Primary hip hemiarthroplasty for unstable intertrochanteric fractures in elderly patients

Yaşlıların anstabil intertrokanterik femur kırıklarında primer hemiartroplasti uygulaması

Abstract

PRIMARY HIP HEMIARTHROPLASTY FOR UNSTABLE INTERTROCHANTERIC FRACTURES IN ELDERLY PATIENTS Purpose: The purpose of this study is to evaluate, the clinical and radiological results of patients with unstable intertrochanteric fractures treated with primary hemiarthroplasty. Patients and Methods: 20 elderly patients with unstable intertrochanteric fracture of femur were treated by primary hip hemiarthroplasty. Mean age at surgery was 71.3 and average follow-up was 10.8 months. 12 of them were female and 8 of them were male. 16 patients were treated with cemented bipolar hemiarthroplasty and 4 patients were treated with cemented Thompson type prosthesis. All of the patients were mobilized by a walker or crutches within the first week after the operation. Results: Two of them died within the 2 months after the surgery, 18 patients returned to their prefracture status. Superficial hematoma was seen in 2 patients, Grade II heterotopic ossification was seen in 2 patients and Grade III heterotopic ossification was seen in one patient. Discussion: Treatment of intertrochanteric fractures of the femur in elderly patients is controversial and complications due to immobilization during convalescence are very frequent, including pneumonia, pressure sores, metabolic disturbances, circulatuary and respiratuary system disorders. Primary hemiarthroplasty seems to be effective in preventing these complications and maintaining prefracture status by early weight bearing.

Özet

Intertrokanterik femur kırıkları genellikle hayatın ileri yaşlarında görülmektedir. Bu kırıkların tedavisindeki amaç, hastayı bir an evvel ayağa kaldırarak gelişebilecek immobilizasyon komplikasyonlanndan korumaktır. Şubat 1995-Kasım 1996 tarihleri arasında S.B. Ankara Hastanesi 1. Ortopedi ve Travmatoloji Kliniği'nde ortalama yaşları 71.3 olan 20 hastanın anstabil intertrokanterik kırığı primer hemiartroplasti uygulaması ile tedavi edildi. 16 hastaya sementli bipolar endoprotez, 4 hastaya ise sementli Thompson endoprotezi uygulandı. Ortalama olarak 10.8 ay takip edilen hastalar preoperatif yaşam kalitelerine ulaştılar. Hastalardan iki tanesi (% 10) bu süre içinde exitus oldu. Komplikasyon olarak iki olguda yüzeyel hematoma, iki olguda Grade 2 bir olguda Grade 3 heterotopik ossifikasyon görüldü. Sonuçta yaşlı ve sistemik hastalığı olan anstabil intertrokanterik kırıklı hastaların tedavisinde primer parsiyel endoprotez uygulamasının seçkin bir tedavi yöntemi olduğu kanaatine varıldı.