Efficacy Of Artificial Hip Replacement In The Treatment Of Elderly Femoral Intertrochanteric Fractures

ObjectiveTo investigate the operative procedures and clinical outcomes of the femoral greater and lesser trochanter reconstruction with prosthetic replacement for unstable intertrochanteric fractures in elderly patients.MethodsFrom September 2015 to October 2017,74 elderly patients with unstable femoral intertrochanteric fractures were treated by the reduction and fixation of fractures of the femoral greater trochanter with Kirschner wire tension band,the femoral lesser trochanter with circle wire and femoral stem prosthetic replacement,whose data were retrospectively analyzed.Among them,there were 29 males and 45 females,whose average age was 84.4 years old(range:73-104 years).According to the Evans-Jenson classification,there were 34 cases of type Ⅲ,15 cases of type Ⅱb,22 cases of type Ⅱa and 13 cases of type Ⅰb.Allsurgeries were performed through posterolateral approach.With the smooth running of stem prostheses of taper 2°,compression,reduction and fixation could be carried out for patients with intertrochanteric fractures.Anatomical reduction and fixation were carried out for patients with comminuted fractures of the greater trochanter using Kirschner wire tension band and the lesser trochanter using circle wire.Regular follow-up in theoutpatient clinic was performed at 1,3,6,and 12 months postoperatively.The bone healing condition between the prostheses and the bone interface was observed based on the X-ray films,and the hip function was evaluated according to the Harris hip score.ResultsThe patients were followed up for anaverage period of 28.5 months(range;8-38 months).The biotype press-fit and initial stability of the The cortex of the femur and hip stem were immediately achieved postoperatively in 70 patients.The X-ray films showed bone healing in71 patients with fractures of the greater trochanter at 3 months postoperatively.The mean Harris hip score was(93.1±3.3)points at 1year postoperatively.70 patients felt satisfied.ConclusionsKirschner wire tension band and circle wire is used in the anatomical reduction and fixation of fractures of the greater and lesser trochanter,combined with femoral stem prosthetic replacement,which is a good way to treat elderly patients with unstable femoral intertrochanteric fractures,with excellent fracture fixation and implant stability.ObjectiveTo provide an evidence for management of femoral intertrochanteric fractures by performing a systematic review(meta-analysis)on hip arthroplasty versus internal fixation.MethodsThe relative data bases such as Medline,Pub Med,Cochrane,CNKI,Wanfang Date were searched systematically,researchers selected randomized controlled trials(RCT)and prospective clinical controlled trials(CCT)on hip arthroplasty versus internal fixation for intertrochanteric fractures.some relevant orthopaedic journals were also searched.evaluated using Jadad score and then analyzed using Rev Man5.3.ResultsIn total,10 RCTs and 5 CCTs were included.1358 patients involred,among which 599 patients received hip arthroplasty whicle 759 patients received internal fixation surgery.In some outcome indicators,internal fixation group should be divided into intramedullary fixation and extramedullary fixation in order to discuss separately.Meta-analysisdemonstrated that compared with internal fixation,hip arthroplasty had the advantages of length of hospital stay(P<0.0001),incidences of complications [RR=0.46,95%CI(0.34,0.61),Z=5.27,P< 0.00001].But the two groups showed no significant differences on the operative time and postoperative Harris hip score(P>0.05).arthroplasty has more intraoperative bleeding volume than intramedullary fixation [MD=234.88,95%CI(127.73,342.04),Z=4.30,P<0.001]and has less postoperative bed time than extramedullary fixation[MD=-33.73,95%CI(-53.37,-14.09),Z=3.37,P= 0.0008],while in the intraoperative bleeding volume is the same as extramedullary fixation and in the postoperative bed is the same as intramedullary fixation(P>0.05).ConclusionThere are insufficient evidences to determine whch has more advantages between arthroplasty and internal fixation for unstable intertrochanteric fractures in the elderly.The surgical method of intertrochanteric fractures in the elderly should be worked out individually.In order to provide a definite evidence for the management of unstable intertrochanteric fractures in the elderly,more randomized controlled trials of larger sample sizes are needed.