Moreno EJF, León SJA

Language: Spanish
References: 20
Page: 168-173
PDF size: 368.81 Kb.

ABSTRACT

Introduction: transtrochanteric fractures are frequent in elderly adults with poor bone quality and have a higher incidence in women. These fractures are associated with high rates of morbidity and mortality due to prolonged prostration, especially in individuals over 75 years old, depending their comorbidities. In some cases, joint replacement is chosen over conventional techniques such as osteosynthesis with the aim of quickly reintegrating into their daily activities and avoiding complications associated with prostration. Case report: 79-year-old male, smoker, with high functional demands, who enters the orthopedic unit with a diagnosis of an unstable comminuted transtrochanteric fracture (AO 31A2.3), which is managed with total arthroplasty to avoid the risk of complications associated with prostration and the complexity of the fracture. In this particular case, there is a life expectancy of more than 10 years; therefore, total arthroplasty was decided upon, avoiding the risk of acetabular protrusion of hemiprosthesis, as well as diaphyseal support due to the incompetence of the metaphyseal of conventional primary stems. Controversial and radical treatment is performed, yielding satisfactory results, demonstrating that it is a valid option, although not available to everyone due to the high cost in addition to high technical demands for correct placement.

REFERENCES

1. Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures. J Bone Joint Surg Am. 2004; 86: 398-410.

2. Im GI, Shin YW, Song YJ. Potentiallity unstable intertrochanteric fractures. J Orthop Trauma. 2005; 19: 5-9.

3. Johansson H, Clark P, Carlos F, Oden A, McCloskey EV, Kanis JA. Increasing age- and sex-specific rates of hip fracture in Mexico: a survey of the Mexican Institute of Social Security. Osteoporos Int. 2011; 22 (8): 2359-2364. doi: 10.1007/s00198-010-1475-z.

4. Campbell's Operative Orthopaedics, Canale TS, Beaty JH. Cap 7. Artroplastia de cadera. Decimocuarta edición. 1600 John F. Kennedy Blvd. Ste. 1600, Philadelphia, PA: Elsevier; 2021. Tomo 1. p 347.

5. Kyle RF. Fractures of the proximal part of the femur. J Bone Joint Surg Am. 1994; 76: 924-950.

6. Haidukewych GJ, Berry DJ. Hip artrhoplasty for salvage of failed treatment of intertrochanteric hip fractures. J Bone Joint Surg Am. 2003; 85: 899-905.

7. Ambriz R. Falla mecánica de implante en fracturas inestables de fémur proximal (sistema DHS y placa LCP). [Tesis para título de postgrado ortopedista]. México: Universidad Nacional Autónoma de México; 2023.

8. Fragoso LL. Frecuencia de reintervención quirúrgica por falla mecánica en pacientes postoperados con sistema DHS en fracturas AO 31A1.3 en el hospital de traumatología DVFN del año 2020 al 2022. [Tesis para título de postgrado ortopedista]. México: Universidad Nacional Autónoma de México; 2023.

9. Wadhwani J, Gil-Monzó ER, Pérez-Correa JI, García-Álvarez J, Blas-Dobón JA, Rodrigo-Pérez JL. No todo es "cut-out": reclasificación de las complicaciones mecánicas del tornillo cefálico del clavo intramedular. Rev Esp Cir Osteoart. 2019; 54 (280): 136-42. doi: 10.37315/sotocav201928054136.

10. Tosqui-Arellano DA. Estudio comparativo sobre la calidad de vida en pacientes >75 años, tratados por fracturas transtrocantéricas con osteosíntesis vs hemiprótesis. [Tesis para título de postgrado ortopedista]. Universidad Autónoma del Estado De Mexico. 2021. Disponible en: http://hdl.handle.net/20.500.11799/111012

11. Zelizer-Saito AK, Sanchez-Trinidad JC. Evolución en el manejo de pacientes adultos mayores con diagnóstico de fractura transtrocantérica de cadera tratados con artroplastia de cadera vs osteosíntesis en el Hospital Regional 1° de Octubre. [Tesis para título de postgrado en ortopedia]. México: Universidad Nacional Autonoma de Mexico; 2023. Disponible en: https://ru.dgb.unam.mx/bitstream/20.500.14330/TES01000844077/3/0844077.pdf

12. Hagino T, Ochiai S, Sato E, Watanabe Y, Senga S. Prognostic prediction in patients with hip fracture: Risk factors predicting difficulties with discharge to own home. J Orthopaed Traumatol. 2011; 12: 77-80.

13. Leonardsson O, Rolfson O, Hommel A, Garellick G, Akesson K, Rogmark C. Patient-reported outcome after displaced femoral neck fracture: a national survey of 4467 patients. J Bone Joint Surg Am. 2013; 95 (18): 1693-1699. doi: 10.2106/JBJS.L.00836.

14. Bonnevialle P, Saragaglia D, Ehlinger M, Tonetti J, Maisse N, Adam P, et al. Trochanteric locking nail versus arthroplasty in unstable intertrochanteric fracture in patients aged over 75 years. Orthop Traumatol Surg Res. 2011; 97 (6 Suppl): S95-100. doi: 10.1016/j.otsr.2011.06.009.

15. Su EP; Pellicci PM. The role of constrained liners in total hip arthroplasty. Clin Orthop Relat Res. 2004; 420: 122-129.

16. Acevedo D, Trapana JE, Constantinescu D, Carvajal Alba JA. Trochanteric bolt failure in a modular femoral revision system. J Am Acad Orthop Surg Glob Res Rev. 2023; 7 (9): e23.00066. doi: 10.5435/JAAOSGlobal-D-23-00066.

17. Alvarez DB, Aparicio JP, Fernandez EL, Jimenez JP. Implant breakage, a rare complication with Gamma nail. A review of 843 fractures of the proximal femur treated with Gamma nail. Acta Orthop Belg. 2004; 70: 435-443.

18. Said GZ, Farouk O, El-Sayed A, Said H. Salvage of failed dynamic hip screw fixation of intertrochanteric fractures. Injury. 2006; 37:194-202.

19. Lindskog DM, Baumgaertner MR. Unstable intertrochanteric hip fractures in the elderly. J Am Acad Orthop Surg. 2004; 12 (3): 179-190.

20. Bucholz RW, Court-Brown CM, Heckman JD, Tornetta P, editores. Rockwood and green's fractures in adults. Filadelfia, PA, Estados Unidos de América: Lippincott Williams and Wilkins; 2010.