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
Related Articles
- EP ID EP691481
- DOI 10.4274/imj.galenos.2020.15679
- Views 137
- Downloads 0
Non-operating Room Anaesthesia Practices in an Endoscopy Unit at a Tertiary Centre: A Retrospective Evaluation
Introduction: In recent years, gastrointestinal endoscopic procedures have been performed with sedo-analgesia at many centres. We aimed to present a 1-year retrospective analysis of non-operating room anaesthesia (NORA)...
Comparison of Sublingual and Nasal Applications of Dexmedetomidine Premedication in Pediatric Patients
Introduction: Alpha-2 adrenergic agonists are used for premedication in the pediatric population to reduce separation anxiety and achieve smooth induction. The clinical effects of clonidine are similar in both oral and n...
Is Component Separation a Safe Method in Incisional Hernias?
Introduction: Incisional hernias after abdominal surgical procedures cause morbidity, significant loss of labor and affect quality of life. In this study, we investigated whether component separation (CS) technique is a...
The Relationship of Lumbar Multifidus Muscle Change to Disc Hernia and Low Back Pain: An Magnetic Resonance Imaging Study
Introduction: Our aim was to evaluate the relationship between lumbar multifidus (LM) muscle atrophy and lumbar disc herniation by magnetic resonance imaging (MRI) findings in patients with low back pain. Methods: Lumba...
Cyto-Histopathological Findings of Myofibroblastoma of the Breast: A Case Report
Myofibroblastoma of the breast is a rare mesenchymal tumor, probably originating from stromal fibroblasts. In this case report, cyto-histopathological findings of myofibroblastoma of the breast are discussed. A 68-years-...