A Comparative Study Of Different Surgical Methods To The Treatment Of Intertrochanteric Fracture With Lateral Wall Instability In The Elderly

Objective To investigate the effects of Proximal femoral nail Anti-rotation(PFNA),Proximal femur locking compress plate(PF-LCP)and Artificial femoral head replacement(AFHR)for intertrochanteric fracture with lateral wall instability in the elderly.Methods The research used prospective cohort study.According to the inclusion and exclusion criteria,101 patients of intertrochanteric fracture with lateral wall instability in the elderly were treated in second affiliated hospital of xiamen medical university from January' 2011 to December 2017.The patients were randomly classified into three groups:34 patients were treated with PFNA.35 patients were treated with PF-LCP.32 patients were treated with AFHR.The main outcome measures were the intraoperative blood loss,the duration of surgery,the surgical complications,the incision size,the number of c-arm fluoroscopy,the partial weight-bearing time and total weight-bearing time,hospitalization time and the hospitalization costs.Results The three groups of PFNA,PF-LCP and AFHR were successfully performed under the direction of senior associate chief physician or chief physician.The PFNA group had less blood loss,shorter incision and less costs than AFHR group and PF-LCP group(P<0.05).There was no significant difference in surgical complications among the three groups.The AFHR group had the least number of c-arm fluoroscopy,which was significantly different from PFNA group and PF-LCP group.There were able to move to the ground earlier after surgery both PFNA group and AFHR group.But the AFHR group was able to complete weight bearing quickly after surgery which was significantly shorter than PFNA group and PF-LCP group(P<0.05).Conclusion In this study,all of the three groups of PFNA,PF-LCP and AFHR can effectively treated intertrochanteric fracture with lateral wall instability in the elderly that were had less surgical complications.However,compared with AFHR and PF-LCP,PFNA is more effective in terms of patient rehabilitation and postoperative care.