Clinical results of intramedullary and hemiarthroplasty in the treatment of intertrochanteric fracture with coronal fracture in the elderly
QIU Wang-bao
SHI Bao-qing
WANG Han-bang
LIANG Wei
Abstract：Objective To compare the effectiveness of intramedullary and hemiarthroplasty in the treatment of intertrochanteric fracture with coronal fracture in the elderly.Methods A retrospective analysis of 50 elderly patients with intertrochanteric fracture and coronal fracture was conducted.All underwent operation between July 2017 and February 2022.According to the different surgical methods,the patients were divided into 2 groups:Group A[27 cases,proximal femoral nail(PFN),proximal femoral nail antirotation(PFNA)/TriGen InterTAN hip fracture nailing system(InterTAN)]and Group B(23 cases,hemiarthroplasy).There was no significant difference in age,gender,body mass index(BMI),preoperative visual analogue scale(VAS),preoperative hemoglobin and serum albumin levels and preopertive prepare time(P>0.05).Operation time,intraoperative blood loss,length of hospital stay,postoperative VAS score,postoperative hemoglobin and serum albumin levels,Harris score of postoperative 1,3,6 months,and complications were recorded and compared between the two groups.All patients were followed up for 6 to 24 months.Results There was no significant difference in operation time,length of hospital stay,postoperative hemoglobin and serum albumin level,and complications between the two groups.The intraoperative blood loss was(250.90±70.11)ml in the intramedullary fixation group and(314.80±61.49)ml in the hemiarthroplasty group,and the differences were statistically significant(P = 0.001).The postoperative VAS scores between the two groups were not significantly different.VAS score in the intramedullary fixation group was(7.10±1.10)preoperatively and(4.90±0.97)postoperatively,the differences were statistically significant(P = 0.000).VAS score in Group B was(7.20±1.06)preoperatively and(4.40±0.97)postoperatively,the differences were statistically significant(P = 0.000).Both operations could effectively relieve pain.The Harris score results:(37.40±5.17)in the intramedullary fixation group and(46.10±7.38)in the hemiarthroplasty group 1 month postoperatively,and the differences were statistically significant(P = 0.000);(57.10±8.17)in the intramedullary fixation group and(64.70±6.13)in the hemiarthroplasty group 3 months postoperatively,and the differences were statistically significant(P = 0.000).Functions of the hemiarthroplasty group were better than that of intramedullary fixation group,and there was no statistically significant difference between the two groups 6 months postoperatively.However,both surgeries can significantly improve the function of patients.Complications of the two groups:4 cases(14.8%)in the intramedullary fixation group and 3 cases(13%)in the hemiarthroplasty group,with no significant differences(χ2 = 0.029,P = 0.857).Conclusions Both PFN/PFNA/InterTAN intramedullary fixation and hemiarthroplasty can achieve good results for intertrochanteric fractures combined with coronal fractures.Coronal fracture will increase the difficulty of the operation.The early functional recovery of hemiarthroplasty patients is better than that of intramedullary fixation.However,intramedullary fixation can also achieve good function along with time goes.
Keywords：Femoral fracturesFracture fixationintramedullaryInternal fixatorsArthroplastyreplacementhip
Publication Date：2023-12-19
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：8( 929-936 )