Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2016

Open Access 01-12-2016 | Research article

Comparison of intramedullary and extramedullary fixation of stable intertrochanteric fractures in the elderly: a prospective randomised controlled trial exploring hidden perioperative blood loss

Authors: Leyi Cai, Te Wang, Lu Di, Wei Hu, Jianshun Wang

Published in: BMC Musculoskeletal Disorders | Issue 1/2016

Login to get access

Abstract

Background

Hip fracture is a severe and common injury that occurs predominantly in the elderly. Blood loss in the perioperative period is associated with a greater risk of dying in anaemic patients. The aim of the study was to explore the best way to treat stable intertrochanteric fractures, taking hidden blood loss into account.

Methods

This prospective, randomised blinded study included patients aged over 65 years with stable intertrochanteric fractures (Evans grades I and II). The patients were allocated to one of two groups treated via extramedullary or intramedullary fixation. Patient data were retrieved from electronic charts. Functional recovery was evaluated using the Functional Recovery Score of Zuckerman. Postoperative complications were also recorded. The formula of Nadler and Gross was used to calculate blood loss.

Results

There were 92 patients in the extramedullary and 106 in the intramedullary group. Age, sex, the cause of injury, the type of fracture, the observed blood loss, functional recovery, time to union, complications, and American Society of Anesthesiologists classification did not differ significantly between the two groups (all p-values > 0.05). The frequencies of lung infection, electrolyte imbalance, and hypoproteinemia differed between groups (all p-values < 0.05). Total and hidden blood loss were higher in the intramedullary group (p = 0.001).

Conclusion

Extramedullary (compared with intramedullary) fixation of stable intertrochanteric fractures significantly reduces perioperative blood loss but affords similar functional outcomes and times to union. In view of the morbidity and complications associated with acute anaemia and transfusions, extramedullary fixation may be the optimal choice for treatment of stable fractures, being associated with reduced blood loss.

Trial registration

The study was retrospectively registered at the Chinese Clinical Trial Registry, number: ChiCTR-INQ-16009754, trial registration date: 6th Nov. 2016.
Literature
1.
Matre K, Havelin LI, Gjertsen JE, Vinje T, Espehaug B, Fevang JM. Sliding hip screw versus IM nail in reverse oblique trochanteric and subtrochanteric fractures. A study of 2716 patients in the Norwegian Hip Fracture Register. Injury. 2013;44:735–42.CrossRefPubMed
2.
Ekström W, Al-Ani AN, Sääf M, Cederholm T, Ponzer S, Hedström M. Health related quality of life, reoperation rate and function in patients with diabetes mellitus and hip fracture--a 2 year follow-up study. Injury. 2013;44:769–75.CrossRefPubMed
3.
Chang JD, Yoo JH, Reddy P, Lee SS, Hwang JH, Kim TY. Risk factors for contralateral hip fracture in elderly patients with previous hip fracture. Injury. 2013;44:1930–3.CrossRefPubMed
4.
Borges A, Torres J, Sao Simao R, et al. Impact of preoperative analytical values on post-operative mortality rate of intertrochanteric fractures. Acta Med Port. 2014;27(2):218–22.CrossRefPubMed
5.
Kuzyk PR, Lobo J, Whelan D, Zdero R, McKee MD, Schemitsch EH. Biomechanical evaluation of extramedullary versus intramedullary fixation for reverse obliquity intertrochanteric fractures. J Orthop Trauma. 2009;23:31–8.CrossRefPubMed
6.
Uzoigwe CE, Burnand HG, Cheesman CL, Aghedo DO, Faizi M, Middleton RG. Early and ultra-early surgery in hip fracture patients improves survival. Injury. 2013;44:726–9.CrossRefPubMed
7.
Sidhu AS, Singh AP, Singh AP, Singh S. Total hip replacement as primary treatment of unstable intertrochanteric fractures in elderly patients. Int Orthop. 2010;34:789–92.CrossRefPubMed
8.
Canale ST, Beaty JH. Campbell’s operative orthopaedics. 11th ed. Mosby: Elsevier Masson; 2007.
9.
Frohlich P, Benko T. DHS (Dynamic Hip Screw)-osteosynthesis in the management of femoral fractures in the hip region and the place of this method in the treatment of such injuries. Magy Traumatol Ortop Kezseb Plasztikai Seb. 1993;36:59–64.PubMed
10.
Dhamangaonkar AC, Joshi D, Goregaonkar AB, et al. Proximal femoral locking plate versus dynamic hip screw for unstable intertrochanteric femoral fractures. J Orthop Surg (Hong Kong). 2013;21:317–22.CrossRef
11.
Knobe M, Gradl G, Ladenburger A, et al. Unstable intertrochanteric femur fractures: is there a consensus on definition and treatment in Germany? Clin Orthop Relar Res. 2013;471:2831–40.CrossRef
12.
Shen L, Zhang Y, Shen Y, et al. Antirotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures: a meta-analysis of randomized controlled studies. Orthop Traumatol Surg Res. 2013;99:377–83.CrossRefPubMed
13.
Fogagnolo F, Kfuri Jr M, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg. 2004;124:31–7.CrossRefPubMed
14.
Foss NB, Kehlet H. Hidden blood loss after surgery for hip fracture. J Bone Jt Surg [Br]. 2006;88:1053–9.CrossRef
15.
Hu F, Jiang C, Shen J, Tang P, Wang Y. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury. 2012;43:676–85.CrossRefPubMed
16.
Kumar D, Mbako AN, Riddick A, Patil S, Williams P. On admission haemoglobin in patients with hip fracture. Injury. 2011;42:167–70.CrossRefPubMed
17.
Turgut A, Kalenderer Ö, Günaydın B, et al. Fixation of intertrochanteric femur fractures using Proximal Femoral Nail Antirotation (PFNA) in the lateral decubitus position without a traction table. Acta Orthop Traumatol Turc. 2014;48:513-520.
18.
Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery. 1962;51:224–32.PubMed
19.
Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983;58:277–80.CrossRefPubMed
20.
Zuckerman JD, Koval KJ, Aharonoff GB, Skovron ML. A functional recovery score for elderly hip fracture patients: II Validity and reliability. J Orthop Trauma. 2000;14:26–30.CrossRefPubMed
21.
Schipper IB, Marti RK, van der Werken C. Unstable trochanteric femoral fractures: extramedullary or intramedullary fixation. Review of literature. Injury. 2004;35:142–51.CrossRefPubMed
22.
Weiser L, Ruppel AA, Nuchtern JV, et al. Extra- vs. intramedullary treatment of pertrochanteric fractures: a biomechanical in vitro study comparing dynamic hip screw and intramedullary nail. Arch Orthop Trauma Surg. 2015;135:1101–6.CrossRefPubMed
23.
Verettas DA, Ifantidis P, Chatzipapas CN, et al. Systematic effects of surgical treatment of hip fractures: Gliding screw-plating vs intramedullary nailing. Injury. 2010;41:279–84.CrossRefPubMed
24.
Saudan M, Lubbeke A, Sadowski C, et al. Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma. 2002;16:386–93.CrossRefPubMed
25.
Crawford CH, Malkani AL, Cordray S, Roberts CS, Sligar W. The trochanteric nail versus the sliding hip screw for intertrochanteric hip fractures: a review of 93 cases. J Trauma. 2006;60:325–8. discussion 328-9.CrossRefPubMed
26.
Seyedi HR, Mahdian M, Khosravi G, et al. Prediction of mortality in hip fracture patients: role of routine blood tests. Arch Bone Jt Surg. 2015;3:51–5.PubMedPubMedCentral
27.
Wang J, Wei J, Wang M. The risk factors of perioperative hemoglobin and hematocrit drop after intramedullary nailing treatment for intertrochanteric fracture patients. J Orthop Sci. 2015;20:163–7.CrossRefPubMed
28.
Gautier E, Ganz K, Krugel N, et al. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br. 2000;82:679–83.CrossRefPubMed
Metadata
Title
Comparison of intramedullary and extramedullary fixation of stable intertrochanteric fractures in the elderly: a prospective randomised controlled trial exploring hidden perioperative blood loss
Authors
Leyi Cai
Te Wang
Lu Di
Wei Hu
Jianshun Wang
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2016
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-016-1333-z

Other articles of this Issue 1/2016

BMC Musculoskeletal Disorders 1/2016 Go to the issue

Research article

Short- to long-term follow-up of total femoral replacement in non-oncologic patients

Research article

Macrophage migration inhibitory factor enhances lipopolysaccharide-induced fibroblast proliferation by inducing toll-like receptor 4

Research article

Hidden musculoskeletal involvement in inflammatory bowel disease: a multicenter ultrasound study

Study protocol

A protocol of a randomized controlled multicenter trial for surgical treatment of lumbar spondylolisthesis: the Lumbar Interbody Fusion Trial (LIFT)

Research article

Effects of different surgical techniques on mid-distal humeral shaft vascularity: open reduction and internal fixation versus minimally invasive plate osteosynthesis

Research article

Influence of disruption of the acromioclavicular and coracoclavicular ligaments on glenohumeral motion: a kinematic evaluation