Primary arthroplasty for trochanteric fractures in elderly and senile age

А.I. Каnziuba, V.G. Klimovitskyi, P.A. Hailo, M.A. Каnziuba

Abstract


Background. Fractures of the proximal femur are the most popular category of complex and traumatic injuries of the musculoskeletal system in elderly patients. Restricted physiological reserve in patients of this age group, as well as comorbidities contribute to long periods of patients’ staying at hospital, complications and high risk associated with this significant economic costs. The most common complication is secondary displacement of fragments as a result of early load of the operated limb. In 28 % of patients infectious complications of wound healing are observed. Using of osteosynthesis is limited due to significant degenerative changes in the hip joint. Alternatively trochanteric osteosynthesis for femur fractures in elderly patients in recent years is considered a primary hip replacement. According to the authors’ data, the use of arthroplasty provides early activation of patients, reduces the risk of infectious and thromboembolic complications, cardiovascular complications, completely eliminates the problem of fragments consolidation and aseptic necrosis of the femoral head. The purpose of investigation was to justify the use of arthroplasty for trochanteric fractures and describe technical features of femoral component endoprosthesis. Materials and methods. The study group included 38 patients operated during 2012–2016 in the department s of Donetsk Research and Development Institute of Traumatology and Orthopedics and clinics of the Medical Faculty of Uzhgorod National University. The patients’ age ranged from 72 to 88 years (average age 76.4 ± 2.1 years). Terms of primary hip arthroplasty was 3 to 9 days after the injury. According to AO classification, 34 patients had transtrochanteric fractures: 13 — ordinary ones (31-A1); 21 patients had multifragment fractures (31-A2). Four patients were operated for multifragment transtrochanteric fractures (31-A3). Thirty-four patients underwent hemiarthroplasty unipolar endoprosthesis. Thirty-two patients underwent cement fixation implants — with a standard stem in 27 cases, with the extended stem in 5patients. In 2 patients stem without cement revision was implanted. In 4 patients total arthroplasty with cement fixation of both components of endoprosthesis was performed. Results. When planning the surgical approach and restore metaphyseal femur acceptability no damage to the muscles attached to an array of trochanter major was provided. Technical features of stem implantation depend on the transtrohanteric fracture type. We found it impossible to reposition and provisionally fix pieces of amputate muscles that are attached to trohanteric areas because they further ensure the stability of the artificial joint. In biomechanical terms it is very important to restore the medial wall of the femur at or below of the small trohanter location along which the load of most of the implanted endoprosthesis stems is distributed. Depending on the location of fragments of the trohanteric area fixing with wire in a circular cable ties was additionally performed. All patients achieved satisfactory initial fixation of the femoral component of the endoprosthesis. In the presence of involutional osteoporosis and expressed exhausted physical capacity primary arthroplasty allowed ensure early mobilization, supporting and motor function in all operated patients. Conclusions. Arthroplasty results indicate the feasibility of this type of surgery in elderly and senile osteoporosis in the presence of significant disability and to restore the static and dynamic functioning. The reconstruction of the proximal femur provides the possibility of implanting the femoral component of the implant using bone cement under conditions of individual choice of stem length.


Keywords


trochanteric area; fractures; endoprothesis

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DOI: https://doi.org/10.22141/1608-1706.2.18.2017.102557

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