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Treatment of intertrochanteric femur fractures in the elderly: Cephalomedullary nailing versus hemiarthroplasty. A retrospective analysis of 264 cases

Yıl 2025, Cilt: 1 Sayı: 1, 25 - 31, 01.05.2025

Mustafa Caner Okkaoglu , Yüksel Uğur Yaradılmış , Mert Karaduman , İsmail Demirkale , Mahmut Özdemir Hakan Şeşen , Murat Altay

Öz

Background: The most common treatment of unstable fractures of the proximal femur in the elderly is cephalomedullary nailing. Hemiarthroplasty was proposed to facilitate early functional recovery. This study adresses the outcome after osteosynthesis or hemiarthroplasty, using a cohort of patients enrolled in a retrospective study and treated using these two common conceptual approaches. It was hypothetized that hemiarthroplasty provided faster functional recovery with lower secondary intervention risk than cephalomedullary nailing.
Methods: The study included 264 patients with unstable intertrochanteric femur fractures between March 2011 and April 2013. Comparison was made between 148 patients treated with hemiarthroplasty (HA) with 116 patients treated with cephalomedullary nailing (CMN). Mortality, complication and revision rates and postoperative cumulative ambulation scores were compared.
Results: Mortality rate was significantly higher in the HA group: 49 (31 %) vs. 19 (16.1 %); p=0.031. Complication rates were higher in the CMN group: 34.5 % (40 of 116) vs. 21.62 % (32 of 148) (p=0.272). However, a statistically significant greater number of revisions or additional procedures were observed in the CMN group (22 of 116 vs. 10 of 148 or 18.9 % vs. 6.76 %; p=0.023). The preoperative comorbidities, cumulative ambulation scores and Singh index were not statistically different between the groups.
Conclusions: The non-compliance of this age group regarding non weight bearing together with severe osteoporosis can make CMN prone to mechanical failure. Thus, HA can be a rational option, offering comparable functional outcomes to cephalomedullary fixation.

Anahtar Kelimeler

Intertrochanteric hip fracture Elderly Cephalomedullary nailing

Kaynakça

  • 1. Anglen JO, Weinstein JN. American Board of Orthopaedic Surgery Research Committee: Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg Am 2008, 90(4):700-7. doi: 10.2106/JBJS.G.00517
  • 2. Mereddy P, Kamath S, Ramakrishnan M, Malik H, Donnachie N. The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures. Injury 2009, 40:428-32. doi: 10.1016/j.injury.2008.10.014
  • 3. Forward DP, Doro CJ, OʼToole RV et al.A biomechanical comparison of a locking plate, a nail, and a 95° angled blade plate for fixation of subtrochanteric femoral fractures. J Orthop Trauma 2012, 26:334-340. doi: 10.1097/BOT.0b013e3182254ea3
  • 4. Kummer FJ, Olsson O, Pearlman CA, Ceder L, Larsson S, Koval KJ. Intramedullary versus extramedullary fixation of subtrochanteric fractures. A biomechanical study. Acta Orthop Scand 1998, 69:580-584. doi: 10.3109/17453679808999259
  • 5. Shen L, Zhang Y, Shen Y, Cui Z. Antirotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures: a meta-analysis of randomized controlled studies. Orthop Traumatol Surg Res 2013, 99(4):377-83. doi: 10.1016/j.otsr.2012.12.019
  • 6. Tang P, Hu F, Shen J, Zhang L, Zhang L. Proximal femoral nail antirotation versus hemiarthroplasty: a study for the treatment of intertrochanteric fractures. Injury 2012, 43(6):876-81. doi: 10.1016/j.injury.2011.11.008
  • 7. Liu Y, Tao R, Liu F et al. Mid-term outcomes after intramedullary fixation of peritrochanteric femoral fractures using the new proximal fen-moral nail antirotation (PFNA). Injury 2010, 41(8):810-7. doi: 10.1016/j.injury.2010.03.020
  • 8. Kesmezacar H, Oğüt T, Bilgili MG, Gökay S, Tenekecioğlu Y. Treatment of intertrochanteric femur fractures in elderly patients: internal fixation or hemiarthroplasty. Acta Orthop Traumatol Turc 2005, 39:287-294.
  • 9. Haentjens P, Casteleyn PP, Opdecam P. Primary bipolar arthroplasty or total hip arthroplasty for the treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Acta Orthop Belg 1994, 60:124-128.
  • 10. Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Ortop Relat Res 1998, 348: 87-94.
  • 11. Kesemenli CC, Memisoglu K, Necmioglu S, Kayikci C. Treatment of intertrochanteric femur fractures with 95° fixed-angle blade plate in elderly patients. Eur J Orthop Surg Traumatol 2010, 20:629–634. doi: 10.1007/s00590-010-0627-3
  • 12. Vekris MD, Lykissas MG, Manoudis G et al. Proximal screws placement in intertrochanteric fractures treated with external fixation: comparison of two different techniques. J Orthop Surg Res 2011, 22:48-62. doi: 10.1186/1749-799X-6-48
  • 13. AO: Committee of Coding and Classification of the Orthopaedic Trauma Association. Fracture and dislocation compendium. J Orthop Trauma 1996, 10:31–35. doi: 10.1186/1749-799X-6-48
  • 14. Singh M, Nagrath AR, Maini PS, Haryana R. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg 1970, 52A:457–467.
  • 15. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987, 40:373-383. doi: 10.1016/0021-9681(87)90171-8
  • 16. Foss NB, Kristensen MT, Kehlet H. Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients: the cumulated ambulation score. Clin Rehabil 2006, 20:701-708. doi: 10.1191/0269215506cre987
  • 17. Strauss E, Frank J, Lee J, Kummer FJ, Tejwani N. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation. Injury 2006, 37(10):984-989. doi: 10.1016/j.injury.2006.06.008
  • 18. Lenich A1, Vester H, Nerlich M, Mayr E, Stöckle U, Füchtmeier B. Clinical comparison of the second and third generation of intramedullary devices for trochanteric fractures of the hip Blade vs screw. Injury 2010, 41(12):1292-6. doi: 10.1016/j.injury.2010.07.499
  • 19. J. Vaqueroa, J. Munoza, S. Pratb et al. Proximal Femoral Nail Antirotation versus Gamma3 nail for intramedullary nailingof unstable trochanteric fractures. A randomised comparative study. Injury, Int. J. Care Injured 2012, 43(S2), P47–P54. doi: 10.1016/S0020-1383(13)70179-7
  • 20. Xu Yaozeng, Geng Dechun, Yang Huilin, Zhu Guangming, Wang Xianbin. Comparative study of trochanteric fracture treated with the proximal femoral nailanti-rotation and the third generation of gamma nail. Injury, Int. J. Care Injured 2010, 41:1234–1238. doi: 10.1016/j.injury.2010.03.005
  • 21. Yue-Hua Yang, Yu-Ren Wang, Sheng-Dan Jiang, Lei-Sheng Jiang. Proximal femoral nail antirotation and third-generation Gamma nail: which is a better device for the treatment of intertrochanteric fractures? Singapore Med J 2013, 54(8): 446-4. doi: 10.11622/smedj.2013152
  • 22. Schipper IB, Steyerberg EW, Castelein RM et al. Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail. J Bone Joint Surg Br 2004, 86:86-94. doi: 10.1302/0301-620X.86B1.14455
  • 23. Sipilä S, Salpakoski A, Edgren J et al. Promoting mobility after hip fracture (ProMo): study protocol and selected baseline results of a year-long randomized controlled trial among community-dwelling older people. BMC Musculoskelet Disord 2011, 12:277. doi: 10.1186/1471-2474-12-277
  • 24. O'Malley NT, Blauth M, Suhm N, Kates SL. Hip fracture management, before and beyond surgery and medication: a synthesis of the evidence. Arch Orthop Trauma Surg 2011, 131:1519-1527. doi: 10.1007/s00402-011-1341-2
  • 25. Piziak VK, Rajab MH. An effective team approach to improve postoperative hip fracture care. J Orthop Trauma 2011, 25:72-75. doi: 10.1097/BOT.0b013e3181db703c
  • 26. Yu-Yahiro JA, Resnick B, Orwig D, Hicks G, Magaziner J. Design and implementation of a home-based exercise program post-hip fracture: the Baltimore hip studies experience. PM R 2009, 1:308-318. doi: 10.1016/j.pmrj.2009.02.008
  • 27. Panula J, Pihlajamäki H, Mattila VM et al. Mortality and cause of death in hip fracture patients aged 65 or older: a population-based study. BMC Musculoskelet Disord 2011, 12:105. doi: 10.1186/1471-2474-12-105
  • 28. Kim SY, Kim YG, Hwang JK. Cementless calcar-replacement hemiarthroplasty compared with intramedullary fixation of unstable intertrochanteric fractures. A prospective, randomized study. J Bone Joint Surg Am 2005, 87:2186-2192. doi: 10.2106/JBJS.D.02768
  • 29. Intiso D, Di Rienzo F, Grimaldi G et al. Survival and functional outcome in patients 90 years of age or older after hip fracture. Age Ageing 2009, 38:619-622. doi: 10.1093/ageing/afp126
  • 30. Tang P, Hu F, Shen J, Zhang L, Zhang L. Proximal femoral nail antirotation versus hemiarthroplasty: a study for the treatment of intertrochanteric fractures. Injury 2012, 43:876-881. doi: 10.1016/j.injury.2011.11.008
  • 31. Geiger F, Zimmermann-Stenzel M, Heisel C, Lehner B, Daecke W. Trochanteric fractures in the elderly: the influence of primary hip arthroplasty on 1-year mortality. Arch Orthop Trauma Surg 2007, 127:959-966. doi: 10.1007/s00402-007-0423-7
  • 32. Zhang Z, Ge J, Lu X, Chen G, Zhuo N. Evaluation on curative effect of three operative methods in treatment of senile intertrochanteric fracture. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2009, 23:556-561.
  • 33. Miedel R, Törnkvist H, Ponzer S, Tidermark J. Musculoskeletal function and quality of life after an unstable trochanteric fracture treated with the trochanteric gamma nail. Arch Orthop Trauma Surg 2012, 132:1495-1503. doi: 10.1007/s00402-012-1568-6
  • 34. Vatansever A, Oziç U, Okcu G. Assessment of quality of life of patients after hemiarthroplasty for proximal femoral fractures. Acta Orthop Traumatol Turc 2005, 39:237-242.
  • 35. Dragomir-Daescu D, Op Den Buijs J, McEeligot S et al. Robust QCT/FEA Models of Proximal Femur Stiffness and Fracture Load During a Sideways Fall on the Hip. Annals of Biomedical Engineering 2011, 39(2):742-55. doi: 10.1007/s10439-010-0196-y
  • 36. Hambli R, Bettamer A, Allaoui S. Finite element prediction of proximal femur fracture pattern based on orthotropic behaviour law coupled to quasi-brittle damage. Med Eng Phys. 2012, 34(2):202-210. doi: 10.1016/j.medengphy.2011.07.011
  • 37. Schileo E, Taddei F, Cristofolini L, Viceconti, M. Subject-specific finite element models implementing a maximum principal strain criterion are able to estimate failure risk and fracture location on human femurs tested in vitro. J Biomech 2008, 41(2):356-67. doi: 10.1016/j.jbiomech.2007.09.009

Yıl 2025, Cilt: 1 Sayı: 1, 25 - 31, 01.05.2025

Mustafa Caner Okkaoglu , Yüksel Uğur Yaradılmış , Mert Karaduman , İsmail Demirkale , Mahmut Özdemir Hakan Şeşen , Murat Altay

Öz

Kaynakça

  • 1. Anglen JO, Weinstein JN. American Board of Orthopaedic Surgery Research Committee: Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg Am 2008, 90(4):700-7. doi: 10.2106/JBJS.G.00517
  • 2. Mereddy P, Kamath S, Ramakrishnan M, Malik H, Donnachie N. The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures. Injury 2009, 40:428-32. doi: 10.1016/j.injury.2008.10.014
  • 3. Forward DP, Doro CJ, OʼToole RV et al.A biomechanical comparison of a locking plate, a nail, and a 95° angled blade plate for fixation of subtrochanteric femoral fractures. J Orthop Trauma 2012, 26:334-340. doi: 10.1097/BOT.0b013e3182254ea3
  • 4. Kummer FJ, Olsson O, Pearlman CA, Ceder L, Larsson S, Koval KJ. Intramedullary versus extramedullary fixation of subtrochanteric fractures. A biomechanical study. Acta Orthop Scand 1998, 69:580-584. doi: 10.3109/17453679808999259
  • 5. Shen L, Zhang Y, Shen Y, Cui Z. Antirotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures: a meta-analysis of randomized controlled studies. Orthop Traumatol Surg Res 2013, 99(4):377-83. doi: 10.1016/j.otsr.2012.12.019
  • 6. Tang P, Hu F, Shen J, Zhang L, Zhang L. Proximal femoral nail antirotation versus hemiarthroplasty: a study for the treatment of intertrochanteric fractures. Injury 2012, 43(6):876-81. doi: 10.1016/j.injury.2011.11.008
  • 7. Liu Y, Tao R, Liu F et al. Mid-term outcomes after intramedullary fixation of peritrochanteric femoral fractures using the new proximal fen-moral nail antirotation (PFNA). Injury 2010, 41(8):810-7. doi: 10.1016/j.injury.2010.03.020
  • 8. Kesmezacar H, Oğüt T, Bilgili MG, Gökay S, Tenekecioğlu Y. Treatment of intertrochanteric femur fractures in elderly patients: internal fixation or hemiarthroplasty. Acta Orthop Traumatol Turc 2005, 39:287-294.
  • 9. Haentjens P, Casteleyn PP, Opdecam P. Primary bipolar arthroplasty or total hip arthroplasty for the treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Acta Orthop Belg 1994, 60:124-128.
  • 10. Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Ortop Relat Res 1998, 348: 87-94.
  • 11. Kesemenli CC, Memisoglu K, Necmioglu S, Kayikci C. Treatment of intertrochanteric femur fractures with 95° fixed-angle blade plate in elderly patients. Eur J Orthop Surg Traumatol 2010, 20:629–634. doi: 10.1007/s00590-010-0627-3
  • 12. Vekris MD, Lykissas MG, Manoudis G et al. Proximal screws placement in intertrochanteric fractures treated with external fixation: comparison of two different techniques. J Orthop Surg Res 2011, 22:48-62. doi: 10.1186/1749-799X-6-48
  • 13. AO: Committee of Coding and Classification of the Orthopaedic Trauma Association. Fracture and dislocation compendium. J Orthop Trauma 1996, 10:31–35. doi: 10.1186/1749-799X-6-48
  • 14. Singh M, Nagrath AR, Maini PS, Haryana R. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg 1970, 52A:457–467.
  • 15. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987, 40:373-383. doi: 10.1016/0021-9681(87)90171-8
  • 16. Foss NB, Kristensen MT, Kehlet H. Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients: the cumulated ambulation score. Clin Rehabil 2006, 20:701-708. doi: 10.1191/0269215506cre987
  • 17. Strauss E, Frank J, Lee J, Kummer FJ, Tejwani N. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation. Injury 2006, 37(10):984-989. doi: 10.1016/j.injury.2006.06.008
  • 18. Lenich A1, Vester H, Nerlich M, Mayr E, Stöckle U, Füchtmeier B. Clinical comparison of the second and third generation of intramedullary devices for trochanteric fractures of the hip Blade vs screw. Injury 2010, 41(12):1292-6. doi: 10.1016/j.injury.2010.07.499
  • 19. J. Vaqueroa, J. Munoza, S. Pratb et al. Proximal Femoral Nail Antirotation versus Gamma3 nail for intramedullary nailingof unstable trochanteric fractures. A randomised comparative study. Injury, Int. J. Care Injured 2012, 43(S2), P47–P54. doi: 10.1016/S0020-1383(13)70179-7
  • 20. Xu Yaozeng, Geng Dechun, Yang Huilin, Zhu Guangming, Wang Xianbin. Comparative study of trochanteric fracture treated with the proximal femoral nailanti-rotation and the third generation of gamma nail. Injury, Int. J. Care Injured 2010, 41:1234–1238. doi: 10.1016/j.injury.2010.03.005
  • 21. Yue-Hua Yang, Yu-Ren Wang, Sheng-Dan Jiang, Lei-Sheng Jiang. Proximal femoral nail antirotation and third-generation Gamma nail: which is a better device for the treatment of intertrochanteric fractures? Singapore Med J 2013, 54(8): 446-4. doi: 10.11622/smedj.2013152
  • 22. Schipper IB, Steyerberg EW, Castelein RM et al. Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail. J Bone Joint Surg Br 2004, 86:86-94. doi: 10.1302/0301-620X.86B1.14455
  • 23. Sipilä S, Salpakoski A, Edgren J et al. Promoting mobility after hip fracture (ProMo): study protocol and selected baseline results of a year-long randomized controlled trial among community-dwelling older people. BMC Musculoskelet Disord 2011, 12:277. doi: 10.1186/1471-2474-12-277
  • 24. O'Malley NT, Blauth M, Suhm N, Kates SL. Hip fracture management, before and beyond surgery and medication: a synthesis of the evidence. Arch Orthop Trauma Surg 2011, 131:1519-1527. doi: 10.1007/s00402-011-1341-2
  • 25. Piziak VK, Rajab MH. An effective team approach to improve postoperative hip fracture care. J Orthop Trauma 2011, 25:72-75. doi: 10.1097/BOT.0b013e3181db703c
  • 26. Yu-Yahiro JA, Resnick B, Orwig D, Hicks G, Magaziner J. Design and implementation of a home-based exercise program post-hip fracture: the Baltimore hip studies experience. PM R 2009, 1:308-318. doi: 10.1016/j.pmrj.2009.02.008
  • 27. Panula J, Pihlajamäki H, Mattila VM et al. Mortality and cause of death in hip fracture patients aged 65 or older: a population-based study. BMC Musculoskelet Disord 2011, 12:105. doi: 10.1186/1471-2474-12-105
  • 28. Kim SY, Kim YG, Hwang JK. Cementless calcar-replacement hemiarthroplasty compared with intramedullary fixation of unstable intertrochanteric fractures. A prospective, randomized study. J Bone Joint Surg Am 2005, 87:2186-2192. doi: 10.2106/JBJS.D.02768
  • 29. Intiso D, Di Rienzo F, Grimaldi G et al. Survival and functional outcome in patients 90 years of age or older after hip fracture. Age Ageing 2009, 38:619-622. doi: 10.1093/ageing/afp126
  • 30. Tang P, Hu F, Shen J, Zhang L, Zhang L. Proximal femoral nail antirotation versus hemiarthroplasty: a study for the treatment of intertrochanteric fractures. Injury 2012, 43:876-881. doi: 10.1016/j.injury.2011.11.008
  • 31. Geiger F, Zimmermann-Stenzel M, Heisel C, Lehner B, Daecke W. Trochanteric fractures in the elderly: the influence of primary hip arthroplasty on 1-year mortality. Arch Orthop Trauma Surg 2007, 127:959-966. doi: 10.1007/s00402-007-0423-7
  • 32. Zhang Z, Ge J, Lu X, Chen G, Zhuo N. Evaluation on curative effect of three operative methods in treatment of senile intertrochanteric fracture. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2009, 23:556-561.
  • 33. Miedel R, Törnkvist H, Ponzer S, Tidermark J. Musculoskeletal function and quality of life after an unstable trochanteric fracture treated with the trochanteric gamma nail. Arch Orthop Trauma Surg 2012, 132:1495-1503. doi: 10.1007/s00402-012-1568-6
  • 34. Vatansever A, Oziç U, Okcu G. Assessment of quality of life of patients after hemiarthroplasty for proximal femoral fractures. Acta Orthop Traumatol Turc 2005, 39:237-242.
  • 35. Dragomir-Daescu D, Op Den Buijs J, McEeligot S et al. Robust QCT/FEA Models of Proximal Femur Stiffness and Fracture Load During a Sideways Fall on the Hip. Annals of Biomedical Engineering 2011, 39(2):742-55. doi: 10.1007/s10439-010-0196-y
  • 36. Hambli R, Bettamer A, Allaoui S. Finite element prediction of proximal femur fracture pattern based on orthotropic behaviour law coupled to quasi-brittle damage. Med Eng Phys. 2012, 34(2):202-210. doi: 10.1016/j.medengphy.2011.07.011
  • 37. Schileo E, Taddei F, Cristofolini L, Viceconti, M. Subject-specific finite element models implementing a maximum principal strain criterion are able to estimate failure risk and fracture location on human femurs tested in vitro. J Biomech 2008, 41(2):356-67. doi: 10.1016/j.jbiomech.2007.09.009
Toplam 37 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Ortopedi
Bölüm Original Article
Yazarlar

Mustafa Caner Okkaoglu 0000-0002-9149-1858

Yüksel Uğur Yaradılmış 0000-0002-7606-5690

Mert Karaduman 0000-0003-1136-411X

İsmail Demirkale 0000-0001-7230-1599

Mahmut Özdemir 0000-0003-2674-9549

Hakan Şeşen 0000-0001-6874-7061

Murat Altay 0000-0002-1898-3733

Erken Görünüm Tarihi 28 Nisan 2025
Yayımlanma Tarihi 1 Mayıs 2025
Gönderilme Tarihi 14 Mart 2025
Kabul Tarihi 27 Mart 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 1 Sayı: 1

Kaynak Göster

Vancouver Okkaoglu MC, Yaradılmış YU, Karaduman M, Demirkale İ, Özdemir M, Şeşen H, Altay M. Treatment of intertrochanteric femur fractures in the elderly: Cephalomedullary nailing versus hemiarthroplasty. A retrospective analysis of 264 cases. Sanatorium Med J. 2025;1(1):25-31.
 Kapak Resmi İndir

Sanatorium Medical Journal is a peer-reviewed, open-access journal dedicated to medical research. 

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