ADVANTAGES OF MODIFIED NECK SCREW IN OSTEOSYNTHESIS OF PROXIMAL FEMORAL FRACTURES IN ELDERLY PATIENTS

BACKGROUND. Extra-articular fractures of the proximal femur are severe lower extremity trauma, most patients are of elderly and senile age, what makes the problem of surgical management actual.

MATERIALS AND METHODS.We made a retrospective analysis of surgical treatment in 91 patients treated in 2010–2013. Entry criteria were: age over 65 years, application of a standard proximal femoral fixator (PFF) and PFF with modified neck screw, postoperative monitoring period up to 36 months. The overall performance was assessed depending on the fracture type in accordance with AO/ASIF classification (A1, A2, and A3). To assess the effectiveness of the proposed PFF with modified neck screw we formed the study group (n=28) and the comparison group (n=63). The PFF with modified neck screw was applied in the study group. The standard PFF was applied (“Osteosynthesis”, Rybinsk) in the control group. The x-ray, clinical and statistical methods of research were used. To assess the functional status and quality of life, harris hip score was applied.

RESULTS. In overall performance, excellent results occurred in 35.3% 12 months postoperatively, good — 29.7%, satisfactory — 26%, unsatisfactory — 8.8%. In patients with A1 type fractures, excellent and good results (77.7%) were higher in total than the corresponding figures in patients with A2 (51.3%) and A3 (75.0%) type fractures. Unsatisfactory results more frequently occurred in patients with A2 type fractures (p=0.038). Twelve months after the surgery excellent and good results in the study group (75.0%) exceeded the similar data in the comparison group (46.0%) by 1.63 times (p=0.039). Unsatisfactory results were observed 3.08 times more often in patients of the comparison group (3.6% and 11.1%, respectively), p=0.041.

CONCLUSION. Application of PFF with modified neck screw, allowed 75.0% excellent and good results to be achieved in the study group, compared to 46.0% in the comparison group.

1. Tikhilov R.M., Kochish A.Yu., Mironenko A.N., et al. Current status of patients with extra-articular fractures of the proximal femur (review). Travmatologiya i ortopediya Rossii. 2009;4:113–118. (In Russian).

2. Georgiannos D, Lampridis V, Bisbinas I. Subtrochanteric femoral fractures treated with the Long Gamma3 nail: A historical control case study versus long trochanteric Gamma. Orthop Traumatol Surg Res. 2015;101(6):675–680.

3. Dudaev A.K., Tsed A.N., Radysh V.E., et al. Features of surgical treatment of patients with extra-articular fractures of the proximal femur. Travmatologiya i ortopediya Rossii. 2010;4:11–17. (In Russian).

4. Ma K.L., Wang X., Luan F.J., et al. Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: a meta-analysis. Orthop Traumatol Surg Res. 2014; 100(8):859–866.

5. Henzman C., Ong K., Lau E., et al. Complication risk after treatment of Intertrochanteric hip fractures in the medicare population . Orthopedics. 2015;38(9):799–805.

6. Antoniadi Yu.V., Volokitina E.A., Zverev F.N. New technologies in the surgical treatment of elderly patients with near- and intraarticular fractures of the proximal femur. Ural’skiy meditsinskiy zhurnal. 2012;6:116–120. (In Russian).

7. Ozkan K., Türkmen İ., Sahin A., et al. A biomechanical comparison of proximal femoral nails and locking proximal anatomic femoral plates in femoral fracture fixation: A study on synthetic bones. Indian J Orthop. 2015;49(3):347–351.

8. Embden D., Stollenwerck G.A., Koster L.A., et al. The stability of fixation of proximal femoral fractures: a radiostereometric analysis. Bone Joint J. 2015;97-B(3):391–397.

9. Orthopaedic scores. Harris Hip Score. Available at: http://www.orthopaedicscore.com/scorepages/harris_hip_score.html (Accessed Nov 28, 2016).

10. Fernandez M.A., Griffin X.L., Costa M.L. Management of hip fracture. Br Med Bull. 2015;115(1):165–172.

11. Tosounidis T.H., Castillo R., Kanakaris N.K., Giannoudis P.V. Common complications in hip fracture surgery: Tips/tricks and solutions to avoid them. Injury. 2015, 46 Suppl 5:S3–S11.

12. Antoniadi Yu.V., Volokitina E.A., Zverev F.N., Kozlov V.A. Intramedullary gamma-nail. Patent 154108 RF IPC51 A61B17/72 (2006.01). St. 01/12/2015; pub. 08/20/2015, Bul. 23.