scholarly journals Arthroplasty Is Not Superior Than Internal Fixation for Intertrochanteric Fractures in the Elderly: a Meta-analysis

2021 ◽  
Author(s):  
Kexiao Yu ◽  
Weizhong Lu ◽  
Qiuke Xiao ◽  
Ruijie Wan ◽  
Lujue Dong ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Internal Fixation ◽  
Meta Analysis ◽  
Operation Time ◽  
The Elderly ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Increased Risk ◽  
Significant Difference

Abstract Background: Surgical treatment is the first choice for intertrochanteric fractures in the elderly as it allows early rehabilitation and functional recovery. Recently, more and more surgeons prefer arthroplasty instead of internal fixation in the treatment of senile intertrochanteric fractures. However, there is conflicting evidence as to which is the best surgical treatment for them. In this article, we performed a systematic review and meta-analysis to compare the clinical effectiveness of internal fixation (IF) and arthroplasty (AR) for intertrochanteric fractures in the elderly. Methods: The online databases of PubMed, Cochrane Database, and Web of Science were searched to include studies conducted from 01/01/2000 to 11/30/2018 in English using keywords to identify articles relevant to this study. All studies had to have evaluated the treatment of patients with intertrochanteric fractures in the elderly(≥60 years of age). The quality of the trials was assessed and meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.3 version. Results: A total of 14 studies involving a total of 1588 patients were suitable for inclusion in this meta-analysis. There was no significant difference between the IF and AR groups for postoperative complications-related general condition (OR=1.24; 95% CI= 0.90, 1.70; P=0.19), hospital stay (SMD=0.16; 95% CI= -0.5, 0.82; P =0.64), and Harris hip score (SMD= -0.12; 95% CI= -0.79, 0.54; P =0.71). AR group had a significantly lower rate of complications-related operation (OR= 2.21; 95% CI= 1.41, 3.45; P=0.0005) and reoperation (OR=2.74; 95% CI= 1.57, 4.76; P=0.0004). However, compared with AR group, IF group could reduce the blood loss (OR=-4.08; 95% CI=-4.58, -3.59; P<0.00001), transfusion requirement (SMD= -0.67; 95% CI= -1.08, -0.26; P=0.001), operation time (SMD= -0.80; 95% CI= -1.47, -0.12; P < 0.00001), and have a lower rate of mortality within 1-year (OR= 0.67; 95% CI= 0.52, 0.86; P=0.002).Conclusion: AR is associated with less rates of complications-related operation and reoperation but has an increased risk of blood loss, transfusion, operation time and mortality within 1-year. Our findings demonstrated that AR does not have significant advantages over IF for intertrochanteric fractures in the elderly.

scholarly journals Arthroplasty versus internal fixation for intertrochanteric fractures in the elderly: A meta-analysis

2020 ◽  
Author(s):  
Kexiao Yu ◽  
Weizhong Lu ◽  
Qiuke Xiao ◽  
Ruijie Wan ◽  
Lujue Dong ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Internal Fixation ◽  
Meta Analysis ◽  
Operation Time ◽  
The Elderly ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Increased Risk ◽  
Significant Difference

Abstract Background Surgical treatment is the first choice for intertrochanteric fractures in the elderly as it allows early rehabilitation and functional recovery. Recently, more and more surgeons prefer arthroplasty instead of internal fixation in the treatment of senile intertrochanteric fractures. However, there is conflicting evidence as to which is the best surgical treatment for them. In this article, we performed a systematic review and meta-analysis to compare the clinical effectiveness of internal fixation (IF) and arthroplasty (AR) for intertrochanteric fractures in the elderly. Methods The online databases of PubMed, Cochrane Database, and Web of Science were searched to include studies conducted from 01/01/2000 to 11/30/2018 in English using keywords to identify articles relevant to this study. All studies had to have evaluated the treatment of patients with intertrochanteric fractures in the elderly(≥ 60 years of age). The quality of the trials was assessed and meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.3 version. Results A total of 14 studies involving a total of 1588 patients were suitable for inclusion in this meta-analysis. There was no significant difference between the IF and AR groups for postoperative complications-related general condition (OR = 1.24; 95% CI = 0.90, 1.70; P = 0.19), hospital stay (SMD = 0.16; 95% CI= -0.5, 0.82; P = 0.64), and Harris hip score (SMD= -0.12; 95% CI= -0.79, 0.54; P = 0.71). AR group had a significantly lower rate of complications-related operation (OR = 2.21; 95% CI = 1.41, 3.45; P = 0.0005) and reoperation (OR = 2.74; 95% CI = 1.57, 4.76; P = 0.0004). However, compared with AR group, IF group could reduce the blood loss (OR=-4.08; 95% CI=-4.58, -3.59; P < 0.00001), transfusion requirement (SMD= -0.67; 95% CI= -1.08, -0.26; P = 0.001), operation time (SMD= -0.80; 95% CI= -1.47, -0.12; P < 0.00001), and have a lower rate of mortality within 1-year (OR = 0.67; 95% CI = 0.52, 0.86; P = 0.002). Conclusion AR is associated with less rates of complications-related operation and reoperation but has an increased risk of blood loss, transfusion, operation time and mortality within 1-year. Our findings demonstrated that AR does not have significant advantages over IF for intertrochanteric fractures in the elderly.

Predictive Value of Charlson Comorbidity Index and Cofactors on 2-Year Mortality in Older Patients With Intertrochanteric Fractures: A Retrospective Analysis

2021 ◽  
Author(s):  
Jianda Xu ◽  
Homma Yasuhiro ◽  
Yuta Jinnai ◽  
Tomonori Baba ◽  
Zhuang Xu ◽  
...  
Keyword(s):  
Blood Loss ◽  
Older Patients ◽  
Demographic Data ◽  
Survival Rates ◽  
Operation Time ◽  
Intertrochanteric Fractures ◽  
Time Out ◽  
Time Operation ◽  
Significant Difference ◽  
First Time

Abstract The aim of this study was to evaluate the role of Charlson comorbidities index (CCI) and cofactors on 2-year mortality in older patients with intertrochanteric fractures. 60 cases with unilateral intertrochanteric fracture were retrospectively analyzed and divided into Low-CCI group (CCI: 1-4) or high-CCI groups (CCI: 5-6). All the patients’ electronic hospital records were reviewed. The preoperative situations (demographic data, comorbidities and fracture conditions), perioperative situations (wait time, operation time, implant choice, blood loss, transfusion or not) and postoperative situations (complications, first time out of bed, function about 1-/2- week and 2-year mortality) were recorded. 51.67% were in low-CCI group and 48.33% in high-CCI group. The survival rates in low- and high-CCI group were 93.5% and 86.2 % respectively. According to the functional results of 1- or 2- week after operation, no significant difference was found (P=0.955, 0.140). Log-rank analysis showed that the main prognostic factors were blood loss, first time out of bed and complication (P<0.05). Multivariate analysis confirmed that complication and first time out of bed were significant factor on survival rate (P=0.029, 0.010). Charlson comorbidities index maybe not the indicator of 2-year mortality in older patients with intertrochanteric fractures. In order to improve the prognosis, more attentions should be paid to reduce the complications and encourage postoperative earlier excise out of bed.

Computed Tomographic Image Analysis of Proximal Femoral Nail Antirotation and Dynamic Hip Screw in the Treatment of Intertrochanteric Fractures

2019 ◽  
Vol 9 (8) ◽  
pp. 1746-1752
Author(s):  
Yugang Teng ◽  
Yuanzhen Zhang ◽  
Zhenyu Wang
Keyword(s):  
Image Analysis ◽  
Postoperative Complications ◽  
Internal Fixation ◽  
The Elderly ◽  
Healing Time ◽  
Intertrochanteric Fractures ◽  
Ct Image ◽  
Analysis Technique ◽  
Significant Difference ◽  
Ct Image Analysis

Objective: Based on the observation of Computed Tomography (CT) image analysis technique, the efficacy of Proximal Femoral Nail Antirotation (PFNA) and Dynamic hip screw (DHS) in the treatment of intertrochanteric fractures in the elderly was analyzed. Methods: Thirty-nine elderly patients with unstable intertrochanteric fractures were randomly divided into two groups: 19 patients in the DHS internal fixation group and 20 patients in the PFNA group. They were treated with DHS and PFNA internal fixation, and were observed based on CT image analysis techniques. The patient performs follow-up testing of the procedure before and after surgery. Results: There was a statistically significant difference in mean operative time and intraoperative blood loss between the groups (P < 0.01). The incidence of intraoperative and postoperative complications was statistically different between the two groups (P < 0.05). The incidence of postoperative and postoperative complications in the PFNA group was lower than that in the DHS group. The excellent and good rates of DHS group and PFNA group were 89.47% and 95.00%, respectively. There was no significant difference between the two groups (P > 0.05). There was a significant difference in fracture healing time between the PFNA group and the DHS group (P < 0.01). Discussion: Compared with DHS, PFNA has the advantages of short operation time, low bleeding volume and short hospital stay. There were 7 cases of internal fixation failure or non-union in the DHS group and 1 case of delayed healing in the PFNA group. Conclusion: DHS and PFNA were used to treat intertrochanteric fractures in the elderly. After observation by CT image analysis technique, there was no significant difference in efficacy. The average operative time of PFNA was the shortest, the intraoperative blood loss was the least, the incidence of intraoperative and postoperative complications was low, and the fracture healing time was short. PFNA has a lesser effect on the blood circulation and bone destruction at the fracture end, and it is more secure. It is a reasonable surgical method for the treatment of senile osteoporotic intertrochanteric fractures.

Robotic-assisted Ivor-Lewis esophagectomy in the elderly patient.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 93-93
Author(s):  
Andrea M. Abbott ◽  
Tobin Joel Crill Strom ◽  
Nadia Saeed ◽  
Ravi Shridhar ◽  
Sarah E. Hoffe ◽  
...  
Keyword(s):  
Blood Loss ◽  
The Elderly ◽  
Separate Analysis ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Ivor Lewis Esophagectomy ◽  
Estimated Blood Loss ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact

93 Background: Esophageal cancer continues to increase in incidence worldwide with the age of diagnosis continuing to move towards an older onset. Robotic assisted approaches to esophagectomy have demonstrated decreased complications and length of hospitalization (LOH). We sought to examine the impact of age on outcomes in patients undergoing robotic assisted esophagectomy (RAIL). Methods: From 2009-2013, we identified patients undergoing robotic assisted Ivor Lewis esophagectomy. Patients were then stratified according to 3 age groups. Cohort 1, age less then 50, cohort 2, age 50-70, and cohort 3 >70. Statistical comparisons between LOH, operative time (OT), estimated blood loss (EBL), adverse events (AE) and mortality were made with Kruskal-Wallis and Chi-square tests. Results: We identified 134 patients who underwent RAIL and found no statistically significant difference between the three cohorts for OT, LOH, days spent in intensive care, AE or mortality. There was a difference in EBL with higher median blood loss (150 cc) seen in cohort 1 (50-600cc) and 3 (50-400cc) compared to cohort 2 (100 cc, (25-400cc)), p < 0.01. The most common AE were arrhythmia and pneumonia but this was not significantly different between the cohorts. The overall AE rate was 10% (cohort 1), 21% (cohort 2), 34% (cohort 3), p=0.14. There were 4 leaks (p =0.38) and 2 deaths (p=0.90) in the entire cohort. A separate analysis was done to compare elderly (>70) to the non-elderly (<70). Median EBL was higher in the elderly cohort (100cc (25-600) vs 150cc (50-400), p <0.01). There was a trend towards longer LOH in the elderly (9 (4-35) vs 11 (6-38) days, p =0.06). AE and mortality were not significantly different, although there was a trend toward increased AE (19.8% vs 34%, p=0.07) in the elderly, with arrhythmia being the most common AE. Conclusions: RAIL is a safe surgical technique for use in an aging patient population. We demonstrated there was no increased risk of LOH, AE or death in the elderly patients compared to their younger cohort.

scholarly journals Transforaminal and Posterior Lumbar Interbody Fusion for Llumbar Degenerative Diseases, which one is better: A meta-analysis Through a Ggrade Analysis of Evidence

2021 ◽  
Author(s):  
aixian tian ◽  
xinlong ma ◽  
jianxiong Ma
Keyword(s):  
Blood Loss ◽  
Interbody Fusion ◽  
Meta Analysis ◽  
Posterior Lumbar Interbody Fusion ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Lumbar Interbody Fusion ◽  
Significant Difference

Abstract BackgroundTo explore the efficacy and safety between posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar degenerative diseases.MethodsWe searched the literature in Pubmed, Embase, Cochrane Library and Web of Science. The index words were posterior lumbar interbody fusion, PLIF, transforaminal lumbar interbody fusion, TLIF, lumbar interbody fusion, spinal fusion, degenerative disc disease and lumbar degenerative diseases. Primary outcomes were fusion rate and complications. Secondary outcomes were visual analog scale (ΔVAS), Oswestry Disability Index (ΔODI), total blood loss, operation time and length of hospital stay. Review Manager 5.3 and Stata13.1 was used for the analysis of forest plots, heterogeneity, sensitivity and publication bias.Results17 studies were included (N=1562; PLIF, n=835; TLIF, n=727). The pooled data showed PLIF had a higher complications (P= 0.000), especially in nerve injury (p = 0.003) and dural tear (p = 0.005). PLIF required longer operation time (p = 0.004), more blood loss (p = 0.000) and hospital stays (p = 0.006). Surprisingly subgroup analysis showed there was significant difference in complications in patients under 55 (p = 0.000) and Asian countries (p = 0.000). No statistical difference was found between the two groups with regard to fusion rate (p = 0.593),ΔVAS (p = 0.364) andΔODI (p = 0.237).ConclusionsThis meta-analysis showed there were no significant difference in fusion rate, ΔVAS and ΔODI. However TLIF could reduce complications, especially nerve injury and dural tear. Besides, TLIF was associated with statistically significant less blood loss, shorter operation time and shorter length of hospital stay.

scholarly journals Comparison of Clinical Outcomes With Proximal Femoral Nail Anti-rotation Versus Bipolar Hemiarthroplasty for the Treatment of Elderly Intertrochanteric Fractures

2021 ◽  
Author(s):  
Wen-Bo Wei ◽  
Sha-Jie Dang ◽  
Ling Wei ◽  
MengXi Xin
Keyword(s):  
Postoperative Complications ◽  
Operation Time ◽  
The Elderly ◽  
Proximal Femoral Nail ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Fractures ◽  
Hospitalization Time ◽  
Femoral Nail ◽  
Time Operation ◽  
Significant Difference

Abstract Background: Although proximal femoral nail anti-rotation (PFNA) and bipolar hemiarthroplasty (BHA) are selected by most of the orthopaedic surgeons for elderly intertrochanteric fractures (ITFs) patients, there is still no consensus on the superiority of PFNA and BPH for ITFs in the elderly. The study aims to compare the curative effects of proximal femoral nail anti-rotation (PFNA) and cementless bipolar hemiarthroplasty (BHA) on ITFs in the elderly. Methods: From January 2012 to December 2016, a total of 62 patients participated in the study: BHA (Group B, n=30), PFNA (Group P, n=32). The fractures were classified according to Evans-Jensen. Hospitalization time, operation time, bleeding loss, Harris scores and postoperative complications were compared between the two groups. Results: The operation time was (125.76 ± 33.49) min and (94.38 ± 20.94) min in PFNA group and BHA group (P < 0.05); bleeding loss was (153.33 ± 59.96) mL and (335.31 ± 90.87) mL(P < 0.05); hospitalization time was (17.13 ± 2.92) days and (16.63 ± 3.64) days (P > 0.05); and the Harris scores were (73.20 ± 6.56) points and (68.91 ± 8.15) points (P < 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05). Conclusion: Both PFNA and BHA are safe and effective treatments for femoral intertrochanteric fractures in elderly patients. Nonetheless, BHA can be considered for those with the poor bone condition and short life expectancy.

scholarly journals Intracortical Screw Insertion Plus Limited Open Reduction in Treating Type 31A3 Irreducible Intertrochanteric Fractures in the Elderly

2021 ◽  
Author(s):  
Xiao-wen Huang ◽  
Gu-qi Hong ◽  
Qiang Zuo ◽  
Chen Qun
Keyword(s):  
Blood Loss ◽  
Elderly Patients ◽  
Open Reduction ◽  
Operation Time ◽  
The Elderly ◽  
Fracture Reduction ◽  
Intertrochanteric Fractures ◽  
X Rays ◽  
Intraoperative Blood Loss ◽  
Screw Insertion

Abstract Objective: To discuss the clinical efficacy of intracortical screw insertion plus limited open reduction in treating type 31A3 irreducible intertrochanteric fractures in the elderly. Methods: A retrospective analysis was performed for 23 elderly patients with type 31A3 irreducible intertrochanteric fractures (12 males and 11 females, aged 65-89 years old, with an average of 75.6±5.1 years old) who received treatment at the orthopedics department of our hospital from September 2017 to August 2019. After type 31A3 irreducible intertrochanteric fractures were confirmed by intraoperative C-arm, all of these cases received intracortical screw insertion plus limited open reduction in the broken end with intramedullary screw internal fixation. The basic information of surgery, reduction effects, and FRS scores of the hip joint were assessed. Results: All patients were followed up for an average of 13.8 months. The operation time was 53.8±13.6min (40-95min). The intraoperative blood loss was 218.5±28.6ml (170-320ml). The average number of intraoperative X-rays was 22.8±4.6 (18-33). The average time to fracture union was 4.8±0.7 months. The reduction effect was assessed using Kim's fracture reduction evaluation. 20 cases achieved grade I fracture reduction and 3 cases grade II fracture reduction. All of them achieved excellent or good fracture reduction. Upon the last follow-up, the FRS score was 83.6±9.8, which was not significantly different from the FRS score (84.8±10.7) before the fracture (t= 0.397, P= 0.694). Conclusion: With careful preoperative preparation, intracortical screw insertion plus limited open reduction could achieve high-quality fracture reduction and fixation in elderly patients with type 31A3 irreducible intertrochanteric fractures. Good clinical outcomes were achieved without increasing operation time and intraoperative blood loss.

scholarly journals Percutaneous Compression Plate versus Dynamic Hip Screw for Treatment of Intertrochanteric Hip Fractures: A Meta-Analyse of Five Randomized Controlled Trials

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Lei Zhang ◽  
Jie Shen ◽  
Shengpeng Yu ◽  
Qiang Huang ◽  
Zhao Xie
Keyword(s):  
Blood Loss ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Operation Time ◽  
Dynamic Hip Screw ◽  
Plate Versus ◽  
Controlled Trials ◽  
Intertrochanteric Fractures ◽  
Randomized Controlled ◽  
Hip Screw

Background. Percutaneous compression plating (PCCP) has been advocated to reduce blood loss, relieve pain, and lead to faster rehabilitation for the treatment of intertrochanteric fractures. The purpose of this meta-analysis was to estimate the outcomes and complications of the PCCP versus dynamic hip screw (DHS) fixation for intertrochanteric fractures.Methods. All randomized controlled trials (RCT) that compared PCCP with DHS in treating adult patients with intertrochanteric fractures were included. Main outcomes were collected and analysed using the RevMan 5.1 version.Results. Five trials met the inclusion criteria. Compared with DHS, PCCP had similar operation time (95% CI: −26.01~4.05,P= 0.15), length of hospitalization (95% CI: −1.79~1.25,P= 0.73), mortality (95% CI: 0.37~1.02,P= 0.06), incidence of implant-related complications (95% CI: 0.29~1.82,P= 0.49), and reoperation rate (95% CI: 0.41~3.05,P= 0.83). But blood loss (95% CI: −173.84~−4.81,P= 0.04) and transfusion need (95% CI: −0.53~−0.07,P= 0.01) significantly favored the PCCP.Conclusions. The PCCP was associated with reduced blood loss and less transfusion need, but similar to DHS in other respects. Owing to the limitations of this systematic review, more high-quality RCTs are still needed to assess the clinical efficiency of PCCP.

scholarly journals Direct anterior versus posterolateral approaches for clinical outcomes after total hip arthroplasty: a systematic review and meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Wang Chen ◽  
Jian-Ning Sun ◽  
Ye Zhang ◽  
Yu Zhang ◽  
Xiang-Yang Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Operative Time ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Direct Anterior Approach ◽  
Harris Hip Score ◽  
Cochrane Library

Abstract Objective The main objective of our study was to compare the intraoperative and postoperative outcomes of direct anterior approach (DAA) with posterolateral approaches (PLA). Methods We searched Cochrane library, Web of Science, and PubMed for literatures comparing DAA with PLA. On the basis of inclusion and exclusion criteria, relevant literatures were selected. Two members independently screened qualified literatures, evaluated the literature quality, and extracted data information. Results Eighteen randomized controlled trials (RCTs) and non-RCTs totaling 34,873 patients (DAA = 9636, PLA = 25237) were contained in this systematic review and meta-analysis. The results showed that DAA were reduced in terms of length of hospital stay (weighted mean difference (WMD) = −0.43, 95% confidence interval (CI) −0.78 to −0.09, P = 0.01), LLD (WMD = −2.00, 95% CI −2.75 to −1.25, P < 0.00001), PE/DVT (WMD = 0.36, 95% CI 0.15 to 0.85, P = 0.02), dislocation (WMD = 0.42, 95% CI 0.30 to 0.59, P < 0.00001) and visual analog scale (VAS) (WMD = −0.57, 95% CI −0.91 to −0.23, P = 0.0009) compared with PLA; however, DAA compared with the PLA was increasing in terms of operative time (WMD = 14.81, 95% CI 7.18 to 22.44, P = 0.0001), intraoperative blood loss (WMD = 105.13, 95% CI 25.35 to 184.90, P = 0.01), fracture (WMD = 1.46, 95% CI 1.00 to 2.11, P = 0.05), and Harris hip score (HHS) (WMD = 1.19, 95% CI 0.77 to 1.61, P < 0.00001). Conclusions DAA was preferable effectiveness to PLA in early pain relief and functional recovery; however, PLA has a shorter operation time, intraoperative less blood loss and fracture. Trial registration Registration ID, CRD42020151208

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