Reoperation rate, mortality and ambulatory ability after internal fixation versus hemiarthroplasty for unstable intertro
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ORTHOPAEDIC SURGERY
Reoperation rate, mortality and ambulatory ability after internal fixation versus hemiarthroplasty for unstable intertrochanteric fractures in elderly patients: a study on Korean Hip Fracture Registry Jin‑Woo Kim1 · Hyun‑Chul Shon2 · Sang‑Heon Song3 · Young‑Kyun Lee4 · Kyung‑Hoi Koo4 · Yong‑Chan Ha5 Received: 28 May 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction The treatment of unstable intertrochanteric fracture in elderly patients is challenging and how to treat these patients remains controversial. The purposes of this study were to compare (1) reoperation rate, (2) mortality and (3) the postoperative change of walking ability between patients undergoing internal fixation (IF) and those undergoing bipolar hemiarthroplasty (HA) due to this type of fracture based on the data from the Korean Hip Fracture Registry. Materials and methods Between July 2014 and June 2016, we extracted 623 unstable intertrochanteric fractures (616 patients aged ≥ 65 years) according to the classification of the Association for the Study of Internal Fixation-American Orthopaedic Trauma Association. Among the 564 patients, 396 were treated with IF (IF group) and 168 with bipolar HA (HA group). We compared the reoperation rate and mortality between IF group and HA group. In patients, who were followed up more than 2 years after the surgery, we compared the postoperative change of walking activity from ambulatory outdoors (Koval’s grade 1, 2, 3) to housebound (Koval’s grade 4, 5, 6). Results The rate of reoperation was higher in the IF group (24/396, 6.1%) than in the HA (4/168, 2.4%) (p = 0.046). At the final follow-up, 79 (35.7%) of the 221 IF patients became housebound, whereas 21 (23.3%) of the 90 HA patients became housebound (p = 0.022). Conclusion This study showed HA was associated with lower rate of reoperation and lower decrement rate of walking ability compared to IF in elderly patients with unstable intertrochanteric fractures. Keywords Hip · Unstable intertrochanteric fracture · Internal fixation · Bipolar hemiarthroplasty · Reoperation · Mortality
Introduction
* Yong‑Chan Ha [email protected] 1
Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
2
Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University, Cheongju, South Korea
3
Department of Orthopaedic Surgery, Myongji Hospital, Hanyang University College of Medicine, Goyang‑si, South Korea
4
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
5
Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 102 Heukseok‑ro, Dongjak‑gu, Seoul 06973, South Korea
The number and incidence of hip fractures in elderly population are increasing worldwide [1–3]. The treatment of hip fractures in the elderly is challenging and technically demanding, due to underlying comorbidities and poor bone quality [4, 5]. Among the elderly hip fractu
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