Screw plate fixation, intramedullary fixation and artificial femoral head replacement in the repair of femoral intertrochanteric fractures in the elderly: choice and comparison

doi:10.3969/j.issn.2095-4344.2015.17.016

Abstract

Abstract:

BACKGROUND: Nowadays, the internal fixation materials for the clinical treatment of femoral intertrochanteric fractures are broadly divided into two categories: intramedullary fixation system and extramedullary fixation system. Artificial femoral head replacement can be selected for unstable intertrochanteric fractures. However, the effects of diverse treatments usually lack of macroscopical evaluation.　

OBJECTIVE: To investigate and compare the clinical effects of different surgical treatments for femoral intertrochanteric fractures in the elderly.

METHODS: 168 elderly patients with intertrochanteric fractures, who were treated in the Department of Orthopedics, Beijing Municipal Corps Hospital of Chinese People’s Armed Police Forces from June 2005 to June 2010, were enrolled in this study. They were treated by screw plate fixation system (dynamic hip screw, dynamic condylar screw), intramedullary fixation system (Gamma 3 nail, expandable intramedullary nail) and artificial femoral head replacement, including 69 males and 99 females, at the age of 75-94 years, averagely 81.4 years. According to Evans type, there were 20 cases of type I, 43 cases of type II, 57 cases of type III, 33 cases of type IV and 15 cases of type V. Operative time, blood loss, weight-bearing ambulation time, and hip function were compared and evaluated in patients of each group.

RESULTS AND CONCLUSION: After treatment, patients were followed up for 14-39 months. At 12 months after treatment, Harris score was used to assess hip function in the affected side. Fracture was healed within 12 months. There was no significant difference in excellent and good rate among four groups (P > 0.05). Operative time and blood loss were significantly better in the expandable intramedullary nail group than in the other groups (P < 0.05). Weight-bearing ambulation time was significantly better in the artificial femoral head group than in the other groups (P < 0.01). Results suggest that according to fracture typing, in combination with osteoporosis in elderly patients, suitable repair method could improve therapeutic effects for femoral intertrochanteric fractures, and reduce postoperative complications. Dynamic hip screw is firstly selected for Evens types I and II stable intertrochanteric fractures. The intramedullary fixation system can be selected for unstable intertrochanteric fractures as Evans types III-V. Artificial hip arthroplasty is good for elderly patients with unstable intertrochanteric fractures as well as severe osteoporosis.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: Femur, Fractures, Bone, Femur Head, Hip Prosthesis, Internal Fixators

CLC Number:

R318

Zuo Jin-bu, Yu Lei, Liang Hong-wei, Wang Wei, Zhao Bin. Screw plate fixation, intramedullary fixation and artificial femoral head replacement in the repair of femoral intertrochanteric fractures in the elderly: choice and comparison[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(17): 2711-2718.

Figures/Tables 8

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