Arthroplasty vs proximal femoral nails for unstable intertrochanteric femoral fractures in elderly patients: a systematic review and metaanalysis

BACKGROUND Proximal femoral nails(PFNs)are the most common method for the treatment of unstable intertrochanteric femoral fractures(IFFs),but postoperative bed rest is required.There is a large amount of blood loss during the operation.Osteoporosis in elderly patients may cause nonunion of fractures and other complications.Arthroplasty can give patients early weight bearing and reduce financial burden,but whether it can replace PFNs remains controversial.AIM To compare the clinical outcomes of arthroplasty and PFNs in the treatment of unstable IFFs in elderly patients.METHODS A search was conducted in the PubMed,Embase,and Cochrane Library databases and included relevant articles comparing arthroplasty and PFN.The search time was limited from January 1,2005 to November 1,2020.Two investigators independently screened studies,extracted data and evaluated the quality according to the inclusion and exclusion criteria.According to the research results,the fixed effect model or random effect model were selected for analysis.The following outcomes were analyzed:Harris Hip score,mortality,complications,operation time,blood loos,hospital stay,weight-bearing time,fracture classification and type of anesthesia.RESULTS We analyzed four randomized controlled trials that met the requirements.A total of 298 patients were included in these studies.According to the AO/OTA classification,there are 20 A1 types,136 A2 types,42 A3 types and 100 unrecorded types.Primary outcome:The Harris Hip Score at the final follow-up of the PFN group was higher[mean difference(MD):9.01,95%confidence interval(CI):16.57 to 1.45),P=0.02].There was no significant difference between the two groups in the rate of overall mortality[risk ratio(RR):1.44,P=0.44]or the number of complications(RR:0.77,P=0.05).Secondary outcomes:blood loss of the arthroplasty group was higher(MD:241.01,95%CI:43.06–438.96,P=0.02);the operation time of the PFN group was shorter(MD:23.12,95%CI:10.46–35.77,P=0.0003);and the length of hospital stay of the arthroplasty group was shorter[MD:0.97,95%CI:1.29 to 0.66),P<0.00001].There was no difference between the two groups in the type of anesthesia(RR:0.99).There were only two studies recording the weight-bearing time,and the time of full weight bearing in the arthroplasty group was significantly earlier.CONCLUSION Compared with PFN,arthroplasty can achieve weight bearing earlier and shorten hospital stay,but it cannot achieve a better clinical outcome.Arthroplasty cannot replace PFNs in the treatment of unstable IFFs in elderly individuals.

A comparison of three fixations for intertrochanteric femoral fractures in the elderly

Objective To compare the efficacy of 3 internal fixations,locking proximal femoral plate (LPFP),ASI-AN IMHS and InterTAN,for intertrochanteric femoral fractures in elderly patients.Methods A retrospective study was done to analyse

Progress of systematic psychological interventions in elderly patients with femoral fractures:A comprehensive review

This review aims to gain a deeper understanding of the psychological state of elderly patients with femoral fractures and provide more theoretical and practical support for clinical treatment and care.Through a literature analysis,we found that elderly patients with femoral fractures face various psychological issues such as anxiety,depression,sleep disorders,and social isolation.The application of systematic nursing interventions in clinical practice,including cognitivebehavioral therapy,mindfulness therapy,family therapy,art therapy,interpersonal therapy,emotion-focused therapy,and relaxation training,has yielded significant results.Systematic psychological interventions can improve the psychological state and quality of life of elderly patients with femoral fractures.Therefore,promoting the application and practice of systematic psychological interventions in the clinical care of elderly patients with fractures will provide more effective psychological services to a wider group of patients with fractures in the future.

Therapeutic Effect of Artificial Femoral Head Replacement and Proximal Femoral Nail Antirotation on Elderly Unstable Intertrochanteric Fractures

Objective: To compare the clinical efficacy of artificial femoral head replacement and Proximal femoral nail antirotation (PFNA) in the treatment of unstable femoral intertrochanteric fractures in the elderly. Methods: This study retrospectively analyzed 60 elderly patients with unstable intertrochanteric fractures treated with PFNA and artificial femoral head replacement from 2015.06 to 2018.06, of which 34 were in the PFNA group (Group A) and 26 in the artificial femoral head replacement group (Group B). Statistical analysis of relevant surgical indicators such as surgical time, intraoperative blood loss, postoperative blood transfusion, postoperative time to landing, postoperative infection rate, hospital stay, number of secondary operations, postoperative VAS score, and postoperative Hip function score comparison. Results: All 60 patients were followed up for 1 - 24 months. Compared with the artificial femoral head replacement group, the operation time of PFNA group was shorter, the blood loss during operation was less, and the difference was statistically significant (P 0.05). Conclusion: The hip joint function and pain scores of the artificial femoral head replacement group in the early and follow-up periods are better than those of the PFNA group. The artificial femoral head replacement is more suitable for the treatment of elderly unstable intertrochanteric fractures.

Clinical study on the effect of simvastatin on the bone healing in elderly patients with femoral intertrochanteric fracture merged with type 2 diabetes mellitus

Objective:To explore the effect of simvastatin on the bone mineral density (BMD) and bone metabolism in elderly patients with femoral intertrochanteric fracture merged with type 2 diabetes mellitus (T2DM).Methods: A total of 120 patients with femoral intertrochanteric fracture merged with T2DM who were admitted in our hospital from June, 2014 to October, 2016 were included in the study and randomized into the observation group and the control group (n=60). The patients in the two groups were given minimally invasive PFNA, and blood sugar and blood pressure reducing. The patients in the control group were given alendronate sodium, 70 mg/time, 1 time/week. On this basis, the patients in the observation group were given simvastatin, 40 mg/time,1 time/every night. After 6-month treatment, the efficacy was evaluated. The morning fasting peripheral venous blood before and after treatment in the two groups was collected. The full automatic biochemical analyzer was used to detect the serum Ca, P, and GHb. ECLI was used to detect the serum OC and BAP. ELISA was used to detect the serum TRACP-5b and s-CTX. The dual energy X-ray absorptiomery was used to detect BMD level of the forearm, femoral neck, and anterial position of lumbar spine.Results:Ca, P, and GHb levels after treatment in the two groups were not significantly changed (P>0.05). BMD level of the forearm, femoral neck, and anterial position of lumbar spine after treatment in the observation group was significantly higher than that in the control group (P<0.05). OC and BAP levels after treatment in the observation group were significantly higher than those in the control group (P<0.05), while s-CTX and TRACP-5b levels were significantly lower than those in the control group (P<0.05).Conclusions:Simvastatin can significantly improve the bone metabolism abnormality in elderly patients with femoral intertrochanteric fracture merged with T2DM, enhance BMD, and promote the bone formation and fracture healing;therefore, it deserves to be widely recommended in the clinic.

Influence of early postoperative complication on the operative results in elderly intertrochanteric fractured patients

Objective： Early complications were analyzed in those with Evans Ⅲ type of intertrochanteric fracture treated with operation or nonoperative approaches. Methods：59 cases with Evans Ⅲ type of intertrochanteric fracture between June, 1999 to July, 2006 were admitted in our department. 38 patients were complicated with cardiovascular diseases, such as hypertension and arrhythmia. All the cases were operated. Results：58 cases were operated successfully. One died of pulmonary interstitial fibrosis. Grade data of different age brackets indicated that early infective complications had apparent differences between the operation and the control group. Compared with the control group, the operation group had benefits such as fewer complications, especially the infective complications, and incidence of lower extremities venous thrombosis, and the results showed notable differences. Conclusion：In elderly patients with Evans Ⅲ type of intertrochanteric fracture, the incidence of pulmonary infection was the highest. Venous thrombosis in lower extremities was the most serious complication. So it will be helpful to perform the quadriceps femories function exercise. The postoperative effect is also related with the operation approach.

Intracortical screw insertion plus limited open reduction in treating type 31A3 irreducible intertrochanteric fractures in the elderly

BACKGROUND In most elderly patients with intertrochanteric fractures,satisfactory fracture reduction can be achieved by closed reduction using a traction table.However,intertrochanteric fractures cannot achieve satisfactory reduction in a few patients,which is called irreducible intertrochanteric fractures.Especially for type 31A3 irreducible intertrochanteric fractures,limited open reduction of the broken end with different intraoperative reduction methods is required to achieve satisfactory reduction and fixation.AIM To discuss clinical efficacy of intracortical screw insertion plus limited open reduction in type 31A3 irreducible intertrochanteric fractures in the elderly.METHODS A retrospective analysis was performed on 23 elderly patients with type 31A3 irreducible intertrochanteric fractures(12 males and 11 females,aged 65-89-yearsold)who received treatment at the orthopedics department.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 functional recovery scores of the hip joint were assessed.RESULTS All patients were followed up for 13.8 mo on average.The operation time was 53.8±13.6 min(40-95 min).The intraoperative blood loss was 218.5±28.6 mL(170-320 mL).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 mo.The reduction effect was assessed using Kim’s fracture reduction evaluation.Twenty cases achieved grade I fracture reduction and three cases grade II fracture reduction.All of them achieved excellent or good fracture reduction.Upon the last follow-up,the functional recovery scores score was 83.6±9.8,which was not significantly different from the functional recovery scores 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 contributed to high-quality fracture reduction and fixation.Good clinical outcomes were achieved without increasing operation time and intraoperative blood loss.

Control study of short-term curative effect of minimally invasive total hip arthroplasty using metal-on-metal large-diameter femoral head for the elderly patients with femoral neck fractures

Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty (THA) using metal-on-metal largediameter and conventional diameter femoral head for the elderly patients

Hidden blood loss after intertrochanteric fractures in elderly patients and its influence on the postoperative function recovery:a random controlled trial

Objective To investigate hidden blood loss after various types of intertrochanteric fractures and to determine whether oral iron supplementations is benefical for the postoperative functional recovery in elderly patients.Methods From

Comparison of Proximal Femoral Geometry and Risk Factors between Femoral Neck Fractures and Femoral Intertrochanteric Fractures in an Elderly Chinese Population

Background： Few studies have investigated the differences in proximal femoral geometry and risk factors between patients with different types of hip fracture, especially in elderly Chinese. This study aimed to assess the differences in proximal femoral geometry parameters between patients with femoral neck fractures and patients with intertrochanteric fractures to provide guidance for individualized customized prosthesis and accurate reconstruction of proximal femurs in elderly Chinese patients. Methods： We retrospectively studied the electronic medical records of 198 elderly patients over 65 years of age who were admitted to the orthopedic department with hip fractures between January 2017 and December 2017 in The Third Hospital, Hebei Medical University. Age, fracture site, gender, and proximal femoral geometry parameters （.neck shaft angle [NSA], center edge angle [CEA], femoral head diameter [FHD], femoral neck diameter [FND], femoral neck axial length [FNAL], hip axial length [HAL], and femoral shaft diameter [FSD]） were recorded. Student＇s t-test was used to compare the continuous variables, Chi-square test was used to analyze categorical variables, and multiple logistic stepwise regression analysis was used to evaluate the influencing factors of hip fracture type. Results： Statistically significant differences in NSA （137.63 ± 4.56° vs. 132.07 ± 4.17°, t = 1.598, P 〈 0.001）, CEA （37.62 ± 6.77° vs. 43.11 ±7.09°, t = 5.597, P 〈 0.001 ）, FND （35.21 ± 3.25 mm vs. 34.09 ±3.82 mm, t = 2.233, P = 0.027）, and FNAL （99.30 ± 7.91 mm vs. 103.58± 8.39 ram, t = 3.715, P 〈 0.001 ） were found between the femoral neck fracture group and femoral intertrochanteric fracture group. FHD, FND, FSD, HAL, and FNAL were different between sexes （all P 〈 0.001 ）. The greater NSA was the risk factor for femoral neck fractures （,odds ratio [OR]： 0.70, P 〈 0.001 ）, greater CEA and longer FNAL were risk factors for femoral intertrochanteric fractures （OR： 1.15, 1.17, all P 〈 0.001）, and greater FND was a protective factor for femoral intertrochanteric fractures （OR： 0.74, P 〈 0.001）. Conclusions： We demonstrate differences in geometric morphological parameters of the proximal femur in different hip fracture types, as well as an effect of sex. These differences should he considered in the selection of prostheses for fracture internal fixation and hip replacements. These data could help guide the design of individualized customized prostheses and improve the accurate reconstruction of the proximal femur for elderly Chinese hip fracture patients.

Treatment of a femoral neck fracture combined with ipsilateral femoral head and intertrochanteric fractures: A case report

BACKGROUND This article presents a rare case of a complex hip fracture involving the ipsilateral femoral neck,trochanter,and femoral head,that was accompanied by hip dislocation.Currently,there is no established standard treatment method for this specific type of fracture.Therefore,it is crucial to comprehensively consider factors such as patient age,fracture type,and degree of displacement to achieve a successful outcome.CASE SUMMARY A 38-year-old man sustained a comminuted fracture of his right hip as a result of a car accident.The injuries included a fracture of the femoral head,a fracture of the femoral neck,an intertrochanteric fracture of the femur,and a posterior dislocation of the hip on the same side.We opted for a treatment approach combining the use of a proximal femoral locking plate,cannulated screws,and Kirschner wires.Following the surgery,we developed an individualized rehabil-itation program to restore patient limb function.CONCLUSION For this complex fracture,we selected appropriate internal fixation and for-mulated individualized rehabilitation,which ultimately achieved good results.

Comparative efficacy of proximal femoral nail vs dynamic condylar screw in treating unstable intertrochanteric fractures

BACKGROUND Among the most frequent hip fractures are trochanteric fractures,which usually occur from low-energy trauma like minor falls,especially in older people with osteoporotic bones.AIM To evaluate the treatment efficacy of dynamic condylar screws(DCS)and proximal femoral nails(PFN)for unstable intertrochanteric fractures.METHODS To find pertinent randomized controlled trials and retrospective observational studies comparing PFN with DCS for the management of unstable femoral intertrochanteric fractures,a thorough search was carried out.For research studies published between January 1996 and April 2024,PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar were all searched.The complete texts of the papers were retrieved,vetted,and independently examined by two investigators.Disputes were settled by consensus,and any disagreements that persisted were arbitrated by a third author.RESULTS This study included six articles,comprising a total of 173 patients.Compared to the DCS,the PFN had a shorter operation time[mean difference(MD):-41.7 min,95%confidence interval(95%CI):-63.04 to-20.35,P=0.0001],higher success rates with closed reduction techniques[risk ratio(RR):34.05,95%CI:11.12-104.31,P<0.00001],and required less intraoperative blood transfusion(MD:-1.4 units,95%CI:-1.80 to-1.00,P<0.00001).Additionally,the PFN showed shorter fracture union time(MD:-6.92 wk,95%CI:-10.27 to-3.57,P<0.0001)and a lower incidence of reoperation(RR:0.37,95%CI:0.17-0.82,P=0.01).However,there was no discernible variation regarding hospital stay,implant-related complications,and infections.CONCLUSION Compared to DCS,PFN offers shorter operative times,reduces the blood transfusions requirements,achieves higher closed reduction success,enables faster fracture healing,and lowers reoperation incidence.

Early results of reverse less invasive stabilization system plating in treating elderly intertrochanteric fractures： a prospective study compared to proximal femoral nail

Background Intertrochanteric femur fracture is common in elderly population. Though multiple treatment options are available, the choice of implant remains controversial. The reverse less invasive stabilization system （LISS） plating was introduced for treatment of a patient with ipsilateral intertrochanteric and midshaft femoral fractures. The aim of this research was to compare such technique to intramedullary nailing （proximal femoral nail, PFN） for intertrochanteric fractures.Methods Fifty-six patients with an age of at least sixty-five years and an AO/OTA type-A1 or A2 fractures were included and divided into LISS and PFN treatment group. Background parameters, fracture and surgery details were documented. Follow-up time was at least 12 months. Radiology, complication, Harris Hip Score and Rapid Disability Rating Score （RDRS） were recorded to evaluate fixation status and hip function for each patient during follow-up.Results There was no significant difference between the two groups in surgical time （（48.0±8.6） minutes, vs.（51.8±10.8） minutes, P=0.3836） and intraoperative blood loss （（149.1±45.1） ml vs. （176.4±25.4） ml, P=0.0712）. The LISS group had less postoperative haemoglobin （Hb） reduction （（10.2±4.5） g/L Hb, vs. （15.1-5.9） g/L Hb, P=0.0475）. There was no complication observed in PFN group. All 31A1 type fracture in LISS group showed 100% maintenance of reduction. One nonunion with locking screw breakage and 2 varus union were found in the LISS group. Postoperative hip function was similar between the two groups.Conclusions Though reverse LISS plating may not be recommended as a routine fixation method for elderly unstable intertrochanteric fractures compared to PFN, it may possibly be reserved for rapid fixation and damage control in polytrauma patients and ORIF of subtrochanteric and reverse oblique intertrochanteric fractures.

Comparitive Study between Proximal Femoral Nailing and Dynamic Hip Screw in Intertrochanteric Fracture of Femur

Background: Internal fixation is appropriate for most intertrochanteric fractures. Optimal fixation is based on the stability of fracture. The mainstay of treatment of intertrochanteric fracture is fixation with a screw slide plate device or intramedullary device. So it is a matter of debate that which one is the best treatment, dynamic hip screw or proximal femoral nailing. Method: A prospective randomized and comparative study of 2 years duration was conducted on 60 patients admitted in the Department of Orthopedics in our hospital with intertrochanteric femur fracture. They were treated by a dynamic hip screw and proximal femoral nail. Patients were operated under image intensifier control. The parameters studied were functional outcome of Harris hip score, total duration of operation, rate of union, amount of collapse. These values were statistically evaluated and two tailed p-values were calculated and both groups were statistically compared. Result: The average age of our patient is 67.8 years. Among the fracture, 31% were stable, 58% were unstable, 11% were reverse oblique fracture. The average blood loss was 100 and 250 ml in PFN and DHS group, respectively. In PFN there was more no. of radiation exposure intraoperatively. The average operating time for the patients treated with PFN was 45 min as compared to 70 min in patients treated with DHS. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early period (at 1 and 3 months). In the long term both the implants had almost similar functional outcomes. Conclusion: In our study we have found that the unstable pattern was more common in old aged patients with higher grade of osteoporosis and PFN group has a better outcome in this unstable and osteoporotic fracture. PFN group has less blood loss and less operating time compared to DHS group. In PFN group patients have started early ambulation compared to DHS group.

Effects of alendronate sodium combined with InterTan on osteoporotic femoral intertrochanteric fractures and fracture recurrence

BACKGROUND Osteoporosis is a global disease affecting 6.6%of the total population.Osteoporosis complications include fractures,increased bone fragility,and reduced bone strength.The most commonly affected parts are the vertebral body,hip,and wrist.AIM To examine the effect of alendronate sodium combined with InterTan for osteoporotic femoral intertrochanteric fractures on bone and fracture recurrence METHODS In total,126 cases of osteoporotic femoral intertrochanteric fractures were selected and divided into two groups according to the 1:1 principle by the simple random method.They were admitted to the Department of Orthopedics,First Affiliated Hospital of Xingtai Medical College,from January 2018 to September 2020.The control group was treated with InterTan fixation combined with placebo,and the observation group with alendronate sodium based on InterTan fixation.Operation-related indicators,complications,and recurrent fractures were compared between the groups.Changes in bone metabolism markers,t value for hip bone mineral density,and Harris Hip Score were observed.RESULTS Operation time,intraoperative blood loss,postoperative ambulation time,and complications were compared between the groups,and no significant difference was found.The fracture healing time was significantly shorter in the observation group than in the control group.β-Collagen-specific sequence(β-CTX)and total aminoterminal propeptide of type I procollagen(T-PINP)in the control group at 3 mo after operation were compared with those before operation,and the difference was not significant.Six months after the operation,theβ-CTX level decreased and T-PINP level increased.β-CTX level at 3 and 6 mo in the observation group after operation was lower,and TPINP level was higher,than that before operation.Compared with the control group,T-PINP level of the observation group was significantly higher andβ-CTX level was significantly lower at 3 and 6 mo after operation.The t value of hip bone mineral density was compared in the control group before and 1 mo after operation,and significant difference was not found.Compared with the control group,the t value of hip bone mineral density in the observation group was significantly higher at 1,3,6,and 12 mo after operation.Compared with the control group,the Harris score of the observation group was significantly higher at 1,3,6,and 12 mo after operation.The recurrence rate of fractures in the observation group within 12 mo was 0.00%,which was significantly lower than 6.35%in the control group.CONCLUSION Alendronate sodium combined with InterTan in the treatment of osteoporotic femoral intertrochanteric fractures can increase bone mineral density,improve hip joint function,promote fracture healing,and reduce fracture recurrence.

Meta-analysis of the clinical efficacy of the Gamma3 nail vs Gamma3U-blade system in the treatment of intertrochanteric fractures

BACKGROUND The traditional Gamma3 nail is a mainstream treatment for femoral intertrochanteric fractures.Literature reports that the Gamma3U-blade system can increase the stability of the Gamma3 nail and reduce complication incidence.However,comparative studies between the Gamma3U-blade and Gamma3 systems are limited;hence,this meta-analysis was performed to explore the clinical efficacy of these two surgical methods.AIM To investigate the clinical efficacy of Gamma3 and Gamma3 U-blade for intertrochanteric fractures.METHODS A computerized search for Chinese and English literature published from 2010 to 2022 was conducted in PubMed,Cochrane,CNKI,Wanfang,and VIP databases.The search keywords were gamma 3,gamma 3 U blade,and intertrochanteric fracture.Additionally,literature tracking was performed on the references of published literature.The data were analyzed using Revman 5.3 software.Two individuals checked the inputs for accuracy.Continuous variables were described using mean difference and standard deviation,and outcome effect sizes were expressed using ratio OR and 95%confidence interval(CI).High heterogeneity was considered at(P<0.05,I2>50%),moderate heterogeneity at I2 from 25%to 50%,and low heterogeneity at(P≥0.05,I2<50%).RESULTS Following a comprehensive literature search,review,and analysis,six articles were selected for inclusion in this study.This selection comprised five articles in English and one in Chinese,with publication years spanning from 2016 to 2022.The study with the largest sample size,conducted by Seungbae in 2021,included a total of 304 cases.Statistical analysis:A total of 1063 patients were included in this meta-analysis.The main outcome indicators were:Surgical time:The Gamma3U blade system had a longer surgical time compared to Gamma3 nails(P=0.006,I2=76%).Tip-apex distance:No statistical significance or heterogeneity was observed(P=0.65,I2=0%).Harris Hip score:No statistical significance was found,and low heterogeneity was detected(P=0.26,I2=22%).Union time:No statistical significance was found,and high heterogeneity was detected(P=0.05,I2=75%).CONCLUSION Our study indicated that the Gamma3 system reduces operative time compared to the Gamma3 U-blade system in treating intertrochanteric fractures.Both surgical methods proved to be safe and effective for this patient group.These findings may offer valuable insights and guidance for future surgical protocols in hip fracture patients.

Conversion hip arthroplasty for failed nailing of intertrochanteric fracture: Reflections on some important aspects

In this editorial,I present my comments on the article by Solarino et al.Conversion hip arthroplasty,which is an optional salvage procedure performed following unsuccessful fixation of intertrochanteric femur fractures in elderly pati-ents,entails more complex processes and higher rates of operative complications than primary arthroplasty.Hence,it is important to consider the appropriateness of the primary treatment choice,as well as the adequacy of nailing fixation for intertrochanteric fractures.This article briefly analyzes the possible factors contributing to the nailing failure of intertrochanteric fractures and attempts to find corresponding countermeasures to prevent fixation failures.It also analyzes the choice of treatment between nailing fixation and primary arthroplasty for intertrochanteric fractures.

Comparative study of intertrochanteric fracture fixation using proximal femoral nail with and without distal interlocking screws

BACKGROUND Intertrochanteric(IT)fracture is one of the most common fractures seen in an orthopaedic practice.Proximal femoral nailing(PFN)is a common modality of fixing IT femur fracture.We retrospectively studied whether a PFN with two proximal lag screws can be done without distal interlocking screws in the 31-A1 and 31-A2 fracture patterns according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association(AO/OTA)guidelines for IT femur fractures.AIM To compare the outcomes of IT fractures(AO/OTA 31-A1 and 31-A2)treated by PFN with and without distal interlocking screws.METHODS We carried out a retrospective study of 140 patients in a tertiary care centre who had AO/OTA type 31-A1 and 31-A2 IT fractures.We divided the patients into two groups,in which one of the groups received distal interlocking screws(group 1)and the other group did not(group 2).The subjects were followed up for a mean period of 14 mo and assessed for radiological union time,fracture site collapse,mechanical stability of implant,and complications associated with the PFN with distal interlocking and without distal interlocking.Then,the results were compared.RESULTS PFN without distal interlocking screws has several advantages and gives better results over PFN with distal interlocking screws in the AO/OTA 31-A2 fracture pattern.However,similar results were observed in both groups with the fracture pattern AO/OTA 31-A1.In patients with fracture pattern AO/OTA 31-A2 treated by PFN without distal interlocking screws,there were minimal proximal lockrelated complications and no risk of distal interlock-related complications.The operative time,IITV radiation time and time to radiological union were reduced.These patients also had better rotational alignment of the proximal femur,and the anatomy of the proximal femur was well maintained.It was also noted that in the cases where distal interlocking was performed,there was a gradual decrease in neck shaft angle,which led to varus collapse and failure of bone-implant construct in 21.40%.CONCLUSION In fracture pattern AO/OTA 31-A2,PFN without distal interlocking had better results and less complications than PFN with distal interlocking.

临床治疗老年骨质疏松性股骨粗隆间骨折的疗效观察Curative effect observation on treating senile osteoporotic femoral intertrochanteric fracture

目的：探讨不同方法治疗老年骨质疏松性股骨粗隆间骨折的临床疗效。方法：采用回顾性方法分析，选取我院自2009年3月~2012年3月3年以来收治的92例老年骨质疏松性股骨粗隆间骨折患者的临床资料。随机将其分为两组，各46例，应用股骨近端防旋髓内钉固定治疗为PENA组，采用动力髋螺钉固定治疗为DHS组，两组患者均给予中医药辨证治疗。比较两组患者的手术时间、术中出血量、骨折愈合时间以及术后并发症。结果：两组患者在术中以及术后情况比较，PENA组患者术中以及术后情况均优于DHS组，手术时间、术中出血量、术中以及术后并发症、骨折愈合时间以及髋关节功能评分上均有明显的差异，具有差异统计学意义（P〈0．05）。结论：股骨近端防旋髓内钉对老年骨质疏松性股骨粗隆间骨折患者有显著的疗效，同时操作方法比较简单，创伤小，固定牢固以及并发症少，并且结合中医药辨证治疗，有利于骨折的稳定以及早期进行功能锻炼，值得临床推广。

Effect of early surgery in high surgical risk geriatric patients with femoral neck fracture and taking antiplatelet agents

AIM: To investigate the effect of early surgical intervention on the high surgical risk elderly patients who sustained femoral neck fracture(FNF) and taking concomitant antiplatelet agents. METHODS: Between 2010 and 2012, a prospective study was conducted on 49 geriatric patients, who took antiplatelet agents, sustained FNF and underwent surgery within 72 h [early surgery(ES) group], and these were compared with a retrospective consecutive case series of patients with similar characteristics(45 cases) who had delayed surgery(DS group) after 72 h during an earlier 3-year period. Postoperative outcomeswere followed for one year and compared. RESULTS: There were non-significant differences in perioperative blood loss, blood transfusion, intensive care unit requirement and postoperative mortality(P > 0.05 all). There were 2 patients(4%) in the DS group who died after surgery(P = 0.23). However, the ES group showed a significantly better postoperative outcome in terms of postoperative complications, length of hospital stay, and functional outcome(P < 0.05 all).CONCLUSION: Early hip surgery in geriatric hip fracture patients with ongoing antiplatelet treatment was not associated with a significant increase of perioperative blood loss and postoperative mortality. Moreover, ES resulted in a better postoperative surgical outcome. In early hip surgery protocol, the antiplatelet agents are discontinued and the patient is operated on within 72 h after admission, which is safe and effective for the medically fit patients.