Surgical options for Evans-Jensen type IV intertrochanteric femur fractures in the elderly over 65: a comparison between total hip arthroplasty and proximal femoral nail antirotation
BackgroundCurrently, there is no clear standard for the surgical options for Evans-Jensen Type IV intertrochanteric femur fractures in elderly patients over 65 years old. This study aims to retrospectively analyze and compare the early postoperative limb function and quality of life of patients trea...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2024.1510094/full |
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| author | Ming Sun Hai-Rui Liang He Zhang Tong Bai Rong-Da Xu Si-Yu Duan Zhen-Cun Cai Zhen-Cun Cai |
| author_facet | Ming Sun Hai-Rui Liang He Zhang Tong Bai Rong-Da Xu Si-Yu Duan Zhen-Cun Cai Zhen-Cun Cai |
| author_sort | Ming Sun |
| collection | DOAJ |
| description | BackgroundCurrently, there is no clear standard for the surgical options for Evans-Jensen Type IV intertrochanteric femur fractures in elderly patients over 65 years old. This study aims to retrospectively analyze and compare the early postoperative limb function and quality of life of patients treated with total hip arthroplasty (THA) and proximal femoral nail antirotation (PFNA) for this type of fracture. We hypothesize that there is no significant difference in complications and postoperative recovery between the two surgical methods.MethodsA retrospective analysis was conducted on patients over 65 years old with Evans-Jensen Type IV intertrochanteric femur fractures who were treated between 2020 and 2023. The patients were divided into two groups based on the treatment method: the PFNA group (20 cases) and the THA group (20 cases). General patient information, operative time, intraoperative blood loss, time to postoperative mobilization, time to weight-bearing on the affected limb, Harris hip scores at 1, 3, and 6 months postoperatively, excellent and good rates, SF-36 scores, and postoperative complications were recorded.ResultsCompared to the PFNA group, the THA group had a longer operative time (86.7 ± 9.6 vs. 51.5 ± 5.3 min, p < 0.001) and more intraoperative blood loss (212.0 ± 35.5 vs. 76.5 ± 16.1 ml, p < 0.001). However, the THA group had an earlier time to first postoperative mobilization (3.1 ± 1.4 vs. 43.3 ± 13.09 days, p < 0.001) and earlier time to full weight-bearing on the affected limb (33.5 ± 3.1 vs. 77.9 ± 12.0 days, p < 0.001). The Harris hip scores and SF-36 scores at 1, 3, and 6 months postoperatively were higher in the THA group (p < 0.05 for all). There was no significant difference in the overall incidence of postoperative complications between the two groups (p = 0.41).ConclusionFor elderly patients over 65 years old with Evans-Jensen Type IV intertrochanteric femur fractures, especially those with underlying diseases who cannot tolerate prolonged bed rest, hip replacement surgery (THA) may be preferred. Postoperative patients can begin rehabilitation exercises earlier, preventing the exacerbation of internal medical conditions. Early recovery of hip function on the affected side is faster, and the quality of life of patients is higher. |
| format | Article |
| id | doaj-art-daf145b2c5744ce9a5f17a0775b28ab7 |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-daf145b2c5744ce9a5f17a0775b28ab72025-01-07T06:44:46ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2025-01-011110.3389/fsurg.2024.15100941510094Surgical options for Evans-Jensen type IV intertrochanteric femur fractures in the elderly over 65: a comparison between total hip arthroplasty and proximal femoral nail antirotationMing Sun0Hai-Rui Liang1He Zhang2Tong Bai3Rong-Da Xu4Si-Yu Duan5Zhen-Cun Cai6Zhen-Cun Cai7Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, ChinaDepartment of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, ChinaSports Medicine, Tongliao People’s Hospital, Tongliao, Inner Mongolia, ChinaDepartment of Orthopedics Surgery, Shenyang Ninth People’s Hospital, Shenyang, Liaoning, ChinaDepartment of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, ChinaDepartment of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, ChinaDepartment of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, ChinaLiaoning Province Key Laboratory for Phenomics of Human Ethnic Specificity and Critical Illness, and Shenyang Key Laboratory for Phenomics, Shenyang, Liaoning, ChinaBackgroundCurrently, there is no clear standard for the surgical options for Evans-Jensen Type IV intertrochanteric femur fractures in elderly patients over 65 years old. This study aims to retrospectively analyze and compare the early postoperative limb function and quality of life of patients treated with total hip arthroplasty (THA) and proximal femoral nail antirotation (PFNA) for this type of fracture. We hypothesize that there is no significant difference in complications and postoperative recovery between the two surgical methods.MethodsA retrospective analysis was conducted on patients over 65 years old with Evans-Jensen Type IV intertrochanteric femur fractures who were treated between 2020 and 2023. The patients were divided into two groups based on the treatment method: the PFNA group (20 cases) and the THA group (20 cases). General patient information, operative time, intraoperative blood loss, time to postoperative mobilization, time to weight-bearing on the affected limb, Harris hip scores at 1, 3, and 6 months postoperatively, excellent and good rates, SF-36 scores, and postoperative complications were recorded.ResultsCompared to the PFNA group, the THA group had a longer operative time (86.7 ± 9.6 vs. 51.5 ± 5.3 min, p < 0.001) and more intraoperative blood loss (212.0 ± 35.5 vs. 76.5 ± 16.1 ml, p < 0.001). However, the THA group had an earlier time to first postoperative mobilization (3.1 ± 1.4 vs. 43.3 ± 13.09 days, p < 0.001) and earlier time to full weight-bearing on the affected limb (33.5 ± 3.1 vs. 77.9 ± 12.0 days, p < 0.001). The Harris hip scores and SF-36 scores at 1, 3, and 6 months postoperatively were higher in the THA group (p < 0.05 for all). There was no significant difference in the overall incidence of postoperative complications between the two groups (p = 0.41).ConclusionFor elderly patients over 65 years old with Evans-Jensen Type IV intertrochanteric femur fractures, especially those with underlying diseases who cannot tolerate prolonged bed rest, hip replacement surgery (THA) may be preferred. Postoperative patients can begin rehabilitation exercises earlier, preventing the exacerbation of internal medical conditions. Early recovery of hip function on the affected side is faster, and the quality of life of patients is higher.https://www.frontiersin.org/articles/10.3389/fsurg.2024.1510094/fullintertrochanteric fractureproximal femoral nail antirotationtotal hip arthroplastyEvans-Jensen type IVgeriatric medicine |
| spellingShingle | Ming Sun Hai-Rui Liang He Zhang Tong Bai Rong-Da Xu Si-Yu Duan Zhen-Cun Cai Zhen-Cun Cai Surgical options for Evans-Jensen type IV intertrochanteric femur fractures in the elderly over 65: a comparison between total hip arthroplasty and proximal femoral nail antirotation Frontiers in Surgery intertrochanteric fracture proximal femoral nail antirotation total hip arthroplasty Evans-Jensen type IV geriatric medicine |
| title | Surgical options for Evans-Jensen type IV intertrochanteric femur fractures in the elderly over 65: a comparison between total hip arthroplasty and proximal femoral nail antirotation |
| title_full | Surgical options for Evans-Jensen type IV intertrochanteric femur fractures in the elderly over 65: a comparison between total hip arthroplasty and proximal femoral nail antirotation |
| title_fullStr | Surgical options for Evans-Jensen type IV intertrochanteric femur fractures in the elderly over 65: a comparison between total hip arthroplasty and proximal femoral nail antirotation |
| title_full_unstemmed | Surgical options for Evans-Jensen type IV intertrochanteric femur fractures in the elderly over 65: a comparison between total hip arthroplasty and proximal femoral nail antirotation |
| title_short | Surgical options for Evans-Jensen type IV intertrochanteric femur fractures in the elderly over 65: a comparison between total hip arthroplasty and proximal femoral nail antirotation |
| title_sort | surgical options for evans jensen type iv intertrochanteric femur fractures in the elderly over 65 a comparison between total hip arthroplasty and proximal femoral nail antirotation |
| topic | intertrochanteric fracture proximal femoral nail antirotation total hip arthroplasty Evans-Jensen type IV geriatric medicine |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2024.1510094/full |
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