MANAGEMENT OF UNSTABLE INTERTROCHANTERIC FRACTURE IN OLDER AGE PAITENT WITH FIXATION VERSUS HEMI OR TOTAL PRIMARY REPLACEMENT
Journal Title: GJRA-Global Journal For Research Analysis - Year 2018, Vol 7, Issue 12
Abstract
Background and Objectives: For many decades, attempts have been made to overcome the difficulties which surgeons encounter in the treatment of proximal femoral fractures. Extra medullary and intramedullary implants have improved in recent years, although consensus is lacking concerning the denition and classication of unstable intertrochanteric fractures, with uncertainties regarding treatment. In this era of technologically sound and tested xation methods we shall compare functional outcomes and complications of various methods available for unstable it fracture xation. The purpose of this study is to analyze the role of primary hemi arthroplasty in cases of unstable osteoporotic intertrochanteric femur fractures and compare the outcomes with conventional xation techniques to nd out a better management plan for the patientMaterials and Methods: This is a prospective study of fty cases of unstable intertrochanteric fractures, either treated with primary replacement (hemi or total) or xation. Between january 2016 to january 2018, fty patients with an unstable comminuted intertrochanteric femoral fracture (AO/OTA type 31A2.2, A2.3, A3.2, A3.3) were enrolled in the study, which was approved by our institutional review board. Inclusion Criteria: 1. More than 60 years of age. 2. All patients with unstable IT femur fracture type a. 31- A2.2 and 31- A2.3 (AO/OTA classication) b. Posteromedial fragmentation c. Basicervical d. Reverse oblique e. Displaced greater trochanter (lateral wall fractures) f. Patient must be ambulatory before sustaining injury Exclusion Criteria: a. Chronically debilitated and bed ridden patients. b. Compound fracture c. Medically compromised patients- ASA grade iv &v d. Local infection ¾ Stable fracture Results: Maximum patients (88%) belonged to 60-80 years of age. Since most of the patient belong to elderly age group, medical comorbidities are very common. Average requirement of blood transfusion needed was signicantly higher in hemi replacement group than in xation group. (Z= 3.56, p<0.05). This indicated the surgical complexity of hemi replacement There was signicant shortening of limb in xation group as compared to hemi replacement. (Z=6.98,p value <0.05) Thus hemi replacement provided faster rehabilitation to the patient. This implies that those patients who had hemi replacement had a signicantly better activity of daily living. Harris hip scores were signicantly better in hemi replacement group. (Z=4.31, p value<0.05) suggesting better functional outcomes. There was no signicant difference between immediate postoperative complications though skin incision, operating time, and blood loss were signicantly higher in hemi replacement group.(Z=0.7, p>0.05) but the rate of delayed complications and revision surgeries were signicantly higher in xation group. (p<0.05)There was no signicant difference in mortality rates of both groups despite more blood loss and duration of surgeries in hemi replacement group. Interpretation and Conclusion: In conclusion we state that hemi replacement arthroplasty, is a valid treatment option for mobile and mentally healthy patients, as compared to xation for faster rehabilitation and better activity of daily living. Aims & Objectives: To study the results of primary replacement (hemi or total) in unstable intertrochanteric fractures and compare it with conventional methods of xation. To assess functional outcome in patients having unstable intertrochanteric fractures in both groups as per Harris hip score. To study the effect of pre-existing illness on nal outcome of the patients in both groups. To study the stability of xation in osteoporotic bones. To note any complication developed. To compare nal outcome of this study with that of the other studies.
Authors and Affiliations
Dr Parth N. Patel, Dr. Piyush Mittal, Dr. Sandip Rathod, Dr Parth Banker
Keywords
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