Treatment pecularities in trochanteric fractures

Abstract

Introduction. Trochanteric fracture in adults overwhelming affects elderly subjects. Frequency is increasing with population aging despite the development of treatments for osteoporosis. In elderly subjects, fracture entails a serious risk of loss of independence best reduced with surgery (usually conservative) that should be undertaken with minimal delay. Treatment is surgical, of various sorts. Open reduction internal fixation (ORIF) with intra- or extra-medullary implants is the most frequent attitude in these fractures, which usually heal easily. In elderly patients, arthroplasty is an alternative of choice for some authors. These different treatment modalities are presented, focusing on technical details. Aim of the study. To evaluate the treatment methods of the pertrochanteric hip fractures Materials and methods. We studied a pacient-based cohort, overall 209 pacients from Orthopedic Department of Emergency Medicine Institute during period 07.02.2018 – 07.02.2020. Results. The majority of pertrochanteric hip fractures was found in women – 65% (137), men – 35% (72). In 95% the main cause of the fracture was usual (habitual) trauma, 5% - car accidents. The group was divided by age: 75-96y – 103p (49%), 45-60y – 78p (37%), 45-60y – 24p (11%), <45y – 4p (1.9%). Fractures were divided by Evans Classification: Evans I – 9p (4.3%), Evans II – 22p (10,5%), Evans III – 28p (13,3%), Evans IV – 28p (13,3%), Evans V – 118p (56.4%), Evans R – 4p (1.9%). 37% (79p) had benefit from the orthopedic treatment, 63% (130p) have undergone the surgical method. In 76% (99p) was used PFN, in 17% (22p) – DHS, in 4.5% (6p) – cemented hip hemiarthroplasty was performed, in 2.3% (3p) – DCS, in 1.5% (2p) – uncemented hip hemiarthroplasty, in 0.7% (1p) – total hip joint replacement was performed. The average length of hospitalization was 9 days. Conclusions. Even though there is a large pool of surgical methods of treatment, a big number of patients had the benefit from orthopedics type of treatment. The main cause is the existence of high anaesthetical and surgical riscs. Surgical type of treatment in case of perthrohanteric hip fractures allows to prevent different types of complications.Kaufer variables are used to choose the fixator for the osteosynthesis.The key for better results is to choose an individual postoperative regimen for every pacient.