İntertrokanterik femur kırığı sonrasında proksimal femur çivisi ile başarılı osteosentez elde edilen hastaların fonksiyonel sonuçları

Year 2019, Volume: 44 Issue: 4, 1323 - 1328, 29.12.2019

İlker Eren , Dağhan Koyuncu Emel Gönen

https://doi.org/10.17826/cumj.505416

Cited By: 1

Abstract

Amaç: Bu çalışmanın amacı, intertrokanterik kırık tanısı ile proksimal femur antirotasyon çivisi (PFNA) kullanılarak başarılı radyolojik kaynama elde edilmiş hastaların, postoperatif dönemdeki klinik fonksiyonel durumlarının araştırılmasıdır.

Gereç ve Yöntem: Tek bir merkezde, 2015 – 2017 yılları arasında, düşme sonucu başvurarak, intertrokanterik femur kırığı tanısı ile PFNA kullanılarak opere edilen 65 yaş üzeri hastalar çalışmaya dahil edildi. Hastaların günlük aktivite düzeyinin ve kalça kaynaklı fonksiyonel durumlarının araştırılması için Türkçe geçerlilik ve güvenilirlik çalışması yapılmış olan “Oxford kalça skoru (OKS)” ve “Kalça yetersizliği ve osteoartrit sonuç skoru – Fiziksel fonksiyon kısa form (HOOS-PS)” değerlendirmeleri, hastaların kendileri veya birinci derece yakınları ile iletişime geçilip yanıtları işlenerek kullanıldı. İstirahat halinde ve aktivite sırasındaki ağrıyı değerlendirmek üzere ortalama istirahat ve aktivite vizüel analog skala (VAS) skorları kullanıldı. Mobilizasyon düzeylerini araştırmak için “Palmer – Parker Mobility Score (PPM)” kullanıldı. 

Bulgular: Yirmi bir hastanın fonksiyonel skor değerlendirmeleri ameliyattan ortalama 18,1±9 ay sonra araştırıldı. Bu 21 hastanın; ortalama istirahat VAS skorları 2.3±1.4, aktivite VAS skorları 3,5±1,8; OKS 30,4±12,2; HOOS-PS 10,9±5,1 ve PPM 5,5±3,3 olarak kaydedildi.  

Sonuç: Geriatrik populasyonda sık görülen femur intertrokanterik kırıklarında, PFNA ile osteosentez uygulanarak başarılı radyolojik sonuçlar sağlanan hastalar; her ne kadar ağrı yönünden iyi sonuçlara sahip olsalarda, fonksiyonel ve mobilizasyon düzeyleri düşük olmaktadır.

Keywords

osteoporosis, geriatric fracture, hip fracture, intertrochanteric fracture, proximal femoral nail

Functional results of intertrochanteric femur fractures after successful osteosynthesis with proximal femoral nails

Abstract

Purpose: The aim of this study is to investigate the post-operative functional condition of patients who had intertrochanteric fractures and had successful fracture healing with proximal femoral nail (PFNA).

Materials and Methods: Patients over 65 years who were admitted to a single center with intertrochanteric femur fractures after fall injury between 2015-2017 and treated using PFNA were included to the study. To investigate daily activity levels and functional status related to hip joint, Turkish versions of “Oxford Hip Score (OHS)” and “Hip Disability and Osteoarthritis Outcome Score – Physical Function Shortform (HOOS-PS)” were used to question patients or their first-degree relatives. To inspect pain at rest or with activity, visual analogue scale (VAS) was used. To investigate mobility levels, “Palmer – Parker Mobility Score (PPM)” was used.

Results: Functional levels were investigated in 21 patients 18,1±9 months after the operation. 21 patients who were questioned had mean VAS score at rest 2.3±1.4, mean VAS score with activity 3.5±1,.; OHS 30.4±12.2; HOOS-PS 10.9±5.1 and PPM 5.5±3.3. 

Conclusion: Although PFNA is a successful treatment method in intertrochanteric femur fractures, patients do not reach the anticipated mobilization and functional levels when compared with healthy individuals at same age, even though they have low pain levels.

Keywords

Intertrochanteric femur fractures, geriatric fractures, proximal femoral nail, mobility

References

• (1)Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project. www.ahrq.gov/data/hcup (2)Panula J, Pihlajamäki H, Mattila VM, Jaatinen P, Vahlberg T, Aarnio P et al. Mortality and cause of death in hip fracture patients aged 65 or older: a population-based study. BMC Musculoskelet Disord 2011; 12:105.(3)Mears SC. Classification and surgical approaches to hip fractures for nonsurgeons. Clin Geriatr Med 2014; 30:229.(4)Jiang X, Wang Y, Ma X, et al. Proximal femoral nail antirotation versus reverse less invasive stabilization system-distal femur for treating proximal femoral fractures: A meta-analysis. Medicine. 2016;95(14):e3168.(5)Sharma A, Mahajan A, John B et al. A Comparison of the Clinico-Radiological Outcomes with Proximal Femoral Nail(PFN) and Proximal Femoral Nail Antirotation (PFNA) in Fixation of Unstable Intertrochanteric Fractures. J Clin Diagn Res, 2017 Jul;11(7):RC05-RC09.(6)Dawson J, Fitzpatrick R, Carr A, Murray D. Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br. 1996;78(2):185-90(7)Gossec L, Hawker G, Davis AM, Maillefert JF, Lohmander LS, Altman R et al., OMERACT/OARSI initiative to define states of severity and indication for joint replacement in hip and knee osteoarthritis. J Rheumatol, 2007; 34(6): 1432-35.(8)Parker M J, Palmer C R. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br. 1993; 75: 797-8.(9)Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G, Frankel VH. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. JBJS, 1995 Oct;77(10):1551-6.(10)Grimes JP, Gregory PM, Noveck H et al. The effects of time-to-surgery on mortality and morbidity in patients following hip fracture. Am J Med 2002; 112:702.(11)Pervez H, Parker MJ, Vowler S. Prediction of fixation failure after sliding hip screw fixation. Injury. 2004 Oct;35(10):994-8.(12)Boese CK, Frink M, Jostmeier J, Haneder S, Dargel J, Eysel P et al. The Modified Femoral Neck-Shaft Angle:Age and Gender Related Differences in Femoral Neck - Shaft Angles , ORS Annual Meeting, Poster No. 2279, 2011(13)McLean JM, Cappelletto J, Clarnette J, Hill CL, Gill T, Mandziak D, et al. Normal Population Reference Values for the Oxford and Harris Hip Scores – Electronic Data Collection and Its Implications For Clinical Practice. Hip Int. 2017 Jul 25;27(4):389-39.(14)Davis AM, Perruccio AV, Canizares M, Tennant A, Hawker GA, Conaghan PG, et al. The development of a short measure of physical function for hip OA HOOS-Physical Function Shortform (HOOS-PS): an OARSI/OMERACT initiative. Osteoarthritis Cartilage. 2008 May;16(5):551-9.(15)Sundén A, Lidengren K, Roos EM, Lohmander LS, Ekvall Hansson E. Hip Complaints Differ Across Age and Sex: A Population-Based Reference Data for the Hip Disability and Osteoarthritis Outcome Score (Hoos) . Health Qual Life Outcomes. 2018 Oct 11;16(1):200.(16)Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists and American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis – 2016. Endocr Pract. 2016; 22(Suppl 4):1–42.(17)Balasubramanian A, Tosi LL, Lane JM, Dirschl DR, Ho PR, O'Malley CD. Declining rates of osteoporosis management following fragility fractures in the U.S., 2000 through 2009. J Bone Joint Surg Am. 2014 Apr 2;96(7):e52.(18)Vochteloo AJ, Moerman S, Tuinebreijer WE, Maier AB, de Vries MR, Bloem R et al. More than half of hip fracture patients do not regain mobility in the first postoperative year. Geriatr Gerontol Int, 13: 334-341.