Die Behandlung per- und subtrochantärer Femurfrakturen in osteoporotischem Knochen mit der Gleitnagelosteosynthese. Klinische und röntgenologische Ergebnisse von 100 Fällen

Abstract

Introduction: The aim of surgical treatment of per- or subtrochanteric femoral fractures in the elderly patient is to obtain a full weight bearing osteosynthesis which is a precondition to regain the preoperative level of mobility. Loss of mobility is associated with a high lethality rate. The reduced quality of bone due to age is another challenge in the treatment of those fractures. Our study should resolve if the gliding nail (GN) lives up to the particular requirements of surgical treatment of per- or subtrochanteric femoral fractures in the elderly patient. Materials and Methods: We analysed the data of 92 patients with unstable pertrochanteric and 8 patients with subtrochanteric fractures of the femur treated with GN osteosynthesis. The data was collected and analyzed in a retrospective manner. Results: Mainly geriatric patients of female sex were affected. 71% of the patients suffered from osteoporosis. In 80 cases the Standard GN was inserted. Assisted mobilisation of the patients began on the 1 st postoperative day. A follow-up examination was possible in 83 cases after a median time of 0.8 years, 17 patients died during follow-up. The preoperative level of mobility was regained in 60 patients. Two patients became bed-ridden and therefore lost their social independency. The most frequent implant-related problem was dislocation of the double-t femur neck blade (n = 6; 7%) mostly occurring in patients with diminished cancellous bone in the femoral neck. Discussion: Our clinical results reflect the biomechanical properties of the GN in the treatment of unstable per- or subtrochanteric fractures of the femur in diminished bone quality. We therefore recommend the device for creating full weight bearing osteosynthesis in these types of fractures.