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 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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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).</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

scholarly journals Application of Wire-Assisted Reduction Guided by Minimally Invasive Wire Introducer in the Treatment of Irreducible Femoral Intertrochanteric Fractures

2020 ◽  
Author(s):  
Xiaocong Lin ◽  
Xiuxi Huang ◽  
Kaibin Fang ◽  
Qingfeng Ke ◽  
Shaojian Shi ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Open Reduction ◽  
Intertrochanteric Fracture ◽  
Operation Time ◽  
Fracture Reduction ◽  
Control Group ◽  
Intertrochanteric Fractures ◽  
Observation Group ◽  
Reduction Operation ◽  
Femoral Intertrochanteric Fracture

Abstract Background: Open reduction was often required in the treatment of irreducible femoral intertrochanteric fractures. A minimally invasive wire introducer was designed to assist the reduction of such fractures. The aim of our study was to investigate the clinical outcomes of this technique.Methods: Between 2013 and 2018, 92 femoral intertrochanteric fracture patients who were treated with intramedullary nail fixation and difficult reduction using the traction beds were retrospectively reviewed. Decision for surgery was based on the displacement of the fracture. The patients was divided into two groups, 31 in the control group and 61 in the observation group. The control group were received open reduction operation. And the observation group still received the closed reduction operation, using minimally invasive wire introducer to guide the wire and assist the fracture reduction. The operation time, blood loss, VAS scores, angulation, reduction, neck-shaft angle, redisplacement, limb length discrepancy, and union time were recorded.Results: All patients of two groups were successfully operated and were followed up for an average of 23.8 months. There was no statistical difference in baseline data between the two groups. The observation group had shorter operation time, lower VAS score and less intraoperative bleeding. And the datas are statistically different.Conclusion: Minimally invasive wire introducer is a good technology to guide the wire for irreduciblr femoral intertrochanteric fracture reduction. Using this technique, irreduciblr femoral intertrochanteric fractures could be restored and good clinical outcome was achieved.Level of evidence: Level IV; Case Series; Treatment Study

scholarly journals Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients

2019 ◽  
Vol 5 (3) ◽  
pp. 458
Author(s):  
Nikil Sanaba Paramesh ◽  
Usman Taufiq
Keyword(s):  
Femoral Neck ◽  
Blood Loss ◽  
Elderly Patients ◽  
Operation Time ◽  
Reoperation Rate ◽  
Femoral Neck Fractures ◽  
Intraoperative Blood Loss ◽  
Cerebrovascular Complications ◽  
Uncemented Hemiarthroplasty ◽  
Hip Function

<p class="abstract"><strong>Background:</strong> Controversy still exists regarding using cemented or uncemented hemiarthroplasty for femoral neck fractures in elderly patients. The aim of this study is to compare the effectiveness and safety of the two surgical techniques in femoral neck fracture patients over 60 years old.</p><p class="abstract"><strong>Methods:</strong> We searched PUBMED from inception to December 2012 for relevant randomized controlled trials (RCTs). Outcomes of interest include postoperative hip function, residue pain, complication rates, mortality, reoperation rate, operation time and intraoperative blood loss. Odds ratios (OR) and weighted mean differences (WMD) from each trial were pooled using random-effects model or fixed-effects model given on the heterogeneity of the included studies.<strong></strong></p><p class="abstract"><strong>Results:</strong> Our control trial involved 132 patients (132 hips) who were eligible for the study. Our results demonstrate that cemented hemiarthroplasty is associated with better postoperative hip function (OR = 0.48, 95% CI, 0.31–0.76; p = 0.002), lower residual pain (OR = 0.43, 95%CI, 0.29–0.64; p&lt;0.0001), less implant-related complications (OR = 0.15, 95%CI, 0.09–0.26; p&lt;0.00001) and longer operation time (WMD = 7.43 min, 95% CI, 5.37–9.49 min; p&lt;0.00001). No significant difference was observed between the two groups in mortality, cardiovascular and cerebrovascular complications, local complications, general complications, reoperation rate and intraoperative blood loss.</p><p class="abstract"><strong>Conclusions:</strong> Compared with uncemented hemiarthroplasty, the existing evidence indicates that cemented hemiarthroplasty can achieve better hip function, lower residual pain and less implant-related complications with no increased risk of mortality, cardiovascular and cerebrovascular complications, general complications, local complications and reoperation rate in treating elderly patients with femoral neck fractures.</p>

scholarly journals Does 3D-Assisted Acetabular Fracture Surgery Improve Surgical Outcome and Physical Functioning?—A Systematic Review

2021 ◽  
Vol 11 (10) ◽  
pp. 966
Author(s):  
Anne M. L. Meesters ◽  
Neeltje M. Trouwborst ◽  
Jean-Paul P. M. de Vries ◽  
Joep Kraeima ◽  
Max J. H. Witjes ◽  
...  
Keyword(s):  
Blood Loss ◽  
Physical Functioning ◽  
Acetabular Fracture ◽  
Three Dimensional ◽  
Operation Time ◽  
Fracture Reduction ◽  
Intraoperative Blood Loss ◽  
Odds Ratios ◽  
Conventional Surgery ◽  
Fracture Surgery

Three-dimensional technology is increasingly being used in acetabular fracture treatment. No systematic reviews are available about the added clinical value of 3D-assisted acetabular fracture surgery compared to conventional surgery. Therefore, this study aimed to investigate whether 3D-assisted acetabular fracture surgery compared to conventional surgery improves surgical outcomes in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy usage, complications, and postoperative fracture reduction, and whether it improves physical functioning. Pubmed and Embase databases were searched for articles on 3D technologies in acetabular fracture surgery, published between 2010 and February 2021. The McMaster critical review form was used to assess the methodological quality. Differences between 3D-assisted and conventional surgery were evaluated using the weighted mean and odds ratios. Nineteen studies were included. Three-dimensional-assisted surgery resulted in significantly shorter operation times (162.5 ± 79.0 versus 296.4 ± 56.0 min), less blood loss (697.9 ± 235.7 mL versus 1097.2 ± 415.5 mL), and less fluoroscopy usage (9.3 ± 5.9 versus 22.5 ± 20.4 times). The odds ratios of complications and fracture reduction were 0.5 and 0.4 for functional outcome in favour of 3D-assisted surgery, respectively. Three-dimensional-assisted surgery reduces operation time, intraoperative blood loss, fluoroscopy usage, and complications. Evidence for the improvement of fracture reduction and functional outcomes is limited.

scholarly journals MutiLoc Nail Versus Philos Plate in Treating Proximal Humeral Fractures: A Retrospective Study Among the Alderly

2021 ◽  
Vol 12 ◽  
pp. 215145932110439
Author(s):  
Guoyun Bu ◽  
Weitang Sun ◽  
Jian’an Li ◽  
Tao Yang ◽  
Mingxin Li ◽  
...  
Keyword(s):  
Blood Loss ◽  
Elderly Patients ◽  
Operation Time ◽  
The Elderly ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Plate Group ◽  
Philos Plate ◽  
Fracture Types

Background Proximal humeral fractures (PHFs) account for 4–5% of all fractures in the elderly. There is still a controversy among the treatments in the displaced PHFs. Our aim was to explore the clinical outcome of PHFs with the treatment of MultiLoc nail or Philos plate in the elderly patients. Methods A total of 82 sustained elderly patients with PHFs were finally recruited between Dec 2016 and Dec 2017. 34 patients were treated with MultiLoc nail and 48 patients were treated with Philos plate. The demographics, fracture types, blood loss, operation time, union time, postoperative complications, visual analog scores (VASs), Constant scores, American Shoulder and Elbow Scores (ASESs), and neck-shaft-angle (NSA) between the two groups were compared. Results No differences were observed in the demographics, fracture types, VAS, Constant scores, and ASES scores between the two groups at final follow-up. Compared with the plate group, the blood loss, operation time, and union time were significantly lower in the nail group (all P < .05). The rate of general complications was 54.17% in the plate group, which was higher than that in the nail group (26.47%, P = .01). Three patients experienced reoperation in the plate group (3/48; 6.25%), but none in the nail group. Although there were no significant differences in intraoperative NSA between the two groups, the NSA at final follow-up in the nail group was much higher than the plate group (137.55 ± 5.53°vs 134.47 ± 5.92°, P = .02). Conclusions Multiloc intramedullary nail showed the similar effectiveness of final VAS, final Constant scores, and ASES scores in PHFs treatment with Philos plate. However, MultiLoc nail is superior to Philos plate in blood loss, operation time, complications, reoperation rate, and the change of NSA.

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 Proximal femoral nail anti-rotation versus cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture in the elderly: a retrospective study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Shenghu Zhou ◽  
Jun Liu ◽  
Ping Zhen ◽  
Weiwei Shen ◽  
Yanfeng Chang ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Elderly Patients ◽  
Intertrochanteric Fracture ◽  
Operation Time ◽  
The Elderly ◽  
Proximal Femoral Nail ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Fractures ◽  
Intraoperative Bleeding ◽  
Femoral Intertrochanteric Fracture

Abstract Background The treatment for unstable intertrochanteric fractures in the elderly has always been a controversial issue. The aim in this study was to compare the curative effects of proximal femoral nail anti-rotation (PFNA) and cementless bipolar hemiarthroplasty (CPH) on femoral intertrochanteric fracture in the elderly. Methods From March 2008 to December 2012, 108 elderly patients with femoral intertrochanteric fractures were treated by PFNA or CPH. There were 63 males and 45 females, aged 75.3–99.1 years [(83.7 ± 5.6) years]. The patients’ bone mineral density was routinely measured, and the fractures were classified according to Evans-Jensen. The patients were divided into CPH group and PFNA group. The differences in operation time, intraoperative bleeding, immobilization duration, hospitalization time, Harris scores and postoperative complications including deep venous thrombosis, lung and urinary infection were analyzed. Results All patients were followed for 12.5–36.2 months [(28.0 ± 6.3) months)]. The operation time was (53.7 ± 15.2) min and (77.5 ± 16.8) min in PFNA group and CPH group, respectively (P < 0.05); intraoperative bleeding was (132.5 ± 33.2) mL and (286.3 ± 43.2) mL, respectively (P < 0.05); immobilization duration was (28.2 ± 3.7) days and (3.1 ± 1.2) days, respectively (P < 0.05); hospitalization time was (7.6 ± 1.8) days and (6.9 ± 2.2) days, respectively (P > 0.05); and the Harris scores after 1 year were (87.7 ± 7.9) points and (88.3 ± 9.2) points, respectively (P > 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05). Conclusion Both PFNA and CPH are safe and effective treatments for femoral intertrochanteric fracture in elderly patients. Nonetheless, CPH allows faster mobilization and recovery. Trial registration Registration Number: ChiCTR1900022846. Reg Date:2019-04-26 00:27:33 Retrospective registration

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.

THE FEASIBILITY OF FAST TRACK PROTOCOL FOR ELDERELY PATIENTS WITH COLORECTAL CANCER

2016 ◽  
pp. 26-29
Author(s):  
D. . Zitta ◽  
V. . Subbotin ◽  
Y. . Busirev
Keyword(s):  
Colorectal Cancer ◽  
Colorectal Surgery ◽  
Blood Loss ◽  
Elderly Patients ◽  
Fast Track ◽  
Randomized Study ◽  
Conventional Group ◽  
Intraoperative Blood Loss ◽  
Elective Colorectal Surgery ◽  
Complications Rate

Fast track protocol is widely used in major colorectal surgery. It decreases operative stress, shortens hospital stay and reduces complications rate. However feasibility and safety of this approach is still controversial in patients older than 70 years. The AIM of the study was to estimate the safety and effectiveness of fast track protocol in elderly patients with colorectal cancer. MATERIALS AND METHODS. Prospective randomized study included 138 elective colorectal resectionfor cancer during period from 1.01.10 till 1.06.15. The main criteria for the patients selection were age over 70 years and diagnosis of colorectal cancer. 82 of these patients received perioperative treatment according to fast track protocol, other 56 had conventional perioperative care. Patients underwent following procedures: right hemicolectomy (n=7), left hemicolectomy (n=12), transverse colectomy (n=1), sigmoidectomy (n=23), abdomeno-perineal excision (n=19) and low anterior resection of rectum (n=76). Following data were analized: duration of operation, intraoperative blood loss, time offirst flatus and defecation, complications rates. RESULTS. Mean age was 77,4 ± 8 years. There were no differences in gender, co morbidities, body mass index, types of operations between groups. Duration of operations didn't differ significantly between 2 groups. Intraoperative blood loss was higher in conventional group. The time of first flatus and defecation were better in FT-group. There was no mortality in FT-group vs 1,8 %o mortality in conventional group. Complications rate was lower in FT-group: wound infections 3,6% vs 9 %, anastomotic leakage 4,8 %o vs 9 %o, ileus 1,2 vs 5,4 %o, peritonitis 2,4 %o vs 3,6%o, bowel obstruction caused by the adhesions 6 % vs 5,3 %. Reoperation rate was similar 4,8 % vs 3,6 %. CONCLUSION. Fast track protocol in major elective colorectal surgery can be safely applied in elderly patients. The application of fast track protocol in elderly patients improves the restoration of bowel function and reduces the risk of postoperative complication.

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