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Primary hemiarthroplasty for treatment of unstable pertrochanteric femoral fractures (AO/OTA Type 31 A2.3) in elderly osteoporotic patients

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: The aim of this study was to prospectively analyze the role of primary hemiarthroplasty in unstable osteoporotic pertrochanteric fractures (AO/OTA Type 31 A2.3), with emphasis given to postoperative Functional Independent Measure (FIM) and Harris Hip Score (HHS).

Methods: Fifty-six consecutive patients (average age 78.25 ± 5.45), out of which 24 males (79.29 ± 4.99) and 32 females (77.47 ± 5.72), with unstable pertrochanteric femoral fractures, operated with primary hemiarthroplasty procedure from 2012 to 2014 were included in this prospective study with a follow-up of two years. Primary outcomes were FIM and HHS. Secondary outcomes included duration of surgery, estimated intraoperative blood loss, time to first postoperative full weight-bearing, time to walking ability with and without crutches, average hospital stay, postoperative complications, and mortality.

Results: The FIM score at 3 months was 85.9 ± 5.7. HHS at two years was excellent for 41 patients (73, 2%), good for eight (14.3%), fair for four (7.1%), and poor for three (5.4%). The mean duration of surgery was 62.6 min, estimated intraoperative blood loss 175.5 mL, time to first postoperative full weight-bearing 2.2 ± 0.4 days, ability to walk with crutches 6.3 ± 1.8 days and without crutches 44.2 ± 12.7 days, and the average hospital stay was 9.6 ± 2.7 days.

Conclusion: This study highlighted good clinical postoperative outcome scores for primary hemiarthroplasty for the treatment of unstable pertrochanteric femoral fractures in elderly osteoporotic patients. This procedure seems to be secure and effective, and offers a good quality of life in terms of FIM and HHS.

No MeSH data available.


Post operation X-ray.
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Figure 4: Post operation X-ray.

Mentions: Definitive greater trochanter fixation was done by tension band wires inserted in holes drilled in the proximal and distal fragments. The lesser trochanter was also reduced and fixed using tension band wiring (Figure 2). After fragment fixation, cemented femoral stems were used in all the cases because of poor bone quality. Low viscosity cement was used due to better penetration through drilled holes. For patients under 85 years old bipolar hemi-prostheses were used, and for patients over 85 years old Austin-Moore hemi-prostheses were used. The range of motion and stability were checked again. The capsule was repaired, the short external rotators reattached, and the wound closed over a suction drain. Preoperative (Figure 3) and postoperative (Figure 4) radiographs were obtained. In order to prevent the deep venous thrombosis (DVT), we used fractionized heparin and bilateral elastic stockings. Patients were allowed full weight-bearing ambulation on the first postoperative day.


Primary hemiarthroplasty for treatment of unstable pertrochanteric femoral fractures (AO/OTA Type 31 A2.3) in elderly osteoporotic patients
Post operation X-ray.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5384320&req=5

Figure 4: Post operation X-ray.
Mentions: Definitive greater trochanter fixation was done by tension band wires inserted in holes drilled in the proximal and distal fragments. The lesser trochanter was also reduced and fixed using tension band wiring (Figure 2). After fragment fixation, cemented femoral stems were used in all the cases because of poor bone quality. Low viscosity cement was used due to better penetration through drilled holes. For patients under 85 years old bipolar hemi-prostheses were used, and for patients over 85 years old Austin-Moore hemi-prostheses were used. The range of motion and stability were checked again. The capsule was repaired, the short external rotators reattached, and the wound closed over a suction drain. Preoperative (Figure 3) and postoperative (Figure 4) radiographs were obtained. In order to prevent the deep venous thrombosis (DVT), we used fractionized heparin and bilateral elastic stockings. Patients were allowed full weight-bearing ambulation on the first postoperative day.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: The aim of this study was to prospectively analyze the role of primary hemiarthroplasty in unstable osteoporotic pertrochanteric fractures (AO/OTA Type 31 A2.3), with emphasis given to postoperative Functional Independent Measure (FIM) and Harris Hip Score (HHS).

Methods: Fifty-six consecutive patients (average age 78.25 ± 5.45), out of which 24 males (79.29 ± 4.99) and 32 females (77.47 ± 5.72), with unstable pertrochanteric femoral fractures, operated with primary hemiarthroplasty procedure from 2012 to 2014 were included in this prospective study with a follow-up of two years. Primary outcomes were FIM and HHS. Secondary outcomes included duration of surgery, estimated intraoperative blood loss, time to first postoperative full weight-bearing, time to walking ability with and without crutches, average hospital stay, postoperative complications, and mortality.

Results: The FIM score at 3 months was 85.9 ± 5.7. HHS at two years was excellent for 41 patients (73, 2%), good for eight (14.3%), fair for four (7.1%), and poor for three (5.4%). The mean duration of surgery was 62.6 min, estimated intraoperative blood loss 175.5 mL, time to first postoperative full weight-bearing 2.2 ± 0.4 days, ability to walk with crutches 6.3 ± 1.8 days and without crutches 44.2 ± 12.7 days, and the average hospital stay was 9.6 ± 2.7 days.

Conclusion: This study highlighted good clinical postoperative outcome scores for primary hemiarthroplasty for the treatment of unstable pertrochanteric femoral fractures in elderly osteoporotic patients. This procedure seems to be secure and effective, and offers a good quality of life in terms of FIM and HHS.

No MeSH data available.