[Clinical research of hemiprosthesis arthroplasty for the treatment of unstable intertrochanteric fractures in elderly patients].

OBJECTIVE

To report the clinical results of hemiprosthesis for unstable intertrochanteric fractures in elderly patients.

METHODS

86 cases (male 35 and females 51) of unstable intertrochanteric fractures in elderly patients were treated with hemiprosthesis arthroplasty in our hospital. The average age was 87 years old (range from 80 to 98 years old). According to the Evans classification of intertrochanteric fractures, there were 31 cases in type IIIA, 35 cases in IIIB and 20 cases in type IV. Most of the patients fell in the room and fractured, with concomitant diseases. After admitted to the hospital, the patients were consulted and treated for the concomitant diseases, and after the general conditions got stable and no absolute contraindications were found, the hemiprosthesis arthroplasty was performed. Almost all of the patients were operated on within 3 days with general anesthesia under the multi-function monitoring. The greater trochanter was reconstructed with figure of 8 wire fixation, the lesser trochanter with figure of 8 wire fixation, the lesser trochanter was fixed with circular wire around proximal femur. The defect within the femoral calcar was filled with bone cement and in a part of the patients, the intertrochanteric fracture was transformed into femoral neck fracture and the femoral calcar was fixed with femoral prosthesis stem.

RESULTS

All operations were successful and the duration of the operation was 45 to 70 minutes with an average of 55 minutes. Blood was transfused in 73 patients during the operation between 400-800 ml with an average 450 ml. The patients got out of the bed within 3 days in 33 cases, 4-7 days in 43 cases, more than 8 days in 8 cases, and 2 patients couldn't get out of the bed. The period of hospitalization was between 13 to 27 days with an average of 16.8 days.

COMPLICATIONS

2 patients got slight deep phlebitis, 5 patients showed psychological disorders, and disorders in bacterial spectrum appeared in 3 patients, and after appropriate treatments, the complications gradually recovered and had no effect on the function of the affected extremity. 2 cases died of multiple organ failure during the hospitalization. 59 patients were followed up for 6 to 48 months with an average 16 months. The result was excellent in 17 cases who resumed their activities as before they got fractured, good in 35 cases who could walk with walking aid, fair in 5 cases who could walk with others help, and poor in 2 cases who could not walk. 1 patient died of other diseases 5 months after discharged. No dislocation, loosening or late infections occurred. 88.1% showed excellent or good result.

CONCLUSION

It's an effective method to treat the unstable intertrochanteric fractures in elderly patients with hemiprosthesis arthroplasty. The result was satisfactory. It can decrease the complications, reduce the mortality, improve the patient's the living quality, and reduce the burden of the patient's family.