Peculiarities of surgical treatment in trochanteric fractures

Abstract

Introduction: Trochanteric fractures are common for elderly and young patients. Around 50% of hip fractures are the trochanteric ones. The average age of the patients with this type of fracture is 75- 79 years old. The purpose of this study was to evaluate the treatment of trochanteric hip fractures with different surgical techniques. Treatment goals for most of these patients included early mobilization with restoration of the anatomic alignment of the proximal part of the femur and the maintenance of the fracture reduction. Materials and methods: This prospective study includes 52 patients with trochanteric fractures, 15 men and 37 women hospitalized in the 2-nd department of the Clinical Hospital of Orthopedics and Traumatology, Chisinau, from January 2014 to March 2015. All the patients were treated surgically. The average patient’s age was 69 years, the youngest one was of 18 years old and the oldest one was of 83 years old. Using the Evan's system of classification, 10 patients had an Evans II, 6 patients had an Evans III, 14 patients had an Evans IV and 22 patients had an Evans V. In our study patients were treated using mainly 2 methods: 24 patients with trochanteric fractures were treated using 95º blade plate and 22 patients using hip artroplasty. Other implants were used as follows: Dynamic Hip Screw at 2 patients, Gama Nail at 2 patients and Dynamic Compression Screw 1 patient, and 130º blade plate at 1 patient. Results: The research was based on 52 medical cases. The hip arthroplasty was performed in patients over 70 years, with a marked degree of osteoporosis and unstable trochanteric fractures. The hip arthroplasty in trochanteric fractures was made using the following types of prosthesis: Zimmer Total Cimented - 2 patients, PAVI-ATLAS Total Uncimented – 4 patients, Zimmer cemented bipolar – 10 patients and Austin Moore – 6 patients. All the implants were well accepted and none of patients had significant difficulties while sitting or lying. Conclusion: In our study the surgical treatment remains the method of choice in the treatment of trochanteric fractures and it is welcomed to be performed, although it is difficult to make any type of internal fixation technically. Hip replacement is a successful procedure for the elderly persons with osteoporosis and unstable trochanteric fractures. The use of hip arthroplasty (total or hemiarthroplasty) in the treatment of trochanteric fractures made possible to accelerate patient’s mobilization and movement, therefore we have maximized the patient’s functional recovery.