Efficacy Comparison Of Great Trochanter Femur Prosthesis Hip Arthroplasty And Dynamic Hip Screw For Treating Unstable Intertrochanteric Fractures In The Elderly

Objective:To compare the results between great trochanter femur (GTF) prosthesis hip arthroplasty and dynamic hip screw (DHS) in the treatment of elderly patient with unstable intertrochanteric fractures.Methods:From January2008to January2013, datum of57cases of elderly patients with unstable intertrochanteric fractures were collected with prosthesis hip arthroplasty (GTF group, n=13) and DHS (DHS group, n=44). The patients’ mean age was77.1years (range,60-92),21males and36females with fresh fractures. By Evans’ Classification, there were38cases of type Ⅲ and19cases of type Ⅳ fractures. There was no significant difference in general data among2groups (P>0.05). The operative time, blood loss, bed rest period, Hospital stay, time to full weight-bearing, Harris hip scores and complications were analyzed.Results:In GTF group, one case of impaired wound healing, one case of lung infection, one case of urinary tract infection. According to Harris hip scores at6months,10cases were rated as excellent,2good and1fair. In DHS group,1case of impaired wound healing,3cases of impaired fracture healing,4cases of bedsores on Buttocks,3cases of lung infections,3cases of urinary tract infections, and1case of femoral shaft fracture occurred. According to Harris hip scores at6months,30cases were rated as excellent,10good and4fair. With appropriate rehabilitation and healthcare, the hip function returned to previous levels.There were high statistically significant differences in bed rest period (P<0.01) and time to full weight-bearing (P<0.01) between two groups, and the GTF group was shorter than DHS group. The Harris hip scores (at one month, three months, six months) of the GTF group were higher than the DHS group, the difference was high statistically significant (P<0.01). The complication rate of the GTF group was lower than the DHS group, showing statistically significant difference (P<0.05). There is no significant difference in operative time (P>0.05) and blood loss (P>0.05) between two groups.Conclusion:1. GTF, with fewer complications and faster functional recovery, allowing shorter bed rest period and full weight-bearing time, has advantage over DHS in the treatment of elderly patient with unstable intertrochanteric fractures.2. For fresh fractures, without hip dysfunction, acetabular dysplasia, and congenital dislocation of the hip, is advisable; but if there is acetabular lesions mentioned above, total hip arthroplasty is recommended.