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BACKGROUND: Digital three-dimensional reconstruction technology is gradually applied to orthopedic diseases with the advantages of visualization, accuracy and non-invasiveness, but there is less evidence-based support for its use in artificial hip hemiarthroplasty for intertrochanteric fractures of the femur in the elderly. OBJECTIVE: To investigate the application value and economic effects of digital three-dimensional reconstruction techniques in artificial hip hemiarthroplasty of intertrochanteric fractures of the femur in the elderly. METHODS: One hundred and thirty elderly patients with intertrochanteric femur fractures admitted to Zunyi First People’s Hospital from January 2019 to December 2022 were selected and randomly divided into a control group (n=65) and an observation group (n=65). Artificial hip hemiarthroplasty was performed in both groups. The control group adopted the film template measurement method for manual preoperative planning while the observation group adopted a digital three-dimensional reconstruction technique. Preoperative planning and intraoperative actual application of prosthesis compliance rate, fibrinogen, D-dimer, bilateral femoral eccentric distance difference, bilateral lower limb length difference, Harris hip function score, visual analog scale score, excellent and good rate of hip function, complications, and hospitalization cost were observed in both groups. RESULTS AND CONCLUSION: (1) The proportion of acetabular side and femoral side prosthesis in grade 0 (fully compliant) was higher in the observation group than that in the control group (P < 0.05). (2) Fibrinogen and D-dimer levels in the observation group were lower than those in the control group 3 days after surgery (P < 0.05). (3) The difference in bilateral femoral eccentric distance and the difference in bilateral lower limb length in the observation group were smaller than those in the control group immediately after surgery (P<0.05). The differences in Harris and visual analog scale scores were not significantly different between the two groups preoperatively, 6 and 12 months postoperatively (P > 0.05). There was no significant difference in excellent and good rate of hip function between the two groups 12 months postoperatively (P>0.05). (4) There was no significant difference in the complication rate between the two groups (P > 0.05). The hospitalization cost of the observation group was higher than that of the control group (P<0.05). (5) It is indicated that digital threedimensional reconstruction technology applied in artificial hip hemiarthroplasty of intertrochanteric femoral fracture in the elderly can not only accurately determine the prosthesis type before surgery, but also accurately reconstruct the bilateral lower limbs offline, but its hospitalization cost is high. [ABSTRACT FROM AUTHOR]

METHODS: One hundred and forty-seven elderly patients (≥ 65 years of age) with displaced femoral neck fractures were admitted from January 2016 to January 2021, of whom 88 had total hip arthroplasty (total hip arthroplasty group) and 59 had artificial femoral head replacement (hemiarthroplasty group). For the patients' preoperative comorbidities, the age-corrected Charlson Comorbidity Scale was used to quantify the scores and calculate patient frailty. The propensity score matching method was used to match the two groups 1:1 and to compare the operation time, bleeding, postoperative hospitalization time, hospitalization cost, nutritional index, postoperative complications, and mortality between the two groups after matching. Postoperative survival time was determined by Kaplan-Meier Survival analysis. RESULTS AND CONCLUSION: (1) After propensity score matching, a total of 42 matched pairs were successful in both groups, and the preoperative data of patients in both groups were balanced and comparable after matching (P > 0.05). (2) Compared with the hemiarthroplasty group, operation time (79.71 minutes vs. 59.07 minutes, P < 0.001), bleeding volume (839.64 mL vs. 597.83 mL, P=0.001), and hospitalization cost (56 508.15 yuan vs. 41 702.85 yuan, P < 0.001) were significantly higher in the total hip arthroplasty group. However, the mortality rate was lower in the total hip arthroplasty group than in the hemiarthroplasty group (36% vs. 57%, HR=0.44, 95%CI: 0.23-0.87, P=0.018), and the mean survival time was longer in the total hip arthroplasty group than in the hemiarthroplasty group (59.4 months vs. 43.7 months, P=0.024). (3) There were no statistically significant differences in postoperative hospitalization time, preoperative and postoperative nutritional indicators, and overall postoperative complication rate between the two groups (P > 0.05). However, in terms of postoperative pain, the incidence of pain was significantly higher in the hemiarthroplasty group than that in the total hip arthroplasty group (24% vs. 7%, P=0.035). (4) Overall, total hip arthroplasty has a better prognosis for survival, while hemiarthroplasty is more appropriate for patients with poor physical fitness. At the same time, postoperative pain may largely affect the quality and survival time of patients after hip arthroplasty. [ABSTRACT FROM AUTHOR]

BACKGROUND: Early surgical treatments, mainly including internal fixation and joint replacement, are favored for unstable or significantly displaced proximal humeral fractures in clinical practice. However, there is still a controversy on the specific regimen for elderly osteoporotic patients. OBJECTIVE: To compare the clinical outcomes of Trigen intramedullary nailing versus shoulder hemiarthroplasty for varus proximal humeral fractures. METHODS: A retrospective study was performed on 54 patients with varus proximal humerus fractures treated with intramedullary nailing or shoulder hemiarthroplasty in the General Hospital of Central Theater Command from January 2016 to January 2019. There were 22 males and 32 females. According to the different treatment methods, all the patients were divided into two groups: 35 patients in the intramedullary nail group and 19 patients in the shoulder hemiarthroplasty. Operation time, intraoperative blood loss, length of hospital stay and shoulder joint mobility, Visual Analogue Scale score, Constant-Murley shoulder joint score, and complications at the last follow-up were recorded and compared between two groups. RESULTS AND CONCLUSION: There was no significant difference in the preoperative data between the intramedullary nail group and the shoulder hemiarthroplasty group (P > 0.05), and they were comparable. The operation time of the intramedullary nail group [(59.6±14.3) minutes] was significantly shorter than that in the shoulder hemiarthroplasty group [(95.7±17.2) minutes] (P < 0.05). The intraoperative blood loss in the intramedullary nail group [(78.5±18.9) mL] was significantly lower than that in the shoulder hemiarthroplasty group [(203.7±23.1) mL] (P < 0.05). There were no significant differences in hospitalization time and follow-up time between the two groups (P > 0.05). The intramedullary nail group was superior to the shoulder hemiarthroplasty group in shoulder mobility and Constant-Murley shoulder joint score at the last follow-up, and the differences were statistically significant (P < 0.05). There were no significant differences in Visual Analogue Scale score and complications at the last follow-up between the two groups (P > 0.05). To conclude, both intramedullary nail and shoulder hemiarthroplasty are effective surgical procedures for proximal humeral fracture with varus deformity. Intramedullary nailing is more invasive, with better recovery of shoulder function. [ABSTRACT FROM AUTHOR]

OBJECTIVE: In hemiarthroplasty, the choice of prosthesis is particularly important, which directly affects the success rate of operation and postoperative complications. Hemiarthroplasty can be divided into bipolar hemiarthroplasty and unipolar hemiarthroplasty. This study systematically evaluated the clinical efficacy and safety of bipolar hemiarthroplasty and unipolar hemiarthroplasty in the treatment of displaced femoral neck fractures in the elderly so as to provide evidence-based support for prosthesis decision-making in hemiarthroplasty. METHODS: The databases including PubMed, The Cochrane Library, OVID, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP database were searched to collect clinical randomized controlled trials of bipolar hemiarthroplasty and unipolar hemiarthroplasty for displaced neck femoral neck fractures in elderly patients at home and abroad. The Cochrane Handbook risk assessment tool was used to evaluate the quality of the included studies. The results of the included studies were meta-analyzed by RevMan 5.3 software. RESULTS: (1) Eighteen randomized controlled clinical trials with high quality were included, with a total of 1 988 fractures patients, including 998 cases in bipolar hemiarthroplasty group and 990 cases in unipolar hemiarthroplasty group. (2) There were no statistically significant differences in mortality, dislocation of prosthesis, loosening of prosthesis, local infection, hip pain, general complication, and surgical informations between bipolar hemiarthroplasty and unipolar hemiarthroplasty (P > 0.05). (3) Harris score was higher in the bipolar hemiarthroplasty group than that in the unipolar hemiarthroplasty group (MD=1.77, 95%CI:0.94-2.61, P < 0.001). The rate of acetabular erosion in bipolar hemiarthroplasty group was lower than that in unipolar hemiarthroplasty group (RR=0.25, 95%CI:0.13-0.47, P < 0.000 1). However, two studies have reported that bipolar implants may be more costly. CONCLUSION: Compared with unipolar hemiarthroplasty, bipolar hemiarthroplasty has lower acetabular wear rate and better recovery of hip function in elderly patients with displaced fem-oral neck fracture. However, whether bipolar prosthesis has better economic benefits than uni-polar prosthesis needs further evaluation in the future. [ABSTRACT FROM AUTHOR]

BACKGROUND: Venous thrombosis is a serious perioperative complication in elderly patients with hip fracture. It is necessary to select an effective intervention program to reduce its risk. OBJECTIVE: To compare the effects of enoxaparin and rivaroxaban on intraoperative hemorrhage and postoperative deep venous thrombosis during perioperative period of hemiarthroplasty in elderly patients with femoral neck fracture. METHODS: A total of 95 patients with femoral neck fractures aged 65 years and older were enrolled in the Department of Orthopedics, Beijing Jiangong Hospital from January 2016 to January 2018. These patients were assigned to two groups. Patients in the control group (n=43) were orally administered rivaroxaban once a day during the perioperative bed rest, and the drug was discontinued once on the operation day. Patients in the trial group (n=52) were given a subcutaneous injection of enoxaparin during the perioperative bed rest, and the drug was stopped 12 hours before the operation. Informed consent was obtained from all patients. This study was approved by the Hospital Ethics Committee. The intraoperative blood loss, postoperative blood loss, perioperative dominant and occult blood loss, postoperative bleeding rate and incidence of postoperative deep venous thrombosis were compared between the two groups. RESULTS AND CONCLUSION: (1) There was no significant difference in the amount of intraoperative blood loss, postoperative blood loss, perioperative dominant blood loss, postoperative bleeding rate, and incidence of postoperative deep venous thrombosis between the two groups (P>0.05). (2) However, the perioperative occult blood loss in the trial group was less than that in the control group (P<0.05). (3) It is suggested that enoxaparin is safe and reliable in the perioperative period of hemiarthroplasty for femoral neck fracture. Compared with rivaroxaban, enoxaparin can reduce the occult blood loss during the perioperative period. [ABSTRACT FROM AUTHOR]

BACKGROUND: Surgical treatment is an accepted method for intertrochanteric fractures. For the older adults accompanied by severe osteoporosis and other diseases, how to treat intertrochanteric fractures still remains controversial. OBJECTIVE: To evaluate the effectiveness and safety of proximal femoral nail antirotation versus hemiarthroplasty in the treatment of unstable intertrochanteric fractures in older adults through meta-analysis. METHODS: According to the Cochrane system evaluation, a computer-based retrieval of Medline, PubMed, SPINGER, John Wiley, Science Direct, EBSCO, CNKI, WanFang, and VIP databases between 2008 and 2018 was performed. The keywords were “proximal femoral nail antirotation or PFNA, hemiarthroplasty, unstable intertrochanteric fractures” in English and Chinese, respectively. The literate was screened based on inclusion and exclusion criteria, and then quality evaluation was conducted. Meta-analysis was undergone on the Rev-Man 5.1 software. RUSULTS AND CONCLUSION: (1) Thirteen clinical trials were included, involving 1 223 patients, and including 6 randomized controlled trials. (2) Meta-analysis results showed that the operation time in the proximal femoral nail antirotation group was shorter [MD=-6.54, 95%Cl (-12.81, -0.21), P < 0.01], intraoperative blood loss was lower [MD=-130.83, 95%CI (-190.99, -70.68), P < 0.01], and the incidence of implant complications was higher [RR=2.32, 95%Cl (1.12, 4.84), P < 0.01] compared with the hemiarthroplasty group. (3) In the hemiarthroplasty group, the ambulation time was earlier [MD=18.06, 95%CI (10.3, 25.79), P < 0.000 1], and the Harris scores were increased [MD=-8.19, 95%Cl (-9.45, -6.93), P < 0.01] compared with the proximal femoral nail antirotation group. (4) There was no significant difference in the postoperative complications, hospitalization time or excellent and good rate in Harris scores between two groups (P > 0.05). (5) In summary, the operation time in the proximal femoral nail antirotation group is shorter and the amount of bleeding was less than those in the hemiarthroplasty group, but the incidence of implant complications is higher than that in the hemiarthroplasty group. The hemiarthroplasty group has an advantage in postoperative Harris score and postoperative loading time. [ABSTRACT FROM AUTHOR]

BACKGROUND: Many domestic and foreign literatures have reported that half hip replacement for unstable intertrochanteric fractures in the elderly has achieved good results, but the unstable intertrochanteric fracture with hemiarthroplasty is difficult to reconstruct the greater trochanter, and its reconstruction method is still controversial. OBJECTIVE: To discuss short-term effect of bipolar hemiarthroplasty and reconstruction of the femoral greater trochanter with cerclage band in the treatment of intertrochanteric fracture in elderly patients. METHODS: Clinical data of 15 elderly patients with intertrochanteric fracture undergoing bipolar hemiarthroplasty, and reconstruction of the femoral greater trochanter with cerclage band in the Xinjiang Uygur Autonomous Region People's Hospital were retrospectively analyzed. Posterolateral approach was selected. The patients were followed up in out-patient clinic yearly at postoperative 1, 3, 6 and 12 months. Fracture healing was judged using X-ray films, and the possibility of infection was observed. Hip function was evaluated using Harris scoring. Subjective satisfaction of patients was recorded. RESULTS AND CONCLUSION: (1) All patients walked within 3 days after operation. All patients were reviewed on time within a year. Postoperative X-ray revealed that the sample achieved initial stability, and had achieved fracture healing of greater trochanter. Blood examination did not show infection index. (2) The Harris score was (86.3±5.8) in final follow-up. Subjective satisfaction of patients was good. (3) In summary, bipolar hemiarthroplasty and reconstruction of the femoral greater trochanter with cerclage band in the treatment of intertrochanteric fracture in elderly patients can obtain good therapeutic effect, and it can achieve good prosthesis stability and large trochanter fracture reduction and fixation. [ABSTRACT FROM AUTHOR]