Comparative Evaluation of Three Different Treatment Approaches for Intertrochanteric Fracture in Advanced Age Patients
Journal Title: Istanbul Medical Journal - Year 2020, Vol 21, Issue 6
Abstract
Introduction: Considering the general condition of elderly patients, it is important to treat intertrochanteric fracture along with early rehabilitation interventions. We compared the mortality and clinical outcomes among the factors of Ender nailing, proximal femoral nailing (PFN) and hemiarthroplasty in patients aged >90 years with intertrochanteric fractures. Methods: We retrospectively evaluated the medical records of 78 patients aged >90 years who were diagnosed with intertrochanteric fracture and treated during 1997-2016 at our clinic. The patients were earlier treated with Ender nailing (n=16), PFN (n=32) and hemiarthroplasty (n=30). The mean age of the patients was 93.3 years (range: 90-104); 14 of them were men and 64 women. All patients were mobile before their fracture. The preoperative American Society Anaesthesiologists (ASA) score and the postoperative hospital stay duration, survival, mobilisation and mobilisation time were evaluated. Results: Among the 78 patients, 60 (76.9%) eventually died and 18 (23.1%) survived. The mean survivals after surgery were 30.5, 27.2 and 21.7 months in the Ender, PFN and hemiarthroplasty groups, respectively. The overall death rates were 62.5% (n=10), 62.5% (n=20) and 100% (n=30) in the Ender, PFN and hemiarthroplasty groups, respectively. No significant difference was noted in the ASA score. The mean postoperative hospital stay durations were 8.2, 9.4 and 7.6 days in the Ender, PFN and hemiarthroplasty groups, respectively. The mean mobilisation days were 36, 4.3 and 4.8 days in the Ender, PFN and hemiarthroplasty groups, respectively. Six (37.5%) patients in the Ender, 5 (16.6%) in the hemiarthroplasty and 5 (15.6%) in the PFN groups could not walk. The Ender group was mobilised significantly late (p<0.001). Conclusion: Although PFN is accepted as the gold standard for treating intertrochanteric fractures, different treatment options can be used, especially in patients with advanced age, osteoporotic and in those presenting with multiple comorbidities. In this study, we found that the patients treated with Ender nail had lower mortality.
Authors and Affiliations
Sevan Sıvacıoğlu, Serkan Bayram, Ömer Naci Ergin
Keywords
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- EP ID EP691481
- DOI 10.4274/imj.galenos.2020.15679
- Views 113
- Downloads 0
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