her iki gruptaki hastalarda aynı kırık tipi vardı. İki grubun kemik mineral yoğunluğu sonuçları, anestezi tipi ve riski benzerdi. İki grup arasında ameliyat sırasında mortalite, toplam mortalite ve mortalite oranlarının aylara göre dağılımı açısından anlamlı farklılık saptanmadı (p>0.05). Ortalama ameliyat süresi PFNA ve hemiartroplasti gruplarında sırasıyla 54.84 dakika (dağılım 40-110 dakika) ve 74.66 dakika (dağılım 55-120 dakika) idi. Ortalama hastanede yatış süresi PFNA ve hemiartroplasti gruplarında sırasıyla 5.91 gün (dağılım 5-12 gün) ve 9.41 gün (dağılım 6-16 gün) idi. Proksimal femoral çivi-antirotasyon grubunda ameliyat süresi ve hastanede yatış süresi daha kısa; fonksiyonel sonuçlar daha iyi idi (p<0.05). Kan transfüzyonu ihtiyacı PFNA grubunda daha az idi.Sonuç: İntertrokanterik femur kırıklarının tedavisinde hem PFNA hem çimentolu, kalkar destekli, bipolar hemiartroplasti iyi tekniklerdir. Yaşlı hastalarda ameliyat süresinin daha kısa ve tekrar ameliyat riskinin düşük olması nedeniyle internal tespit daha uygun olabilir

Anahtar Kelime:

Konular: Ortopedi

Intertrokanterik femur kırıklarının tedavisinde proksimal femoral çivi-antirotasyonun veçimentolu kalkar destekli bipolar hemiartroplastinin mortalite ve morbidite oranları açısından değerlendirilmesi

Öz:

Objectives: This study aims to assess the mortality and morbidity rates of patients with intertrochanteric femoral fractures who were performed proximal femoral nail-antirotation (PFNA) or cemented, bipolar hemiarthroplasty with calcar replacement.Patients and methods: A (42 males, 85 females; mean age 79.2 years; range 55 to 98 years) who were treated due to proximal femoral fracture between January 2008 and January 2011 were compared retrospectively in terms of intraoperative mortality, total mortality, and monthly distribution of mortality rates. Of these 127 patients, 92 (28 males, 64 females; mean age 80.24 years; range 55 to 94 years) who were alive, who achieved at least a 12-month follow-up, and could walk and fulfil daily activities in preoperative period were included in the study. Patients were divided into two groups as PFNA group (n=34) and cemented, bipolar hemiarthroplasty with calcar replacement group (hemiarthroplasty group; n=58). Both groups were compared in terms of duration of operation, requirement for intraoperative blood transfusion, duration of hospital stay, functional outcomes, quality of life, complication and revision rates, and costs of operation.Results: Patients in both groups had the same type of fracture. Bone mineral densitometry results and the type and risk of anesthesia of both groups were similar. No significant difference was detected between two groups in terms of intraoperative mortality, total mortality, and monthly distribution of mortality rates (p>0.05). Mean durations of operation were 54.85 minutes (range 40-110 minutes) and 74.66 minutes (range 55-120 minutes) in the PFNA and hemiarthroplasty groups, respectively. Mean durations of hospital stay were 5.91 days (range 5-12 days) and 9.41 days (range 6-16 days) in the PFNA and hemiarthroplasty groups, respectively. In the PFNA group, durations of operation and hospital stay were shorter and functional results were superior (p<0.05). Requirement for blood transfusion was lower in the PFNA group.Conclusion: Both PFNA and cemented, bipolar hemiarthroplasty with calcar replacement are good techniques in treatment of intertrochanteric femoral fractures. Internal fixation may be more appropriate for elderly patients due to shorter duration of operation and lower risk of reoperation

Anahtar Kelime:

Konular: Ortopedi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

Atik OŞ. Has the awareness of orthopedic surgeons on osteoporosis been increased in the past decade? Eklem Hastalik Cerrahisi 2015;26:63.
Atik OŞ, Can FI, Şenol MS, Eren TK. Less invasive surgery using external fixator for the treatment of subtrochanteric femur fracture in a high-risk geriatric patient. Eklem Hastalik Cerrahisi 2016;27:100-2.
Anglen JO, Weinstein JN. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg [Am] 2008;90:700-7.
Görmeli G, Korkmaz MF, Görmeli CA, Adanaş C, Karataş T, Şimşek SA. Comparison of femur intertrochanteric fracture fixation with hemiarthroplasty and proximal femoral nail systems. Ulus Travma Acil Cerrahi Derg 2015;21:503-8.
Chan KC, Gill GS. Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures. Clin Orthop Relat Res 2000;371:206-15.
PFNA: Leading the way to optimal stability: Synthes. Original instruments andimplants of the Association for the Study of Internal Fixation. AO/ASIF. Technique guide. Stratec Medica 2004;1-44.
Garg B, Marimuthu K, Kumar V, Malhotra R, Kotwal PP. Outcome of short proximal femoral nail antirotation and dynamic hip screw for fixation of unstable trochanteric fractures. A randomised prospective comparative trial. Hip Int 2011;21:531-6.
Sancheti Kh, Sancheti P, Shyam A, Patil S, Dhariwal Q, Joshi R. Primary hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in the elderly: A retrospective case series. Indian J Orthop 2010;44:428-34.
Haentjens P, Casteleyn PP, De Boeck H, Handelberg F, Opdecam P. Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Primary bipolar arthroplasty compared with internal fixation. J Bone Joint Surg [Am] 1989;71:1214-25.
Tang P, Hu F, Shen J, Zhang L, Zhang L. Proximal femoral nail antirotation versus hemiarthroplasty: a study for the treatment of intertrochanteric fractures. Injury 2012;43:876-81.
Kayali C, Agus H, Ozluk S, Sanli C. Treatment for unstable intertrochanteric fractures in elderly patients: internal fixation versus cone hemiarthroplasty. J Orthop Surg (Hong Kong) 2006;14:240-4.
Sahin S, Ertürer E, Oztürk I, Toker S, Seçkin F, Akman S. Radiographic and functional results of osteosynthesis using the proximal femoral nail antirotation (PFNA) in the treatment of unstable intertrochanteric femoral fractures. Acta Orthop Traumatol Turc 2010;44:127-34.
Tang X, Liu L, Yang TF, Tu CQ, Wang GL, Fang Y, et al. Preliminary effect of proximal femoral nail antirotation on emergency treatment of senile patients with intertrochanteric fracture. Chin J Traumatol 2010;13:212-6.
Rodop O, Kiral A, Kaplan H, Akmaz I. Primary bipolar hemiprosthesis for unstable intertrochanteric fractures. Int Orthop 2002;26:233-7.
Parker MJ, Handoll HH. Replacement arthroplasty versus internal fixation for extracapsular hip fractures in adults. Cochrane Database Syst Rev 2006;2:000086.
Zielinski SM, Bouwmans CA, Heetveld MJ, Bhandari M, Patka P, Van Lieshout EM. The societal costs of femoral neck fracture patients treated with internal fixation.Osteoporos Int 2014;25:875-85.
Frihagen F, Waaler GM, Madsen JE, Nordsletten L, Aspaas S, Aas E. The cost of hemiarthroplasty compared to that of internal fixation for femoral neck fractures. 2-year results involving 222 patients based on a randomized controlled trial. Acta Orthop 2010;81:446-52.
Johansson T, Jacobsson SA, Ivarsson I, Knutsson A, Wahlström O. Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures: a prospective randomized study of 100 hips. Acta Orthop Scand 2000;71:597-602.
Rogmark C, Carlsson A, Johnell O, Sernbo I. A prospective randomised trial of internal fixation versus arthroplasty for displaced fractures of the neck of the femur. Functional outcome for 450 patients at two years. J Bone Joint Surg [Br] 2002;84:183-8.
Kapicioglu M, Ersen A, Saglam Y, Akgul T, Kizilkurt T, Yazicioglu O. Hip fractures in extremely old patients. J Orthop 2014;11:136-41.

APA	Esen E, DUR H, ATAOĞLU M, AYANOĞLU T, Turanlı S (2017). Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios. , 35 - 40.
Chicago	Esen Erdinç,DUR Hakan,ATAOĞLU M. Baybars,AYANOĞLU Tacettin,Turanlı Sacit Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios. (2017): 35 - 40.
MLA	Esen Erdinç,DUR Hakan,ATAOĞLU M. Baybars,AYANOĞLU Tacettin,Turanlı Sacit Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios. , 2017, ss.35 - 40.
AMA	Esen E,DUR H,ATAOĞLU M,AYANOĞLU T,Turanlı S Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios. . 2017; 35 - 40.
Vancouver	Esen E,DUR H,ATAOĞLU M,AYANOĞLU T,Turanlı S Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios. . 2017; 35 - 40.
IEEE	Esen E,DUR H,ATAOĞLU M,AYANOĞLU T,Turanlı S "Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios." , ss.35 - 40, 2017.
ISNAD	Esen, Erdinç vd. "Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios". (2017), 35-40.

APA	Esen E, DUR H, ATAOĞLU M, AYANOĞLU T, Turanlı S (2017). Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.), 28(1), 35 - 40.
Chicago	Esen Erdinç,DUR Hakan,ATAOĞLU M. Baybars,AYANOĞLU Tacettin,Turanlı Sacit Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.) 28, no.1 (2017): 35 - 40.
MLA	Esen Erdinç,DUR Hakan,ATAOĞLU M. Baybars,AYANOĞLU Tacettin,Turanlı Sacit Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.), vol.28, no.1, 2017, ss.35 - 40.
AMA	Esen E,DUR H,ATAOĞLU M,AYANOĞLU T,Turanlı S Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.). 2017; 28(1): 35 - 40.
Vancouver	Esen E,DUR H,ATAOĞLU M,AYANOĞLU T,Turanlı S Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.). 2017; 28(1): 35 - 40.
IEEE	Esen E,DUR H,ATAOĞLU M,AYANOĞLU T,Turanlı S "Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios." Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.), 28, ss.35 - 40, 2017.
ISNAD	Esen, Erdinç vd. "Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios". Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.) 28/1 (2017), 35-40.