Clinical Study Of Extramedullary And Intramedullary System For Treatment Of Elderly Patients With Unstable Intertrochanteric Fractures

Objective:To evaluate the clinical efficacy of extramedullary internal fixationsystem(Dynamic hip screw DHS,dynamic condylar screw DCS)and intramedullaryfixation system (Gamma nail,proximal femoral nail antirotation PFN-A) in the treatmentof senile unstable intertrochanteric fracture, provide the basis for the surgical method ofchoice in elderly patients with unstable intertrochanteric fractures. Methods:From March2008to March2011,244patients with unstable intertrochanteric fractures were treated inthe First Affiliated Hospital of Xinjiang Medical University,64cases met the inclusionand exclusion criteria. five cases lost to follow. a total of59patients were followed up.among them36cases in extramedullary group and23cases in intramedullary group. Theaverage age was (75.47±7.580) years (range,65~91years). The follow-up time was from6to36months, average22.6months. Results: Except for the similarity according topostoperative Harris hip score, intramedullary group and extramedullary excellent rate of78.8%and82.6%(P>0.05). The mean operation time, incision length, operative blood loss,the postoperative time in bed, fracture healing time and incidence of complications wereall significantly reduced in intramedullary group compared with extramedullary group(allP<0.05). Conclusion: Intramedullary system is an ideal method for elderly patients withunstable intertrochanteric fractures, including small surgical incisions, less blood loss,reduced surgery time, the shorter postoperative time stay in bed, fracture healing faster，and fewer incidence of complications.