Unstable trochanteric fractures in elderly osteoporotic patients: role of primary hemiarthroplasty.
ABSTRACT Unstable intertrochanteric fractures in osteoporotic patients are difficult to treat. Fixation failure often leads to prolonged morbidity and poor functional outcomes. The objective of the present study was to investigate primary replacement as a suitable option that could minimize complications in selected patients.
From January 2004 to March 2007, 28 elderly osteoporotic patients with unstable intertrochanteric fractures were included in this study. Their fractures were classified according to the AO/OTA classification (8 patients, 31A2.2; 17 patients, 31A2.3 and 3 patients, 31A3.3) and their osteoporosis was confirmed by bone densitometry. Hemiarthroplasty was performed in all patients and the outcomes analyzed using the Harris hip score system.
Of the 28 patients, 19 were women and the mean age was 79 years (range, 52-95 years). At a mean follow up of 4.2 years (range, 3-6 years), there were 17 excellent, 7 good, 2 fair and 2 poor results according to the Harris hip score system.
In elderly osteoporotic patients with unstable intertrochanteric fractures, hemiarthroplasty is a reliable alternative to internal fixation. The functional outcome has been encouraging and we suggest it as a method of treatment in this group of patients.
- SourceAvailable from: Michael D StoneOsteoporosis International 02/2000; 11(6):551-2. · 4.04 Impact Factor
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ABSTRACT: Fitek cementless cups have been adopted in our department in 1989. The first 100 consecutive Fitek implants were analyzed clinically (Harris hip score) and radiographically (anteroposterior and lateral x-rays) with a mean follow-up of 9.7 years. We did not have any case of cup loosening or any other problem requiring cup revision. In this series, we had 86 excellent, 10 good, 2 fair, and 2 poor results. The 2 poor results were because of 2 cases of aseptic loosening of the stem (1 cemented and 1 cementless). The x-rays showed an average angle of cup inclination of 36.5 degrees (range 16 degrees -54 degrees ) after surgery and no variations at the last follow-up. Bidimensional linear wear of the acetabular component showed 6 cases of measurable wear with an average wear rate per year of 0.265 mm. The overall wear rate per year was 0.02 mm. At the time of the last follow-up examination, we had 3 femoral osteolysis and no case of acetabular osteolysis. In our series, we observed "lack of contact" zones above the polar depression in 71 cases immediately after surgery. The average thickness of these lines was 1 (range 0.5-3.5) mm. Of these, at the last follow-up, 61 cases (86%) showed a complete "filling" of the "lack of contact," whereas in 10 (24%), the "filling" was incomplete (4 cases still showing a radiolucent line [<or=0.5 mm] in zone II). In the first group with "complete filling," we found 23 (37%) cases with bone ingrowth and no migration of the cup, whereas 38 (63%) cases showed bone ingrowth with evidence of cup migration. The Mann-Whitney nonparametric U test and the Kruskal-Wallis test showed that the survival rate of the 100 analyzed cups, after a follow-up time of 9.7 years, was 100% (end point: revision for any cause). Fitek cup showed good clinicoradiographic results.The Journal of Arthroplasty 10/2005; 20(6):730-7. · 2.11 Impact Factor
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ABSTRACT: The orthopaedic surgeon has a multitude of internal fixation devices and techniques available for use in the treatment of subtrochanteric fractures of the proximal femur. The successful use of second-generation locking nails is technically demanding. Close attention to positioning of the patient, reduction of the fracture, placement of the guide-wire, and insertion of the nail and of the proximal and distal locking screws is mandatory. The newer, high-strength hip-screws allow good fixation of a fracture that extends into the piriformis fossa. If medial comminution is present, this technique is best performed in conjunction with indirect reduction and bone-grafting. With proper technique, these devices allow the surgeon to manage predictably a complex subtrochanteric fracture that previously had to be treated with traction or extensive dissection and with (frequently inadequate) internal fixation.Instructional course lectures 02/1995; 44:227-53.