Laparoscopic surgery experience does not influence oncological and functional results of robotic-assisted laparoscopic prostatectomy

Introduction: Surgery is one of the treatment alternatives for prostate cancer, and robotic-assisted laparoscopic prostatectomy (RALP) has become the new trend in the past decade. There is no consensus yet for surgeons who will perform RALP whether they need to be trained or experienced in laparoscopy. In this study, it was aimed to investigate the effectiveness of the surgeon’s laparoscopy experience in the perioperative and postoperative results of RALP patients. Material and method: Patients who underwent RALP were retrospectively screened. The first 20 cases done by surgeons in both groups and 40 cases in total were included in the study. Surgeons with laparoscopy training were designated as group 1, and surgeons without laparoscopy training were designated as group 2. Patient’s age, preoperative prostate-specific antigen (PSA) value, prostate biopsy pathology, radical prostatectomy pathology, surgical margin positivity, extracapsular extension, and seminal vesicle invasion status, blood transfusion rate, operation time, length of hospital stay, and 1-year follow-up potency and urinary incontinence rates were compared. Results: There was no difference between the two groups in terms of age, preoperative PSA, preoperative biopsy results, blood transfusion rates, operation times, and the length of hospital stay of the patients. When the postoperative oncological and functional results of the patients were examined, there was no difference between the two groups in the prostatectomy pathology ( p = 0.895), extracapsular extension (pT3a) ( p = 0.519), positive surgical margin (pSM) ( p = 0.723), and seminal vesicle invasion (pT3b) ( p = 0.756). Potency and urinary incontinence rates were similar in both groups at the end of one year follow-up ( p = 0.327, 0.500 respectively). Conclusions: Based on our study, it is clearly seen that regardless of the surgeon’s experience of laparoscopy, it can be safely preferred when looking at the oncological and functional results of RALP.

Download Full-text

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽

10.1024/1023-9332.8.6.255 ◽

2002 ◽

Vol 8 (6) ◽

pp. 255-258 ◽

Cited By ~ 28

Author(s):

Perruchoud ◽

Vuilleumier ◽

Givel

Keyword(s):

Hospital Stay ◽

Pilonidal Sinus ◽

Primary Closure ◽

Average Length ◽

Length Of Hospital Stay ◽

Healing Time ◽

Incision And Drainage ◽

The Mean ◽

Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

Download Full-text

Abdominal sacrohysteropexy UV prolapse and preservation of reproduction.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.05.4562 ◽

2021 ◽

Vol 28 (05) ◽

pp. 652-655

Author(s):

Robina Ali ◽

Riffat Ehsan ◽

Ghazala Niaz ◽

Fatima Abid

Keyword(s):

Hospital Stay ◽

Length Of Hospital Stay ◽

Uterovaginal Prolapse ◽

Prolapse Recurrence ◽

Gynecology And Obstetrics ◽

Duration Of Surgery ◽

Operative Complications ◽

Operative Recovery ◽

Post Operative Complications

Objectives: The purpose of this study was to assess the safety of sacrohystcopxy by determining intraoperative and post-operative complications and its effectiveness by pelvic organ prolapse recurrence on follow up. Study Design: Prospective study. Setting: Department of Gynecology and Obstetrics Unit-II DHQ Hospital PMC, Faisalabad. Period: Jan-2014 to Jan-2017. Material & Methods: Patients with uterovaginal prolapse, admitted through OPD were selected for abdominal sacrohysteropexy. Variables of study including duration of surgery, any intra-operative and post operative complications, need of intra operative blood transfusion, post operative hospital stay; recurrence of POP, number of pregnancies in 06 moths follow up were recorded. Results: During this study period, 319 patients were admitted with uterovaginal prolapse. 32 (10.03%) cases were selected for abdominal sacrohysteropexy. In these 32 patients, 03 (9.37%) were <30years of age, 21(65.62%) were between 30-35 years and 8 (25%) were between 35-40 years of age. About 2(6.25%) were unmarried, while 30(93.7%) were married. In these married women 14(43.75%) were multiparas, another 14(43.75%) were para 1 or 2, while 4(12.5%) were para 3 or more. Duration of surgery was 40-45 minutes in 31(96.87%) patients. In 28(87.5%) cases per operative blood loss was <150ml while in 4(12.5%) it was estimated to be >150ml but less than 300ml. Post operatively only 1(3.12%) case developed wound sepsis and it was the only one (3.12%) who was discharged on 7th post operative day, while rest 31(96.87%) were discharged on 3rd post operative day. No recurrence was noticed in 06 moths follow up, while 2(6.25%) patients became pregnant. Conclusion: Abdominal sacrohysteropexy is a safe and an effective treatment in terms of overall anatomical and functional outcome, complications, post operative recovery, length of hospital stay and sexual functioning, in women who desire uterine and hence fertility preservation.

Download Full-text

Locked intramedullary nailing technique of the femur without brilliance amplifier at the trauma and orthopedics department of the university hospital of peace series on 35 cases during 1 year

MOJ Orthopedics & Rheumatology ◽

10.15406/mojor.2021.13.00556 ◽

2021 ◽

Vol 13 (5) ◽

pp. 95-97

Author(s):

Augustin Delange Hendrick ◽

Almenord Pharol ◽

Khawly Clifford PG ◽

Augustin Delange ◽

Pierre Marie Woolley

Keyword(s):

Hospital Stay ◽

Intramedullary Nailing ◽

Femoral Fractures ◽

Length Of Hospital Stay ◽

University Hospital ◽

Patient Morbidity ◽

Duration Of Hospitalization ◽

The Cost ◽

The University

Femoral fractures increase the length of hospital stay for our patients for several reasons such as lack of blood, economic resources, and lack of infrastructure. The use of a C-arm has been shown to reduce patient morbidity due to early functional recovery and reduced hospital stay. Objective: To develop an intramedullary nailing technique without c-arm with a closed focus to reduce the duration of hospitalization of its patients as well as the cost related to the equipment used for follow-up. Methodology: prospective study on 35 patients for 1 year August 2020 to August 2021 Results: We followed 35 patients in which the mean age was 37.83 years with extremes of 18 and 78 years. The male sex predominates 21 against 14 women or 60% against 40% respectively. The sex ratio is 1.5. A total of 19 diaphyseal fractures (54.3%) were nailed, 9 supracondylar (25.7%) and 7 subtrochanteric (20%). Twenty-seven were closed fractures (71.1%), and 8 were open fractures (22.9%). The length of hospitalization was less than 3 days for 30 patients (85.7%), and more than 3 days for 5 patients (14.3%). Conclusion: We recommend that we promote this closed-hearth technique because it improves the postoperative follow-up of patients. Additionally, it would reduce exposure to radiation from c-arm in hospitals that have this equipment.

Download Full-text

Abstract TP170: Persistently Elevated Factor VIII In Acute Ischemic Stroke Is Associated With Higher CRP, Lower Baseline NIHSS, And Longer Length Of Hospital Stay

Stroke ◽

10.1161/str.44.suppl_1.atp170 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Adrianne M Dorsey ◽

Amelia K Boehme ◽

Laurie Schluter ◽

Karen C Albright ◽

Tiffany R Chang ◽

...

Keyword(s):

Ischemic Stroke ◽

Factor Viii ◽

Hospital Stay ◽

Acute Ischemic Stroke ◽

Acute Phase ◽

Clinical Course ◽

Length Of Hospital Stay ◽

Lower Baseline ◽

Persistent Elevation

Objective: We sought to determine the proportion of patients with elevated factor VIII (FVIII) levels whose FVIII levels remain elevated after the acute phase of stroke, and the patient characteristics that predict sustained elevation of FVIII levels. Background: Factor VIII plays a major role in the fluid phase of blood coagulation. Elevated FVIII has been shown to increase risk of venous and arterial thrombosis. The importance of screening for elevated FVIII after a first thrombotic event especially acute ischemic stroke (AIS) has not been adequately investigated. Design/Methods: We reviewed FVIII levels taken at baseline and follow-up in patients with AIS treated at our stroke center from July 2008 to June 2012. Elevated FVIII was defined as >150%. Baseline demographics, laboratory data, clinical course, outcomes, and time to follow-up were collected in patients with elevated FVIII at baseline and data was compared in patients who had normalized FVIII with patients whose FVIII remained elevated at least 7 days later. Results: Repeat FVIII levels were available for 34/111 patients with elevated FVIII level with AIS. FVIII remained elevated in 68% after a median interval of 110 days. Factors associated with persistent elevation included higher baseline FVIII level (239 vs 185%, p=0.015), elevated CRP (73.3 vs 12.5%, p=0.008), lower baseline NIHSS (4 vs 8, p=0.046), and longer length of hospital stay (8 vs. 3, p=0.0063). Normalization of FVIII was associated with tPA use (54.5% vs 13%, p=0.016). No relationship was found between persistently elevated FVIII and baseline demographics, clinical course and outcomes. Conclusion: Persistently elevated FVIII after AIS may be predicted by higher baseline levels and elevations in CRP. Despite worse baseline stroke severity, patient with normalization of FVIII had similar outcomes as those with persistent elevation, which may be explained by the higher use of tPA in the normalized group. The relevance of elevated FVIII in stroke is not well understood. Our preliminary results suggest elevations persist in the majority and may not merely represent an acute phase reactant.

Download Full-text

Comparison of open and robotic-assisted prostatectomy: The University of British Columbia experience

Canadian Urological Association Journal ◽

10.5489/cuaj.1707 ◽

2014 ◽

Vol 8 (3-4) ◽

pp. 92 ◽

Cited By ~ 9

Author(s):

Louis-Olivier Gagnon ◽

Larry Goldenberg ◽

Kenny Lynch ◽

Antonio Hurtado ◽

Martin Gleave

Keyword(s):

Urinary Incontinence ◽

Length Of Stay ◽

Learning Curve ◽

Tertiary Care ◽

Surgical Margin ◽

Hospital Length Of Stay ◽

Positive Surgical Margin ◽

Robotic Assisted ◽

Post Surgery ◽

The Impact

Introduction: We assessed outcomes and costs of open prostatectomy (OP) versus robotic-assisted prostatectomy (RAP) at a single tertiary care university hospital.Methods: We retrospectively analyzed 200 consecutive OP by 1 experienced open surgeon (MG) and 200 consecutive RAP by an experienced open surgeon (SLG), after allowing for a short learning curve of 70 cases.Results: The 2 groups had similar demographics, including mean age (64.7 vs. 64.2) and mean body mass index (27.2 vs. 27.2). The OP group had a higher proportion of higher risk cancers compared to the RAP group (32.5% vs. 8.5%). Mean skin-to-skin operative room time was less for the OP (114.2 vs. 234.1 minutes). Transfusion rates were similar at 1.5% with OP compared to 3.5% with RAP. The mean length of stay was 1.78 days for OP compared to 1.76 days for RAP, for the last 100 patients in each group. The OP group had more high-grade disease in the prostatectomy specimen, with Gleason ≥8 in 23.5% compared to 3.5% in the RAP group. Positive surgical margin rates were comparable at 31% for OP and 24.6% for RAP, and remained similar after stratification for pT2 and pT3 disease. The grade I and II perioperative complication rate (Clavien-Dindo classification) was lower in the OP group (8.5% vs. 20%). Postoperative stress urinary incontinence rates (4.8% for OP and 4.6% for RAP) and biochemical-free status (91.8% for OP and 96% for RAP) did not differ at 12 months post-surgery. The additional cost of RAP was calculated as $5629 per case. The main limitations of this study are its retrospective nature and lack of validated questionnaires for evaluation of postoperative functional outcomes.Conclusion: While hospital length of stay, transfusion rates, positive surgical margin rates and postoperative urinary incontinence were similar, OP had a shorter operative time and a lower cost compared to the very early experience of RAP. Future parallel prospective analysis will address the impact of the learning curve on these outcomes.

Download Full-text

Neurogenic claudication associated with posterior vertebral rim fractures in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.5.peds1247 ◽

2012 ◽

Vol 10 (3) ◽

pp. 241-245 ◽

Cited By ~ 4

Author(s):

Jonathan G. Thomas ◽

Jerome Boatey ◽

Alison Brayton ◽

Andrew Jea

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Signs And Symptoms ◽

Leg Pain ◽

Neurogenic Claudication ◽

Pediatric Age Group ◽

Fractures In Children ◽

The Mean

Object Outside of the patient population with achondroplasia, neurogenic claudication is rare in the pediatric age group. Neurogenic claudication associated with posterior vertebral rim fracture is even more uncommon but nonetheless causes pain and disability in affected children and adolescents. The purpose of this study was to describe the surgical results of 3 adolescents presenting with neurogenic claudication and posterior vertebral rim fracture when treated with laminectomy alone. Methods The medical and operative records of the 3 pediatric patients were retrospectively reviewed. Presenting signs and symptoms and CT findings, such as the interpedicular distances between T-12 and L-5, were obtained. Perioperative results were assessed, including operative time, blood loss, length of hospital stay, and complications. Findings at latest follow-up were also recorded, including a patient satisfaction survey. Results The 3 patients (1 girl and 2 boys) had a mean age of 14.7 years (range 14–15 years) and underwent follow-up for a mean of 11.3 months (range 5–18 months). Notable preoperative signs and symptoms included back pain (all patients), leg pain (all patients), leg numbness (1 patient), and leg weakness (1 patient). No patient presented with bowel and/or bladder dysfunction. The mean blood loss during laminectomy was 123 ml (range 20–300 ml), and the mean length of hospital stay was 4.3 days (range 3–6 days). On average, decompression was performed at 2.2 levels (range 2–2.5 levels). All 3 patients reported at most recent follow-up that they were “satisfied” with the surgery. There was 1 complication of instability from an iatrogenic pars fracture, which required reoperation and posterior instrumented fusion. Conclusions To the best of the authors' knowledge, this report represents the first surgical series of pediatric neurogenic claudication associated with posterior vertebral rim fractures. Pediatric neurosurgeons may infrequently encounter neurogenic claudication associated with a posterior vertebral rim fracture in children. To treat children with neurogenic claudication associated with posterior vertebral rim fractures, a simple laminectomy may be a safe and efficacious alternative to discectomy and removal of fracture fragments.

Download Full-text

Comparison of conventional fenestration discectomy with Transforaminal endoscopic lumbar discectomy for treating lumbar disc herniation:minimum 2-year long-term follow-up in 1100 patients

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03652-0 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Quanyi Li ◽

Yongchun Zhou

Keyword(s):

Hospital Stay ◽

Lumbar Disc ◽

Length Of Hospital Stay ◽

Bed Rest ◽

Intraoperative Blood Loss ◽

Postoperative Length ◽

Group A ◽

Group B ◽

Endoscopic Lumbar Discectomy

Abstract Purpose To compare the efficacy of conventional interlaminar fenestration discectomy (IFD) with transforaminal endoscopic lumbar discectomy (TELD) for treating lumbar disc herniation (LDH). Methods The clinical data of 1100 patients who had been diagnosed with LDH between January 2012 and December 2017 were retrospectively analysed. IFD was performed on 605 patients in Group A, whereas TELD was performed on 505 patients in Group B. The Oswestry Disability Index, Visual Analogue Scale for pain and modified MacNab criteria were used to evaluate the outcomes. The surgery duration, intraoperative blood loss, postoperative off-bed activity and postoperative length of hospital stay were recorded. Results The follow-up period ranged from 24 to 60 months, with an average of 43 months. The excellent and good outcome rates were 93.5% in Group A and 92.6% in Group B. There was no significant difference in efficacy between the groups (P > 0.05). However, Group B had significantly less intraoperative blood loss and shorter bed rest duration and postoperative length of hospital stay than Group A (P < 0.05). There were two cases of postoperative recurrence in Group A and three in Group B. Conclusions Although conventional IFD and TELD had similar levels of efficacy in treating LDH, TELD had several advantages. There was less intraoperative bleeding, shorter length of hospital stay and shorter bed rest duration. It can be considered a safe and effective surgical option for treating LDH.

Download Full-text

Impact of radiation (RT) regimen on palliative procedures (PP) for patients with resectable locally advanced esophageal cancer treated with exclusive chemoradiation (CRT) or preoperative chemoradiation (CRT+S): results from a phase III trial of the Federation Francophone de Cancerologie Digestive (FFCD 9102)

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.4531 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 4531-4531

Author(s):

G. Crehange ◽

F. Bonnetain ◽

S. Seng ◽

T. N'guyen ◽

X. Mirabel ◽

...

Keyword(s):

Hospital Stay ◽

Locally Advanced ◽

Length Of Hospital Stay ◽

Local Relapse ◽

Phase Iii ◽

Dysphagia Score ◽

Cancérologie Digestive ◽

The Impact ◽

Locally Advanced Esophageal Cancer

4531 Background: The FFCD 9102 trial demonstrated that CRT is an alternative to CRT+S for responding patients. We investigated the type of PP in the follow-up (FU) period, according to the RT scheme: protracted (P-RT) vs. split course (SC-RT). Methods: Resectable T3 N0–1 M0 thoracic esophageal carcinoma were included. First sequence : 2 cycles of cisplatin and 5-FU (day (d)1 - d22) combined with RT. Two schemes of RT were allowed: P-RT (46 Gy / 4.5 weeks (w), 2 Gy / f) or SC-RT (2 one-week courses of 15 Gy, 3 Gy / f). For CRT, the same chemotherapy was given on d43, d64 and d92 combined with 20 Gy / 2w (P-RT) or 15 Gy / 1w (SC-RT). Responding patients after the first sequence were randomized between CRT and CRT+S. The impact of SC-RT vs. P-RT on PP in the FU period was explored using a Mann-Whitney test. Results: From February 1993 to December 2000, 451 pts were registered and 446 were eligible. P-RT: 161 pts, SC-RT: 285 pts. After a median FU of 47.4 months, 2-year overall survival and local relapse-free survival were for P-RT vs. SC-RT: 37.1% vs. 30.5% (p = 0.25) and 76.7% vs. 56.8% (p = 0.002), respectively. P-RT vs. SC-RT: mean length of hospital stay: 48 d vs. 60.5 d (p= 0.0003). Mean number of dilatation sessions: 0.56 vs. 0.66 (p= 0.43). Mean number of stents: 0.21 vs. 0.34 (p= 0.03). Mean number of any PP: 1.01 vs. 1.50 (p= 0.001). Mean dysphagia grade: 2.99 vs. 3.12 (p= 0.21). In the CRT+S-group, P-RT vs. SC-RT: mean length of hospital stay 55.0d vs. 68.7d (p =0.051). Mean number of dilatation sessions: 0.74 vs. 0.74 (p= 0.77). Mean number of stents: 0.09 vs. 0.18 (p= 0.44). Mean number of PP: 1.00 vs. 1.37 (p= 0.054). In the CRT-group, P-RT vs. SC-RT, mean length of hospital stay: 42.6d vs 54.0d (p= 0.053). Mean number of dilatation sessions : 0.38 vs. 0.67 (p= 0.12). Mean number of stents: 0.31 vs. 0.50 (p= 0.03). Mean number of PP: 0.83 vs. 1.86 (p= 0.0005). Conclusions: Stents, rate of PP and length of hospital stay were significantly increased with SC-RT. Dysphagia score was similar between SC-RT and P-RT at last FU. No significant financial relationships to disclose.

Download Full-text

Evaluation of length, maximum Gleason score, and extension of disease at positive surgical margins during radical prostatectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.98 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 98-98

Author(s):

Hooman Djaladat ◽

Mehrdad Alemozaffar ◽

Christina Day ◽

Manju Aron ◽

Jie Cai ◽

...

Keyword(s):

Radical Prostatectomy ◽

Gleason Score ◽

Cox Regression ◽

Surgical Margin ◽

Oncologic Outcomes ◽

Positive Surgical Margin ◽

Extracapsular Extension ◽

Clinical Recurrence ◽

The Impact

98 Background: Positive surgical margin (PSM) found following radical prostatectomy (RP) is known to affect subsequent recurrence and survival. The extent of PSM has been shown to impact clinical outcomes. We examined the effect of length of PSM, extent of disease at PSM and maximum Gleason score at PSM on oncologic outcomes. Methods: A retrospective review of 3971 patients undergoing RP for prostate cancer at our institution between1978-2009 revealed 1053 patients with PSM, out of whom 814 received no hormone therapy. The initial 175 patients were selected to maximize available follow-up, and their slides were re-reviewed for following parameters: length of PSM (mm), maximum Gleason score at PSM, and maximal extension of PSM (intraprostatic incision vs. extracapsular extension). Data was available in 107 patients who are the subject of this study. Multivariable Cox regression models were used to evaluate the impact of above features as well as age, preoperative PSA, pathologic Gleason score, stage and adjuvant radiotherapy on biochemical and clinical recurrence-free survival (RFS), and overall survival (OS). Results: Median follow-up was 17.6 years. Maximum extension of PSM was limited to intraprostatic incision in 63 (58.9%) and extracapsular in 44(41.1%) patients. Median length of PSM was 4 mm (range 1-55 mm); 41 (38.3%) with <3mm and 66 (61.7%) with >4mm. Maximum Gleason score at PSM was <6 in 70 (66.0%) and >7 in 36 (34%) patients. 10-yr PSA RFS, clinical RFS, and OS were 60.2%, 80.7%, and 60.2%, respectively. Multivariable Cox regression modeling showed the length of PSM >4mm and extracapsular extension as independent predictors of PSA RFS and clinical RFS. Age and extracapsular extension were independent predictors of OS. Conclusions: PSM >4mm and extracapsular extension have a higher risk of PSA and clinical recurrence after RP. These findings can help decision-making regarding adjuvant therapy in patients with PSM and should be reported by pathologists in addition to the presence of PSM. [Table: see text]

Download Full-text

A comparative study of the fracture union between long and short proximal femoral intramedullary nails antirotation in the treatment of intertrochanteric femur fractures in the elderly: a multicentric analysis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190793 ◽

2019 ◽

Vol 5 (2) ◽

pp. 288

Author(s):

B. Hari Krishnan ◽

S. K. Rai ◽

Rohit Vikas ◽

Manoj Kashid ◽

Pramod Mahender

Keyword(s):

Postoperative Complications ◽

Blood Transfusion ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Operation Time ◽

The Elderly ◽

Intertrochanteric Fractures ◽

Intraoperative Blood Loss ◽

Fracture Union ◽

Femur Fractures

Background: The objective of the study was to compare the fracture union of long vs. short proximal femoral intramedullary nail antirotation (PFNA) in the treatment of intertrochanteric fractures in elderly patients who was more than 60 years old.Methods: A retrospective analysis of 170 cases of intertrochanteric fractures of the femur (AO type A1 and A2) in the elderly was conducted. There were 64 males (37.6%) and 106 females (62.3%) with the age of 60–90 (mean age 75) years. The general demographic data of patients, operation time, intraoperative blood loss, length of hospital stay, blood transfusion rate, anterior thigh pain, postoperative complications like periprosthetic fractures, infections were recorded.Results: The short nail group also had a significantly shorter operation time (41.5±15.3 minutes vs. 62.5±25.3 minutes, p=0.002) and lower rate of postoperative transfusion (31.3% vs. 58.7%, p=0.041). However the length of hospital stay showed no significant differences. After surgery in short group there were 03 cases of periprosthetic fracture with a total incidence of 03%, however there were none in long nail group. At the end of the follow-up, all patients achieved bony union. The average fracture union time of the long nail group was (8.5±3.2) months, and the short nail group was (7.8±4.7) months, revealing no significant differences (p=0.09).Conclusions: Both the proximal femoral intramedullary long and short nail fixation has a good result in the form of fracture union in treating intertrochanteric femur fractures in the elderly. They showed no significant difference in terms of fracture union, hospital stay, and postoperative complications. The incidence of periprosthetic fractures and anterior thigh pain was slightly high in short nail group. In short intramedullary nailing group there was obvious decrease in the intraoperative blood loss, operation time and postoperative blood transfusion.

Download Full-text