Optimized surgical treatment for osteoporotic hip fractures in the elderly

doi:10.3969/j.issn.2095-4344.2013.48.021

Abstract

Abstract:

BACKGROUND: Active surgical treatments are preferred for elderly hip fractures. Individual fixation method is chosen according to fracture site, type, age and whether there are basic diseases in internal medicine, which plays an important role in the successful treatment of elderly hip fractures.
OBJECTIVE: To explore the effects of optimized surgical treatment on osteoporotic hip fracture in the elderly.
METHODS: Totally 176 patients with osteoporotic hip fracture were treated by different methods between January 2000 and January 2012, including 63 males and 113 females, with a mean age of (76.7±6.3) years. Out of the 84 cases of interchanteric fracture, seven cases were treated with conservative methods, 34 cases were treated with dynamic hip screw internal fixation, 18 cases were treated with cannulated screw internal fixation, seven cases were treated with anatomical plate internal fixation, 12 cases were treated with bipolar femoral placement, and six cases were treated with total hip arthroplasty. Out of the 92 cases with femoral neck fractures, 40 cases were treated with bipolar femoral placement, 37 cases were treated with total hip arthroplasty and 15 cases were treated with cannulated screw internal fixation. Modified Harris hip function scores were used to evaluate the therapeutic effects of different treatment methods. Complications were observed.
RESULTS AND CONCLUSION: Seventy-six cases of interchanteric fractures and 85 cases of femoral neck fractures were followed-up for 8-26 months with an average of (5.7±1.3) months. Three cases suffered from post-operative infection, and one case died due to cardio-pulmonary failure in 10 days after operation. Both intraoperation and postoperative complications included femoral head cutting, intraoperative fracture, internal fixation and prosthetic loosening, postoperative fracture, avascular necrosis of femoral head, coxa vara, legs shorten, and delayed fracture healing. The incidence rates of complications in patients undergoing bipolar femoral placement and total hip arthroplasty were significantly lower than those treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P < 0.05). The outcomes of the treatment according to Harris scoring criterion were better in patients treated with bipolar femoral placement and total hip arthroplasty than in patients treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P < 0.05). No significant differences were found in the incidence rate of complications and Harris scores among patients treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P > 0.05). No significant differences were found in the incidence rate of complications and Harris scores between patients treated with bipolar femoral placement and total hip arthroplasty (P > 0.05). These findings indicate that the treatment of osteoporotic hip fracture in the elderly can achieve satisfactory results if the comprehensive therapies are given. Bipolar femoral placement and total hip arthroplasty are preferred for elderly femoral neck fractures.

Key words: hip fractures, osteoporosis, arthroplasty, replacement, hip, hip prosthesis, femur

CLC Number:

R318

Chen Peng, Liu Wen-he, Yan Lin-lin, Guo Zhi-wen, Tang Xin-wen, Hu Wei-wen, Cao Xi-wen, Wang Fu-jian, Li Yang, Chen Jia-yu. Optimized surgical treatment for osteoporotic hip fractures in the elderly[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(48): 8429-8436.

Figures/Tables 2

Quantitative analysis of participants Totally 176 patients with osteoporotic hip fracture were included in the study, including 84 cases of interchanteric fracture and 92 cases of femoral neck fracture. Seventy-six cases of interchanteric fracture and 84 cases of femoral neck fracture were followed up for 8-26 months. Follow-up results Out of the 76 cases of interchanteric fracture, six cases were treated by conservative methods, 30 cases by dynamic hip screw internal fixation, 17 cases by cannulated screw internal fixation, six cases by anatomical plate internal fixation, 11 cases by bipolar femoral placement, and six cases by total hip arthroplasty. Out of the 85 cases with femoral neck fracture, 36 cases were treated by bipolar femoral placement, 34 cases by total hip arthroplasty and 15 cases by cannulated screw internal fixation. The average fracture healing time was (5.7±1.3) months in the internal fixation cases. Complications Both intraoperation and postoperative complications included femoral head cutting, intraoperative fracture, internal fixation and prosthetic loosening, postoperative fracture, avascular necrosis of femoral head, coxa vara, legs shorten, delayed fracture healing, contralateral hip re-fracture. The incidence rates of complications in patients undergoing bipolar femoral placement and total hip arthroplasty were significantly lower than those treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P < 0.05). No significant differences were found in the incidence rate of complications among patients treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P > 0.05). There was also no significant difference in the incidence rate of complications between patients treated with bipolar femoral placement and total hip arthroplasty (P > 0.05; Table 1)."

References

[1] Liu J. The comparison of different treatment method of internal fixation on inertrochanter fracture of femur. Zhongguo Xiandai Yixue Zazhi. 2011;21(19):2283-2285.
[2] Liu ZH. Bone Mineral and Clinical M. Beijing: China Science and Technology Press, 2006:446-460.
[3] Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51(4):737-755.
[4] Napoli N, Schwartz AV, Palermo L, et al. Risk factors for subtrochanteric and diaphyseal fractures: the study of osteoporotic fractures. J Clin Endocrinol Metab. 2013; 98(2):659-667.
[5] Kung AW, Fan T, Xu L, et al. Factors influencing diagnosis and treatment of osteoporosis after a fragility fracture among postmenopausal women in Asian countries: a retrospective study. BMC Womens Health. 2013;13(1):7-15.
[6] Briongos L, Sañudo S, García-Alonso M, et al. Treatment of osteoporosis and hip fractures in a Spanish health area. Eur Rev Med Pharmacol Sci. 2013;17(2):266-268.
[7] Chen P, Liu WH, Yan LL, et al. Treatment of osteoporotic hip fracture in the elder. Zhongguo Linchuang Xinyixue. 2012;5(5):410-412.
[8] Said GZ, Farouk O, El-Sayed A, et al. Salvage of failed dynamic hip screw fixation of intertrochanteric fractures. Injury. 2006;37(2):194-202.
[9] Zhang C, Wang PJ, Ruan DK, et al. Complications of surgical treatment for femoral intertrochanteric fractures using dynamic hip screw. Zhongguo Gushang. 2009;22(8): 624-626.
[10] Huo JJ, Zhao Y, Tian H, et al. Systematic review on gamma nails versus dynamic hip screws and plate for intertrochanteric fractures of femur in elder. Zhongguo Xiandai Yixue Zazhi. 2011;21(7):773-778.
[11] Jewell DP, Gheduzzi S, Mitchell MS, et al. Locking plates increase the strength of dynamic hip screws. Injury. 2008; 39(2):209-212.
[12] Zheng HG, Tang H, Zhang QL. A comparative study of dynamic hip screw and proximal femoral nail an tirotation in treatment of femoral in tertrochan tericfractures. Zhongguo Jiaoxing Waike Zazhi. 2009;17(6):407-408.
[13] Al-Ani AN, Samuelsson B, Tidermark J, et al. Early operation on patients with a hip fracture improved the ability to return to independent living: A prospective study of 850 patients. J Bone Joint Surg Am. 2008;90(7):1436-1442.
[14] Efstathopoulos NE, Nikolaou VS, Lazarettos JT. Intramedullary fixation of intertrochanteric hip fractures: a comparison of two implant designs. Int Orthop. 2007;1: 71-76.
[15] Parker MJ, White A, Boyle A. Fixation versus hemiarthroplasty for undisplaced intracapsular hip fractures. Injury. 2008;39(7):791-795.
[16] Cui FG, Cong J, Li GS. Treatment of unstable femoral intertrochanteric fracture with dynamic hip screw. Zhongguo Jiaoxing Waike Zazhi. 2008;16(6):471-472.
[17] Leonardsson O, Sernbo I, Carlsson A, et al. Long-term follow-up of replacement compared with internal fixation for displaced femoral neck fractures: results at ten years in a randomised study of 450 patients. J Bone Joint Surg Br. 2010;92(3):406-412.
[18] Li SF. The comparison between different treatment on femoral intertrochanteric fractures by dynamic condylus screw and dynamic hip screw. Zhongyiyao Daobao. 2008; 14(5):63-65.
[19] Gao H. Clinical outcome of femoral head replacement for femoral intertrochanteric fractures or femoral neck fractures in patients over 70 years old. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2008;12(35):6879-6882.
[20] Frihagen F, Nordsletten L, Madsen JE. Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial. BMJ. 2007;335 (7632):1251-1254.
[21] Guan CY, Chang Q, Ma YZ, et al. Treatment of senile patients with unstable femoral intertrochanteric fracture:comparison between hemiprosthesis arthoplasty and internal fixation. Zhongguo Gu yu Guanjie Sunshang Zazhi. 2008;23(12):975.
[22] Faldini G, Grandi G, Romagnoli M, et al. Surgical treatment of unstable intertrochanteric fractures by bipolar hip replacement or total hip replacement in elderly osteoporotic patients. J Orthop Trauma. 2006;7(3):117-121.
[23] Gu GS, Wang G, Sun DH, et al. Cemented bipolar hemiarthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures in senile patients. Chin J Traumatol. 2008;11(1):13-17.
[24] Hsu CJ, Chou WY, Chiou CP, et al. Hemi-arthroplasty with supplemental fixation of greater trochanter to treat failed hip screws of femoral intertrochanteric fracture. Arch Orthop Trauma Surg. 2008;128(8):841-845.
[25] Ho M, Garau G, Walley G, et al. Minimally invasive dynamic hip screw for fixation of hip fractures. Int Orthop. 2009;33(2): 555-560.
[26] Zhang S, Kong CG, Chen WY, et al. Osteoporotic hip fracture: Comparison on various treatments of metal implants. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2010;14(22):4176-4180.
[27] Chen JS, Zheng Q, Li H. Comparison of dynamic hip screw and proximal femoral nail for treating intertrochanteric fractures in elderly patients. Zhejiang Yixue. 2008;30(1): 49-51.
[28] Hammad A, Abdel-Aal A, Said HG, et al. Total hip arthroplasty following failure of dynamic hip screw fixation of fractures of the proximal femur. Acta Orthop Belg. 2008; 74(6):788-792.
[29] Hsu CJ, Chou WY, Chiou CP, et al. Hemi-arthroplasty with supplemental fixation of greater trochanter to treat failed hip screws of femoral intertrochanteric fracture. Arch Orthop Trauma Surg. 2008;128(8):841-845.
[30] Faldini G, Grandi G, Romagnoli M, et al. Surgical treatment of unstable intertrochanteric fractures by bipolar hip replacement or total hip replacement in elderly osteoporotic patients. J Orthop Trauma. 2006;7(3):117-121.
[31] Wang CH, Ma ZX, Bi LF. Analysis on osteoporosis diagnosis and treatment of 986 elderly inpatients with hip fracture. Zhongguo Guzhi Shusong Zazhi. 2010;16(5): 353-355.