Gökhan KARADEMİR, Yücel BİLGİN, Mehmet DEMİREL, Gökhan POLAT, Ali ERŞEN, Taha KIZILKURT, Mehmet İlke BÜGET, Önder YAZICIOĞLU

İnstabil İntertrokanterik Kırıklarda Tedavi Yönteminin Mobilite ve Yaşam Kalitesine Etkisi

Amaç: Bu çalışmanın amacı instabil intertrokanterik kırıklarda proksimal femur çivisi (PFN) ile osteosentez veya artroplasti tedavilerinin mobilite ve yaşam kalitesini üzerine etkilerini araştırmaktı. Yöntem: 2008-2014 yılları arasında PFN (Grup 1, n=66), hemiartroplasti (Grup 2, n=42) veya total kalça artroplastisi (Grup 3, n=9) ile tedavi edilen 117 hastanın (76 Kadın/41 Erkek) tedavi sonuçları restrospektif olarak değerlendirildi. Hastaların mobiliteleri Palmer ve Parker mobilite skoru ile, yaşam kaliteleri Barthel yaşam kalitesi indeksi ile değerlendirildi. Bulgular: Grup 1, Grup 2 ve Grup 3’te ortalama yaşlar sırasıyla 83.51 (aralık, 75-97) yıl, 84.72 (aralık, 75-109) yıl ve 83.37 (aralık, 75-94) yıl idi. Ortalama takip süreleri sırasıyla 23.26 (aralık, 3-43.9) ay, 19.24 (aralık, 3-38) ay ve 20.1 (aralık, 3-40) ay idi. Her 3 grup arasında yaş ve takip süresi açısından istatistiksel anlamlı fark yoktu (p>0.05). Palmer-Parker mobilite skoru Grup 1 için 6.23, Grup 2 için 3.68 ve Grup 3 için 4.22 idi. Barthel indeksi Grup 1 için 68.73, Grup 2 için 37.75 ve Grup 3 için 52.77 idi. Grup 1, Grup 2 ve Grup 3’e kıyasla istatistiksel olarak anlamlı daha yüksek Palmer-Parker skoru ve Barthel indeksi değerine sahip idi (p

Effect of Treatment Modality on Mobility and Quality of Life in Unstable Intertrochanteric Fractures

Purpose: The aim of the study was to investigate mobility and quality of life in patients who underwent osteosynthesis with proximal femoral nail (PFN), or arthroplasty for unstable intertrochanteric fractures. Methods: Treatment outcomes of 117 patients (76 Female/41 Male) who were treated with PFN (Group 1, n=66), hemiarthroplasty (Group 2, n=42), or total hip arthroplasty (Group 3, n=9) between 2008 and 2014 were retrospectively evaluated. The mobility of the patients was evaluated with the Palmer and Parker mobility score, and the quality of life was evaluated with the Barthel quality of life index. Results: The mean ages in the groups were 83.51 (range, 75-97) years, 84.72 (range, 75-109) years, and 83.37 (range, 75-94) years; respectively. The mean follow-up periods were 23.26 (range, 3-43.9) months, 19.24 (range, 3-38) months, and 20.1 (range, 3-40) months; respectively. There was no statistically significant difference between the 3 groups in terms of age and follow-up time (p>0.05). Palmer-Parker mobility scores were 6.23 for Group 1, 3.68 for Group 2, and 4.22 for Group 3. Barthel Indexes were 68.73 for Group 1, 37.75 for Group 2, and 52.77 for Group 3. Group 1 had a statistically significantly higher Palmer-Parker mobility and Barthel Index score than Group 2 and Group 3 (p

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[1]. B. Abrahamsen, T. Van Staa, R. Ariely, M. Olson, C. Cooper, “Excess mortality following hip fracture: a systematic epidemiological review”, Osteoporos Int, vol. 10, no.50, pp. 1633-1650, 2009. doi: 10.1007/s00198-009-0920-3
[2]. O. Johnell, J.A. Kanis, "An estimate of the worldwide prevalence and disability associated with osteoporotic fractures", Osteoporos Int, vol. 17, no. 12, pp. 1726-1733, 2006. doi: 10.1007/s00198-006-0172-4
[3]. M. Butler, M.L. Forte, S.B. Joglekar, MF Swiontkowski, RL Kane, “Evidence summary: systematic review of surgical treatments for geriatric hip fractures”, J Bone Joint Surg Am, vol. 93, no.12, pp. 1104-1115, 2011. doi: 10.2106/JBJS.J.00296
[4]. V.L. Tang, R. Sudore, I.S. Cenzer, W.J. Boscardin, A. Smith, C. Ritchie, M. Wallhagen, E. Finlayson, L. Petrillo, K. Covinsky, "Rates of recovery to pre-fracture function in older persons with hip fracture: an observational study", J Gen Intern Med, vol. 32, no. 2, pp. 153-158, 2017. doi: 10.1007/s11606-016-3848-2
[5]. G. Karademir, Y. Bilgin, A. Erşen, G. Polat, M.I. Buget, M. Demirel, H.I. Balcı, "Hip fractures in patients older than 75 years old: Retrospective analysis for prognostic factors", Int J Surg, vol. 24, part. A, pp. 101-104, 2015. doi: 10.1016/j.ijsu.2015.11.009
[6]. A. Karagiannis, E. Papakitsou, K. Dretakis, A. Galanos, P. Megas, E. Lambiris, G.P. Lyritis, "Mortality rates of patients with a hip fracture in a southwestern district of Greece: ten-year follow-up with reference to the type of fracture", Calcif Tissue Int, vol. 78, no.2, pp. 72-77, 2006. doi: 10.1007/s00223-005-0169-6
[7]. N. Fukui, Y. Watanabe, T. Nakano, T. Sawaguchi, T. Matsushita, "Predictors for ambulatory ability and the change in ADL after hip fracture in patients with different levels of mobility before injury: a 1-year prospective cohort study", J Orthop Trauma, vol. 26, no. 3, pp. 163-171, 2012. doi: 10.1097/BOT.0b013e31821e1261
[8]. K.J. Koval, M.L. Skovron, G.B. Aharonoff, S.E. Meadows, J.D. Zuckerman, "Ambulatory ability after hip fracture. A prospective study in geriatric patients", Clin Orthop Relat Res, vol. 310, no. 1, pp. 150-159, 1995.
[9]. E.E. Desteli, Y. İmren, M. Erdoğan, Ö. Aydagün, "Quality of life following treatment of trochanteric fractures with proximal femoral nail versus cementless bipolar hemiarthroplasty in elderly", Clin Invest Med, vol. 38, no.2, pp. 63-72, 2015.
[10]. M.J. Parker, C.R. Palmer, “A new mobility score for predicting mortality after hip fracture”, J Bone Joint Surg Br, vol. 75, no. 5, pp. 797-798, 1993.
[11]. F.I. Mahoney, D.W. Barthel, “Functional evaluation: the Barthel Index”, Md State Med J, vol. 14, no.1, pp. 61–65, 1965.
[12]. G.Holt, R. Smith, K. Duncan, D.F. Finlayson, A. Gregori, "Early mortality after surgical fixation of hip fractures in the elderly: an analysis of data from the scottish hip fracture audit", J Bone Joint Surg Br, vol. 90, no.10, pp. 1357-1363, 2008. doi: 10.1302/0301-620X.90B10.21328
[13]. G. Holt G, R. Smith, K. Duncan, J.D. Hutchison, A. Gregori, D. Reid, "Outcome after sequential hip fracture in the elderly", J Bone Joint Surg Am, vol. 94, no. 19, pp. 1801-1808, 2012. doi: 10.2106/JBJS.J.01539
[14]. M.A. Fernandez, X.L. Griffin, M.L. Costa, "Management of hip fracture", Br Med Bull, vol. 115, no. 1, pp. 165-172, 2015. doi: 10.1093/bmb/ldv036
[15]. M. Butler , M.L. Forte, S.B. Joglekar, MF Swiontkowski, RL Kane, “Evidence summary: systematic review of surgical treatments for geriatric hip fractures”, J Bone Joint Surg Am, vol. 93, no.12, pp. 1104-1115, 2011. doi: 10.2106/JBJS.J.00296
[16]. E.M. Evans, "The treatment of trochanteric fractures of the femur", J Bone Joint Surg Br, vol.31, no.1, pp. 190-203, 1949.
[17]. M.J. Parker, H.H. Handoll, "Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults", Cochrane Database Syst Rev, vol.9, no. CD000093, 2010. doi: 10.1002/14651858.CD000093.pub5
[18]. M. Bertram, R. Norman, L. Kemp, T. Vos, "Review of the long-term disability associated with hip fractures", Inj Prev, vol. 17, no.6, pp. 365-370, 2011. doi: 10.1136/ip.2010.029579
[19]. R.U. Haq, V. Manhas, A. Pankaj, A. Srivastava, I.K. Dhammi, A.K. Jain, "Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall; a randomised controlled trial", Int Orthop, vol.38, no.7, pp. 1443-1449, 2014. doi: 10.1007/s00264-014-2306-1
[20]. G. Okcu, N. Ozkayin, C. Okta, I. Topcu, K. Aktuglu, "Which implant is better for treating reverse obliquity fractures of the proximal femur: a standard or long nail?", Clin Orthop Relat Res, vol. 471, no. 9, pp. 2768-2775, 2013. doi: 10.1007/s11999-013-2948-0
[21]. M. Di Monaco, F. Vallero, R. Di Monaco, R. Tappero, A. Cavanna, "Hip-fracture type does not affect the functional outcome after acute in-patient rehabilitation: a study of 684 elderly women", Eura Medicophys, vol. 43, no. 4, pp. 439-444, 2007.
[22]. D.T. Wade, C. Collin, "The Barthel ADL Index: a standard measure of physical disability?", Int Disabil Stud, vol.10, no. 2, pp. 64-67, 1988.
[23]. C. Collin, D.T. Wade, S. Davies, V. Horne, "The Barthel ADL Index: a reliability study", Int Disabil Stud, vol. 10, no. 2, pp. 61-63, 1988.
[24]. R. Cornwall, M.S. Gilbert, K.J. Koval, E. Strauss, A.L. Siu, "Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics", Clin Orthop Relat Res, vol. 425, no.1, pp. 64-71, 2004.
[25]. M. Mariconda, G.G. Costa, S. Cerbasi, P. Recano, G. Orabona, M. Gambacorta, M. Misasi, "Factors Predicting Mobility and the Change in Activities of Daily Living After Hip Fracture: A 1-Year Prospective Cohort Study", J Orthop Trauma, vol. 30. no.2, pp. 71-77, 2016. doi: 10.1097/BOT.0000000000000448