Efficacy of joint replacement versus closed reduction and internal fixation in treatment of unstable intertrochanteric fractures combined with osteoporosis

doi:10.12307/2024.023

Abstract

Abstract: BACKGROUND: Stable intertrochanteric fractures can be treated by closed reduction and internal fixation, but there is no absolute advantage for unstable intertrochanteric fractures with osteoporosis.
OBJECTIVE: To investigate the efficacy of arthroplasty in the treatment of unstable intertrochanteric fractures in the elderly with osteoporosis by comparing the indexes related to closed reduction internal fixation and arthroplasty.
METHODS: Clinical data of 102 elderly patients with unstable intertrochanteric fractures of the femur treated in Affiliated Hospital of Qingdao University from January 2017 to January 2020 were retrospectively analyzed. Patients were divided into two groups according to the surgical method. In the Gamma3 group, 62 cases received Gamma3 internal fixation system. In the joint replacement group, 40 cases received an artificial femoral head replacement or total hip replacement. Surgical information, hospitalization, hip function, and postoperative complications were compared between the two groups.
RESULTS AND CONCLUSION: (1) There were statistical differences between the Gamma3 group and the joint replacement group in weight-bearing time (P < 0.001), hospital stay (P < 0.05), intraoperative bleeding (P < 0.001), and length of surgery (P < 0.001). The mean weight-bearing time and hospital stay were shorter in the joint replacement group than in the Gamma3 group. Intraoperative bleeding and duration of surgery were better in the Gamma3 group than in the joint replacement group. (2) There was no significant difference in Harris hip score, subitem centesimal hip score, and postoperative complications 12 months after surgery in both groups (P=0.526, 0.788, 0.228). (3) It is indicated that arthroplasty has achieved better outcomes in the treatment of elderly unstable intertrochanteric fractures combined with osteoporosis, enabling early weight bearing and functional exercise. Careful selection of the appropriate patient and prosthesis type for arthroplasty will result in greater patient benefit.

Key words: intertrochanteric fracture of the femur, unstable type, joint replacement, osteoporosis, closed reduction and internal fixation

CLC Number:

Zhu Ruizhi, Qu Qiang, Cui Pengfei, Liu Dong, Zhang Yongtao, Wang Changyao. Efficacy of joint replacement versus closed reduction and internal fixation in treatment of unstable intertrochanteric fractures combined with osteoporosis[J]. Chinese Journal of Tissue Engineering Research, 2024, 28(12): 1869-1874.

Figures/Tables 6

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