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OBJECTIVE: To probe into the analgesic effects of dexmedetomidine combined with butorphanol in patients with femoral intertrochanteric fracture, and its effects on patients’ cognitive function and stress. METHODS: A total of 196 patients with femoral intertrochanteric fracture admitted into the Guang’an People’s Hospital from Sept. 2020 to Mar. 2022 were selected to be divided into two groups via random number table method, with 98 patients in each group. The control group was given butorphanol for postoperative analgesia, while the observation group received dexmedetomidine combined with butorphanol for postoperative analgesia. The surgical condition, postoperative analgesic effects, cognitive function, stress levels and incidences of adverse drug reactions were compared between two groups. RESULTS: There were no statistically significant differences in the comparison of surgery duration, intraoperative blood loss and length of post-anesthesia care unit stay between two groups (P>0. 05). There were no statistically significant differences in the comparison of visual analogue scale (VAS) scores in resting and active states at 2 and 48 h after surgery, the Ramsay sedation scores at 2, 12, 24 and 48 h after surgery between two groups (P>0. 05). The VAS scores in resting and active states at 12 and 24 h after surgery were significantly lower in the observation group than those in the control group, with statistically significant differences (P<0. 05). There were no statistically significant differences in the comparison of Mini Mental State Examination (MMSE) scores between two groups before surgery, at 24 and 48 h after surgery (P>0. 05). At 12 h after surgery, the MMSE scores of both groups decreased, and the MMSE score of the observation group was higher than that of the control group, with statistically significant differences ( P < 0. 05). There were no statistically significant differences in the comparison of cortisol (Cor) and norepinephrine (NE) levels between two groups at 2 h after surgery (P>0. 05). At 48 h after surgery, the Cor and NE levels of both groups increased, and those of the observation group were lower than the control group, with statistically significant differences (P<0. 05). The adverse drug reactions in both groups after surgery included skin pruritus, drowsiness, vomiting and nausea. There was no statistically significant difference in the comparison of incidences of adverse drug reactions between observation group and control group [ 7. 14% ( 7 / 98) vs. 11. 22% (11 / 98), P > 0. 05)]. CONCLUSIONS: The combination of dexmedetomidine and butorphanol for postoperative analgesia in patients with femoral intertrochanteric fracture can not only achieve significant analgesic effects, but relieve cognitive impairment and stress response, without increasing the incidence of adverse drug reactions. [ABSTRACT FROM AUTHOR]

BACKGROUND: There is controversy regarding the need for marrow reaming in intertrochanteric fractures of the femur. Some believe that unreaming shortens operative time, reduces bleeding, and decreases intraoperative risk in elderly patients, but there is no basis for whether this move reduces the effectiveness of intramedullary nail support. Others believe that reaming allows for the selection of thicker diameter intramedullary nails for better mechanical support, but basic studies have shown that this approach carries risks such as fat embolism and destruction of bone (especially in elderly patients with osteoporosis). OBJECTIVE: To analyze the mechanical distribution characteristics of reamed and unreamed proximal femoral nail antirotation-II in the treatment of type 31-A3 intertrochanteric fractures by finite element analysis. METHODS: A healthy volunteer was included, and CT scans of his femur were obtained in DICOM format, and the files were sequentially imported into Mimics, Geomagic Wrap, SolidWorks, Hypermesh, and Ansys software for processing. The A3.1, A3.2, and A3.3 intertrochanteric fracture models were obtained and assembled with 9 mm, 11 mm diameter, and 170 mm length intramedullary nails, respectively, followed by assigning material properties, setting the interaction relationship of each contact surface and defining the load and boundary conditions, and then solved. The femoral stress distribution, internal fixation stress distribution, femoral displacement, and internal fixation displacement were observed in different models. RESULTS AND CONCLUSION: (1) The femoral stress was less than that of unreamed intramedullary nail fixation for each type of fracture, and the maximum stress value of the femur for A3.3 fracture was greater than that of A3.1 and A3.2. (2) The internal fixation stress was greater than that of unreamed intramedullary nail fixation for each type of fracture, and the maximum stress value of internal fixation for A3.3 fracture was greater than that of A3.1. (3) Reamed versus unreamed intramedullary nailing has less effect on femoral and internal fixation displacement and more effect on stress. (4) It is indicated that the use of reamed intramedullary nail fixation results in a reduction in femoral stress, an increase in the stress borne by the internal fixation as a whole, and a reduction in the stress borne by the distal locking nail. The use of reamed intramedullary nail fixation may provide better treatment results compared to unreamed intramedullary nail fixation. [ABSTRACT FROM AUTHOR]

Abstract Objective To explore the effect of collaborative nursing based on Roy Adaptive Mode (RAM) on postoperative functional reconstruction, soft tissue pain and quality of life in patients with femoral intertrochanteric fracture. Methods A retrospective matched control method was used in this study. A total of 96 patients with femoral intertrochanteric fracture admitted to our hospital from July 2018 to September 2021 were selected. According to different nursing methods, the patients were divided into a collaborative group and a routine group, with 48 cases in each group. Patients in both groups were treated with intramedullary nail surgery. The routine group was given routine perioperative nursing intervention, and the collaborative group was given collaborative nursing intervention on this basis. The hip function recovery and quality of life before and after the intervention were compared between the two groups. The preoperative and postoperative pain degree, and the perioperative complications of the two groups were recorded. Logistic multivariate regression analysis was used to analyze the risk factors affecting the recovery of hip joint function in patients with femoral intertrochanteric fracture after operation, thereby constructing a risk prediction model. ROC curve was used to analyze the clinical value of influencing factors in predicting postoperative hip function recovery in patients with femoral intertrochanteric fracture. Results Harris score each dimension after intervention in the collaborative group was obviously higher than that of before intervention and the conventional group (P

Abstract Background Hemoglobin-to-red blood cell distribution width ratio (HRR) had great predictive value for the prognosis of malignant tumors and cardiovascular disease. However, its predictive value for the occurrence of acute kidney injury (AKI) in elderly intertrochanteric fracture patients remains unclear. This study aims to analyze the correlation between the early postoperative HRR and the risk of postoperative AKI in elderly intertrochanteric fracture patients. Methods We reviewed the medical records of 307 elderly intertrochanteric fracture patients in this single-center retrospective cohort study. We performed univariate analysis on the relevant parameters, and parameters with significant differences were included in the following logistic regression model for multivariate analysis. Then, we used a receiver operating characteristic (ROC) curve to evaluate the predictive value of the early postoperative HRR level for AKI in elderly intertrochanteric fracture patients. Patients were divided into a high HRR group and a low HRR group according to the cutoff point determined by ROC curve analysis. Subsequently, the relevance between postoperative HRR and AKI was further determined using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). Results The area under the curve of the early postoperative HRR for predicting postoperative AKI was 0.714 (95% CI: 0.618–0.809). The cutoff value was 5.44. The sensitivity was 72.7%, and the specificity was 70.8%. Patients were divided into low HRR (⩽ 5.44) and high HRR (> 5.44) groups according to the cutoff value. PSM and IPTW analysis indicated that the risk of AKI in the low HRR group was significantly higher than that in the high HRR group in both the matched cohort (OR = 6.914, 95% CI: 1.714–46.603, p = 0.016) and the weighted group (OR = 2.784, 95% CI: 1.415–5.811, p = 0.040). Conclusions Early postoperative HRR is an accurate, accessible, and economical blood test parameter that can predict the risk of postoperative AKI in elderly patients with femoral intertrochanteric fracture.

Objective·To investigate the effect of early postoperative administration of zoledronic acid on fracture healing and functional recovery in elderly patients with osteoporotic femoral intertrochanteric fracture treated with proximal femoral nail antirotation (PFNA) surgery, and explore other potential prognostic factors.Methods·A total of 174 patients with femoral intertrochanteric fractures of 80 years old or above who underwent PFNA treatment in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January, 2016 to February, 2022, were divided into experimental group (n=26) and control group (n=148) according to whether they received zoledronic acid early after surgery. All patients were followed up twice at 6 weeks and 12 weeks after surgery. The patients in the experimental group were matched with the control group by propensity score matching (PSM) at a ratio of 1:3 (the matching factors included age, gender, fracture type, and body mass index). General characteristics, as well as fracture healing and functional recovery at the two follow-up visits were compared between the two groups after matching. Subsequently, Logistic regression was used to explore the potential prognostic factors on fracture healing at 12 weeks after surgery.Results·PSM resulted in 25 patients in the experimental group and 65 patients in the control group, and there were no statistically significant differences in baseline characteristics between the two groups. The fracture healing rates at 6 weeks and 12 weeks after surgery in the experimental group (16.0% and 96.0%, respectively) were higher than those in the control group (1.5% and 73.8%), and the differences were statistically significant (P

Objective: To explore the effect of collaborative nursing based on Roy Adaptive Mode (RAM) on postoperative functional reconstruction, soft tissue pain and quality of life in patients with femoral intertrochanteric fracture. Methods: A retrospective matched control method was used in this study. A total of 96 patients with femoral intertrochanteric fracture admitted to our hospital from July 2018 to September 2021 were selected. According to different nursing methods, the patients were divided into a collaborative group and a routine group, with 48 cases in each group. Patients in both groups were treated with intramedullary nail surgery. The routine group was given routine perioperative nursing intervention, and the collaborative group was given collaborative nursing intervention on this basis. The hip function recovery and quality of life before and after the intervention were compared between the two groups. The preoperative and postoperative pain degree, and the perioperative complications of the two groups were recorded. Logistic multivariate regression analysis was used to analyze the risk factors affecting the recovery of hip joint function in patients with femoral intertrochanteric fracture after operation, thereby constructing a risk prediction model. ROC curve was used to analyze the clinical value of influencing factors in predicting postoperative hip function recovery in patients with femoral intertrochanteric fracture. Results: Harris score each dimension after intervention in the collaborative group was obviously higher than that of before intervention and the conventional group (P < 0.05). After intervention, the excellent and good rate of hip joint function the collaborative group was 83.33%, which was significantly higher than 60.42% in the routine group (P < 0.05). Postoperative VAS scores each time point in the collaborative group was obviously lower than that in the routine group (P < 0.05). After intervention, the scores of physiological function, physiological role, body pain and general health in the collaborative group were significantly higher than those in the routine group (P < 0.05). The incidence of complications in the collaborative group was 6.25%, which was significantly lower than 22.92% in the routine group (P < 0.05). There were statistically significant differences in age, preoperative ASA grade, internal fixation method, osteoporosis grade and perioperative nursing methods between the excellent hip recovery group and the poor hip recovery group (P < 0.05). Logistic multivariate regression analysis showed that age, preoperative ASA grade, internal fixation method and osteoporosis grade were the risk factors affecting the recovery of hip joint function after operation, and perioperative nursing method was the protective factor (P < 0.05). Among the influencing factors, the internal fixation method and the grade of osteoporosis had certain clinical value in predicting the recovery of hip joint function in patients with femoral intertrochanteric fracture after operation. Conclusion: The RAM model-based collaborative nursing method may effectively restore the hip joint function of patients with femoral intertrochanteric fracture after operation, and may reduce the perioperative pain degree of patients, improve the quality of life of patients and reduce the incidence of complications, which can be popularized and applied in clinical practice. In addition, there are many factors influencing the recovery of hip joint function in patients with femoral intertrochanteric fracture after operation, and targeted measures should be taken according to the influencing factors to improve the effect of intramedullary nail treatment. [ABSTRACT FROM AUTHOR]

Background: Hemoglobin-to-red blood cell distribution width ratio (HRR) had great predictive value for the prognosis of malignant tumors and cardiovascular disease. However, its predictive value for the occurrence of acute kidney injury (AKI) in elderly intertrochanteric fracture patients remains unclear. This study aims to analyze the correlation between the early postoperative HRR and the risk of postoperative AKI in elderly intertrochanteric fracture patients. Methods: We reviewed the medical records of 307 elderly intertrochanteric fracture patients in this single-center retrospective cohort study. We performed univariate analysis on the relevant parameters, and parameters with significant differences were included in the following logistic regression model for multivariate analysis. Then, we used a receiver operating characteristic (ROC) curve to evaluate the predictive value of the early postoperative HRR level for AKI in elderly intertrochanteric fracture patients. Patients were divided into a high HRR group and a low HRR group according to the cutoff point determined by ROC curve analysis. Subsequently, the relevance between postoperative HRR and AKI was further determined using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). Results: The area under the curve of the early postoperative HRR for predicting postoperative AKI was 0.714 (95% CI: 0.618–0.809). The cutoff value was 5.44. The sensitivity was 72.7%, and the specificity was 70.8%. Patients were divided into low HRR (⩽ 5.44) and high HRR (> 5.44) groups according to the cutoff value. PSM and IPTW analysis indicated that the risk of AKI in the low HRR group was significantly higher than that in the high HRR group in both the matched cohort (OR = 6.914, 95% CI: 1.714–46.603, p = 0.016) and the weighted group (OR = 2.784, 95% CI: 1.415–5.811, p = 0.040). Conclusions: Early postoperative HRR is an accurate, accessible, and economical blood test parameter that can predict the risk of postoperative AKI in elderly patients with femoral intertrochanteric fracture. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients with femoral intertrochanteric fracture may have nutritional risks during proximal femoral nail anti-rotation surgery, and a clinical predictive model is established based on nutritional assessment tools. OBJECTIVE: To establish the nomogram of the nutritional risk prediction model for patients with intertrochanteric fracture after proximal femoral nail antirotation fixation and evaluate the accuracy of the model. METHODS: From December 2018 to July 2022, patients with femoral intertrochanteric fractures who underwent proximal femoral nail anti-rotation fixation in First Department of Orthopedics, Second Affiliated Hospital of Baotou Medical College were selected as the study subjects. The nutritional risk status of patients was assessed using nutritional risk screening 2002. Logistic regression was used to build the model. The receiver operating characteristic curve, Calibration plot calibration curve, and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the discrimination, calibration and clinical applicability of the prediction model. The model was visualized using Nomogram diagrams. RESULTS AND CONCLUSION: (1) Seventy-six patients were included according to the inclusion criteria. The incidence of nutritional risk was 80% after being assessed using nutritional risk screening 2002. (2) The results of Logistic regression analysis demonstrated that age ≥ 77 years old, body mass index < 22.80 kg/m², upper arm circumference < 25.01 cm, hemoglobin < 98.51 g/L, albumin < 31.61 g/L, and prealbumin < 138.56 g/L were all independent risk factors for nutritional risk (P < 0.05). (3) The area under the receiver operating characteristic curve was 0.919 (95%CI: 0.843-0.994). (4) The results of the HosmerLemeshow goodness-of-fit test displayed that nutritional risk prediction value was high. (5) It is concluded that the nutritional risk assessment model constructed in this study has a good degree of discrimination and calibration, and has a certain predictive ability, which can be used as a reference tool for nutritional risk assessment of patients after proximal femoral nail anti-rotation fixation. [ABSTRACT FROM AUTHOR]

Background: The incidence of hip fractures is increasing. Femoral intertrochanteric fractures make up 50% of hip fractures and are treated by intramedullary nails. Implant breakage is a recognized complication that can have rare and serious implications. This study aimed to investigate implant breakage rates after surgical treatment for femoral intertrochanteric fractures. Methods: This was a retrospective multicenter analysis. All 1854 patients who underwent surgical treatment for femoral intertrochanteric fractures were selected from 12 hospitals (TRON group) between 2016 and 2020. Exclusion criteria included implants other than those specified and follow-up periods less than three months. Demographic data, surgical details, and radiographic assessments were collected from medical records and X-ray evaluations. Results: Among the 983 study patients, consisting of 245 males (24.9%) and 738 females (75.1%), the implant breakage rate was 0.31%, with three confirmed cases. The average age was 83.9 years. The mean follow-up period was 640.9 days. Two cases were linked to ASULOCK implants, and one to an OLSII implant. Statistical analysis showed a significantly higher incidence of ASULOCK implant breakage (p < 0.001). In the two cases of ASULOCK implant breakage and one case of OLSII implant breakage, breakage in all three implants occurred at the anti-rotation screws. Conclusions: There were no implant breakages of the main body of the implants; all breakages occurred in the additional anti-rotation screw. The necessity of the anti-rotation screw will require further discussion. These results can potentially inform clinical decisions and guide further research in preventing implant breakage. [ABSTRACT FROM AUTHOR]

Abstract Background The accelerated growth of older individuals worldwide has increased the number of patients presenting with fragility hip fractures. Having a hip fracture can cause excess mortality, and patients with hip fracture have a higher risk of death than those without hip fracture. Most studies have treated hip fracture as a single, homogeneous condition, but hip fracture includes two major anatomic types: intertrochanteric fracture and femoral neck fracture. Few studies have specifically evaluated 1-year mortality risk in older individuals with femoral intertrochanteric fracture. The aim of this study was to evaluate 1-year mortality and factors associated with mortality in older individuals with femoral intertrochanteric fracture. Methods A retrospective review was conducted of 563 patients ≥ 65 years old who underwent surgery for femoral intertrochanteric fractures at our institution between January 2010 and August 2018. Patient demographics, comorbidities, and treatment were collected by retrospective chart review. Age, sex, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) classification, Charlson comorbidity index (CCI), Arbeitsgemeinschaft Für Osteosynthesefragen (AO) fracture classification, haemoglobin value at admission, time to surgery, operation time, and intraoperative blood loss were risk factors to be tested. Multivariable logistic regression was used to evaluate associations between variables and death. Results Among the 563 patients, 49 died within 1 year after surgery, and the 1-year mortality rate was 8.7%. Multivariate analysis identified age > 80 years (OR = 4.038, P = 0.011), haemoglobin 14 d (OR = 3.907, P = 0.030) as independent risk factors for 1-year mortality. Comorbidities such as myocardial infarction and chronic pulmonary disease were associated with 1-year mortality after adjusting for age > 80 years and time to surgery > 14 days. Conclusions Patients over 80 years old with haemoglobin

Background: The accelerated growth of older individuals worldwide has increased the number of patients presenting with fragility hip fractures. Having a hip fracture can cause excess mortality, and patients with hip fracture have a higher risk of death than those without hip fracture. Most studies have treated hip fracture as a single, homogeneous condition, but hip fracture includes two major anatomic types: intertrochanteric fracture and femoral neck fracture. Few studies have specifically evaluated 1-year mortality risk in older individuals with femoral intertrochanteric fracture. The aim of this study was to evaluate 1-year mortality and factors associated with mortality in older individuals with femoral intertrochanteric fracture. Methods: A retrospective review was conducted of 563 patients ≥ 65 years old who underwent surgery for femoral intertrochanteric fractures at our institution between January 2010 and August 2018. Patient demographics, comorbidities, and treatment were collected by retrospective chart review. Age, sex, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) classification, Charlson comorbidity index (CCI), Arbeitsgemeinschaft Für Osteosynthesefragen (AO) fracture classification, haemoglobin value at admission, time to surgery, operation time, and intraoperative blood loss were risk factors to be tested. Multivariable logistic regression was used to evaluate associations between variables and death. Results: Among the 563 patients, 49 died within 1 year after surgery, and the 1-year mortality rate was 8.7%. Multivariate analysis identified age > 80 years (OR = 4.038, P = 0.011), haemoglobin < 100 g/l (OR = 2.732, P = 0.002), ASA score ≥ 3 (OR = 2.551, P = 0.005), CCI ≥ 3 (OR = 18.412, P = 0.018) and time to surgery > 14 d (OR = 3.907, P = 0.030) as independent risk factors for 1-year mortality. Comorbidities such as myocardial infarction and chronic pulmonary disease were associated with 1-year mortality after adjusting for age > 80 years and time to surgery > 14 days. Conclusions: Patients over 80 years old with haemoglobin < 100 g/l, ASA score ≥ 3, CCI ≥ 3, and multiple comorbidities, especially myocardial infarction and chronic pulmonary disease before surgery, are at a higher risk of 1-year mortality. Doctors should pay more attention to these vulnerable patients, and a surgical delay greater than 14 days should be avoided. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study involved an analysis of preoperative deep vein thrombosis (DVT) incidence and changes in coagulation function among elderly patients suffering from hip fractures. The objective was to offer guidance on the prevention and management of preoperative DVT in the lower extremities of elderly individuals with hip fractures. METHODS: A total of 282 elderly individuals with a hip fracture were enrolled and divided into two groups based on the location of the fracture: femoral intertrochanteric fracture (FIF, 161 individuals) and femoral neck fracture (FNF, 121 individuals). The two groups were compared with respect to baseline characteristics, including gender, age, and comorbid chronic diseases. Furthermore, the analysis encompassed the incidence of preoperative DVT in both lower extremities, along with seven coagulation parameters and platelet count before the surgical procedure. RESULTS: There was no significant difference in baseline information between the two groups. The incidence of preoperative DVT in the FIF group was higher than that in the FNF group, along with a significantly higher percentage of patients exhibiting increased levels of D-dimer and fibrinogen/fibrin degradation products (FDPs). CONCLUSION: Preoperative hypercoagulability and a greater prevalence of DVT were observed in elderly individuals with FIF compared to individuals with FNF. This indicates that clinicians should pay attention to elderly patients with FIFs, especially those with increased D-dimer and FDP levels. [ABSTRACT FROM AUTHOR]

BACKGROUND: Due to the mismatch between the design of the proximal femoral nail antirotation Asian version (PFNA-II) and Asian population, extrusion of the proximal femoral intertrochanteric nail may occur in the treatment of femoral intertrochanteric fractures. The influence of the protruding length on the curative effect of the operation needs to be further discussed. OBJECTIVE: To quantitatively measure the protruding length of the proximal trochanter of the femur with intramedullary nail after PFNA-II, and to analyze the effect of protruding length on the efficacy of PFNA-II in the treatment of femoral intertrochanteric fractures. METHODS: Totally 68 patients with femoral intertrochanteric fractures treated with PFNA-II internal fixation in the First Affiliated Hospital of Anhui Medical University were selected. The extramedullary process of the proximal trochanter of the femur was quantitatively measured on the anterior and posterior X-ray films of the hip joint within 6 months after operation. According to the existence of extrusion of the proximal trochanter intramedullary nail, the patients were divided into protruding group and non-protruding group. The data of sex, height, fracture type, length and diameter of the intramedullary nail, the position of screw blade in the femoral neck and protruding length of proximal greater trochanter were collected. The postoperative curative effect was judged by visual analog scale pain score and hip joint Harris score at 6 months after operation. The influence of protruding proximal trochanter of the PFNA-II intramedullary nail on the operative effect was observed. RESULTS AND CONCLUSION: (1) There were significant differences in sexual characteristics between the protruding group and the non-protruding group (P=0.001). (2) According to AO/OTA classification, there were no significant differences in fracture type between the protruding group and the non-protruding group (P=0.289). (3) There was no significant difference in the length and diameter of the intramedullary nail between the two groups (P=0.067, P=1.000). (4) There was no significant correlation between the height of all patients and the length of the intramedullary nail (P=0.510), but there was a significant correlation between height and protruding length (P=0.034). There was no significant correlation between screw blade position and protruding length (P=0.968). (5) Six months after operation, there was no significant difference in the hip Harris score (P=0.373), but the visual analog scale pain score was significantly higher in the protruding group than that in the non-protruding group (P=0.000). (6) The results suggest that nail extrusion often occurs in the proximal greater trochanter when PFNA-II is used in the treatment of intertrochanteric fractures in Asians. When the nail extended into the proximal soft tissue of the greater trochanter, patients complained of proximal greater trochanteric pain and the visual analog scale score of proximal greater trochanter pain in the patient was significantly higher than that in the non-protruding group. To be more suitable for the Asian population, we suggest that the PFNA-II should be improved to further shorten the proximal nail end to obtain better clinical results of femoral intertrochanteric fracture fixation. [ABSTRACT FROM AUTHOR]

BACKGROUND: For elderly patients with traumatic hip fractures, the related factors of prognosis are very complex, and the integrity of the lateral wall is one of the influencing factors. It is of important clinical value to understand the effect of lateral wall injury on the prognosis of femoral intertrochanteric fracture. OBJECTIVE: To evaluate the relationship between the integrity of the lateral wall and hip functional recovery and other outcomes in patients with femoral intertrochanteric fractures. METHODS: Totally 82 patients with femoral intertrochanteric fractures were screened and all patients received proximal femoral nail antirotation fixation. According to the thickness of the lateral wall, the patients were divided into the lateral wall intact group (n=31) and lateral wall risk group (n=51). The perioperative indexes, weight-bearing time, fracture healing time, hip joint function and range of motion, postoperative pain and complications were compared between the two groups. RESULTS AND CONCLUSION: (1) The time of hospitalization and the number of fluoroscopies during operation in the lateral wall intact group were significantly lower than those in the lateral wall risk group (P < 0.05), but there was no significant difference in other perioperative indexes. (2) Both groups were able to get down to the ground early after surgery and finally complete weight-bearing, but in the lateral wall risk group, the time of fracture healing was longer; the time of complete weight-bearing was significantly delayed; the Harris score of the last follow-up was lower; the range of motion of hip extension and flexion and neck trunk angle on the affected side were smaller (P < 0.05). (3) There was no significant difference in the incidence of postoperative complications between the two groups, but the overall incidence of complications in the lateral wall intact group was significantly lower (P < 0.05). (4) In summary, after internal fixation of proximal femoral nail antirotation, patients with the intact lateral wall had a relatively better prognosis than those with risk lateral wall. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to compare the difference between proximal femoral bionic nail (PFBN) and hip replacement (HR) for femoral intertrochanteric fracture. MATERIALS AND METHODS: A retrospective analysis of the differences in operative time, length of stay, postoperative Harris score, and postoperative mortality between patients with femoral intertrochanteric fracture treated by PFBN and HR admitted to Jinzhai County People's Hospital from October 2020 to September 2022 was performed. RESULTS: A total of 56 patients with femoral intertrochanteric fracture, 26 with PFBN and 30 with HR, were included in the study. There were no differences in the length of surgery, preand post-operative hemoglobin, or post-operative Harris score at 3 months between the two groups. Compared to the HR group, the PFBN group had a lower total cost, shorter hospital stays, and lower mortality but a longer ambulation time, with a difference of 3.36 weeks. CONCLUSIONS: PFBN may be a promising new treatment for femoral intertrochanteric fracture. [ABSTRACT FROM AUTHOR]

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BACKGROUND: At present, there is a controversy on the internal fixation for the femoral intertrochanteric fracture with fracture of lateral wall. The main method is the proximal femoral nail antirotation. The biomechanical study of intramedullary fixation for femoral intertrochanteric fracture with different lateral wall classifications is less. OBJECTIVE: To compare the biomechanical characteristics of proximal femoral nail antirotation in the treatment of femoral intertrochanteric fracture with different lateral wall classifications by finite element analysis, and to explore the influence of lateral wall on the internal fixation of femoral intertrochanteric fracture. METHODS: A healthy elderly female patient was selected. A 3D finite element model of proximal femur and proximal femoral nail antirotation was established by using Mimics 21.0, Geomagic Wrap, Creo 6.0 and Abaqus 2020 software according to the CT scanning data of proximal femur. The proximal femoral nail antirotation assembly model was established by simulating lateral wall stable, dangerous and ruptured intertrochanteric fractures. The Von Mises stress and displacement distributions of three models of internal fixation were observed under the same load in static and walking conditions. RESULTS AND CONCLUSION: (1) The maximum Von Mises stress and displacement of A3.3 type intertrochanteric fracture were the largest under dynamic state; the maximum Von Mises stress was about twice of type A2.3, and 2.7 times of type A1.3; the maximum Von Mises displacement was about 1.5 times of type A2.3 and 3 times of type A1.3, and there was no significant difference among the various types under static state. (2) The Von Mises stress A3.3 at femoral neck, fracture end and main nail was larger than that of A1.3 and A2.3 under dynamic and static states, especially at main nail. (3) The Von Mises displacements of femoral head, femoral neck, fracture end, lateral wall, medial wall, main nail and spiral blade in A3.3 type were larger than that in A1.3 and A2.3 types; the change was not obvious under static state. (4) These results suggest that the integrity of the lateral wall can reduce the internal fixation stress, make the stress and displacement distribution more reasonable, and help to maintain the stability of intertrochanteric fracture. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the efficacy of exogenous recombined human erythropoietin (rhEPO), combined with tranexamic acid (TXA) and administered by different routes, in the treatment of elderly patients with femoral intertrochanteric fractures. Methods: 252 elderly patients in Suzhou Xiangcheng People's Hospital were randomly divided into groups (A, B and C), with 84 patients in each group. All the patients were given rhEPO and iron sucrose, followed by TXA which was administered via topical injection at the fracture site in Group A, via intravenous infusion in Group B, and via topical injection combined with intravenous infusion in Group C. The perioperative actual total blood loss, occult blood loss, hematocrit (HCT), platelet count (PLT), hemoglobin (Hb), and activated partial thromboplastin time (APTT) were assessed. Also evaluated were prothrombin time (PT), fibrinogen (FIB), blood transfusion rate and incidence of deep venous thrombosis (DVT) of the lower limbs. The results were then compared among the three groups. Results: Perioperative total blood loss and occult blood loss as well as the blood transfusion rate were lowest in Group C, followed by Group B and then Group A. The differences were statistically significant (p < 0.05). The HCT and Hb levels were highest in Group C, followed by Group B and then Group A (p < 0.05). Conclusion: Multi-modal administration of drugs (rhEPO combined with topical injection and intravenous infusion of TXA) is effective in treating elderly patients with femoral intertrochanteric fractures. The strategy efficiently reduces perioperative blood loss and blood transfusion rate, and also improves relevant blood biochemical indicators. [ABSTRACT FROM AUTHOR]

ObjectiveTo compare and analyze the Ortho-Bridge System (OBS) clinical efficacy assisted by 3D printing and proximal femoral nail anti-rotation (PFNA) of AO/OTA type 31-A3 femoral intertrochanteric fractures in elderly patients.MethodsA retrospective analysis of 25 elderly patients diagnosed with AO/OTA type 31-A3 femoral intertrochanteric fracture was conducted from January 2020 to August 2022 at Yan’an Hospital, affiliated to Kunming Medical University. The patients were divided into 10 patients in the OBS group and 15 in the PFNA group according to different surgical methods. The OBS group reconstructed the bone models and designed the guide plate by computer before the operation, imported the data of the guide plate and bone models into a stereolithography apparatus (SLA) 3D printer, and printed them using photosensitive resin, thus obtaining the physical object, then simulating the operation and finally applying the guide plate to assist OBS to complete the operation; the PFNA group was treated by proximal femoral nail anti-rotation. The operation time, the intraoperative blood loss, Harris hip score (HHS), Oxford Hip Score (OHS), and complications were compared between the two groups.ResultsThe operation time and the intraoperative blood loss in the PFNA group were less than that in the OBS group, and there was a significant difference between the two groups (P < 0.05). The HHS during the 6th month using OBS was statistically higher than PFNA (P < 0.05), however, there were no significant differences in OHS during the 6th month between the OBS group and PFNA group (P > 0.05). The HHS and OHS during the 12th month in the OBS group were statistically better than in the PFNA group (P < 0.05).ConclusionThe OBS assisted by 3D printing and PFNA are effective measures for treating intertrochanteric fractures. Prior to making any decisions regarding internal fixation, it is crucial to evaluate the distinct circumstances of each patient thoroughly.

The purpose of this study was to assess the long-term clinical, functional, and radiological results of the patients who underwent osteosynthesis of femoral intertrochanteric fractures using proximal femoral nails (PFNs). The study included forty patients who had PFN osteosynthesis of intertrochanteric fractures between May 2009 and October 2014 and were followed up on for at least 24 months. The average duration of follow-up was 52.6±5.4 months. The patients' clinical, functional, and radiological findings were reviewed retrospectively. The fracture types were determined using the Evans-Jensen classification, and the radiological evaluation was done using Fogagnolo's reduction quality criteria. Fifteen fractures (37.5%) were stable, while 25 (62.5%) were unstable. The most common complication was varus union (10 percent). In 90% of patients, good and acceptable reduction criteria were met. In functional evaluation, 31 patients (77.5%) received excellent or good HHSs. Because of its advantages such as low bleeding amount, short surgical duration, fast mobilization, and long-term satisfactory functional results, proximal femoral nailing should be considered in the first steps of the treatment algorithm for femoral intertrochanteric fractures. [Med-Science 2022; 11(2.000): 864-8]

Objective: To compare the functional and radiological outcome of combine compression interlocking intramedullary nail (InterTan) and proximal femoral nail anti-rotation II (PFNA-II) in the treatment of elderly patients with intertrochanteric fractures. Methods: As a retrospective cohort study, records of 88 patients with intertrochanteric fractures treated in our hospital from January 1st, 2019 to July 31st, 2021 were retrospectively reviewed. According to treatment records, it included 45 patients treated with InterTan (Group-A) and 43 patients treated with PFNA-II (Group-B). The operation safety and functional rehabilitation of the two groups were compared and analyzed. Results: This study included 88 patients with intertrochanteric fractures (mean [SD] age, 68.72 [0.10] years at baseline), of whom 52 (59.09%) were males and 36 (40.91%) were females. Operation time and intraoperative blood loss in Group-B were less than Group-A, while fracture healing time was shorter in Group-A. The fracture separation distance was measured four weeks after the operation. The widening rate of the fracture line in Group-A was lower than Group-B (4.4% vs.18.6%; P<0.05). The incidence of complications in Group-A was lower than Group-B (4.4% vs.18.6%; P<0.05). At three, six and twelve months after the operation, the Harris hip score of the two groups was higher than at discharge (P<0.05), with no significant difference between groups (P>0.05). Conclusions: We found no significant difference in the functional outcome in elderly patients with intertrochanteric fractures treated with InterTan and PFNA-II. Early fracture healing and reduced complication rate however has been noted with InterTan. [ABSTRACT FROM AUTHOR]

ObjectiveDeep venous thrombosis (DVT) of the lower extremity is a common perioperative complication of femoral intertrochanteric fracture. This study aimed to identify the risk factors of lower extremity deep vein thrombosis (DVT) in elderly femoral intertrochanteric fracture patients and establish a nomogram model.MethodsFrom August 2014 to June 2021, a total of 1,652 femoral intertrochanteric fracture patients over the age of 65 were enrolled in our study. We distinguished independent risk factors by univariate and multivariate Cox analyses. A nomogram model was then built, and the discriminative and calibration of the model was evaluated through receiver operating characteristics (ROC) and calibration plots.ResultsA total of 378 patients developed DVT (292 in the training group, 86 in the validation group) while the remaining patients did not. According to the univariate and multivariate Cox analyses results, age (OR = 1.07, 95% CI: 1.04–1.10), fibrinogen (OR = 2.09, 95% CI: 1.68–2.60), D-dimer (OR = 1.33, 95% CI: 1.27–1.40), time from injury to admission (OR = 1.78, 95% CI: 1.55–2.05), functional status (OR = 4.21, 95% CI: 2.86–6.20), and diabetes (OR = 1.65, 95% CI: 1.10–2.48) were identified as independent risk factors of DVT. The ROC values for DVT of the training and validation group were 0.862 and 0.912, and the P-value of the Hosmer-Lemeshow calibration test was 0.767.ConclusionThis nomogram model can be used to predict the probability of preoperative DVT in elderly patients with femoral intertrochanteric fracture and guide physician in perioperative thrombosis management.

Abstract Introduction The 1-year mortality rate after femoral intertrochanteric fracture is higher than that of femoral neck fracture, which also belongs to hip fracture (Cui et al. in Arch Osteoporos 14(1):55, 2019). With the application of the concept of co-management model of orthopedics and geriatrics, the short-term and long-term mortality of all types of hip fractures has decreased (Van Heghe et al. in Calcif Tissue Int, 2021, https://doi.org/10.1007/s00223-021-00913-5 ). However, the mortality of Chinese femoral intertrochanteric fracture patients under this model has not been reported in the literatures. Aim This paper aims to study the risk factors of postoperative all-cause mortality in aged patients with femoral intertrochanteric fracture under the co-management model of orthopedics and geriatrics. Materials and methods This is a single-center prospective cohort study based on the real world, under the co-management of orthopedics and geriatrics, 363 patients aged ≥ 65 years with femoral intertrochanteric fracture were enrolled and followed up for 2–3 years; 52 patients were lost to follow up. Age, gender, body mass index (BMI), history of comorbidities, hip Bone Mineral Density (BMD), fracture history, 25(OH)D level, hemoglobin level, anti-osteoporosis treatment were risk factors to be tested. Kaplan–Meier survival curves and multivariate Cox proportional hazards models were constructed to analyze the impact of factors on all-cause mortality. Results (1) Most of the dead patients were older (the mean age was 83.4 years, compared with 79.8 years for surviving patients), with more complications and without anti-osteoporosis medication; gender, pre-fracture history, BMI, total hip BMD, hemoglobin, 25(OH)D had no difference between the dead and the living patients. (2) Elderly patients with Intertrochanteric fracture can benefit from the early treatment of Zoledronic Acid (within 3 days after the operation). Conclusion Under the co-management of orthopedics and geriatrics, to Chinese patients with Femoral Intertrochanteric fracture, Doctors should pay more attention to their age and chronic disease, and give anti-osteoporosis treatment if allowed.

Objective: To explore a new artificial intelligence (AI)-aided method to assist the clinical diagnosis of femoral intertrochanteric fracture (FIF), and further compare the performance with human level to confirm the effect and feasibility of the AI algorithm.Methods: 700 X-rays of FIF were collected and labeled by two senior orthopedic physicians to set up the database, 643 for the training database and 57 for the test database. A Faster-RCNN algorithm was applied to be trained and detect the FIF on X-rays. The performance of the AI algorithm such as accuracy, sensitivity, miss diagnosis rate, specificity, misdiagnosis rate, and time consumption was calculated and compared with that of orthopedic attending physicians.Results: Compared with orthopedic attending physicians, the Faster-RCNN algorithm performed better in accuracy (0.88 vs. 0.84 ± 0.04), specificity (0.87 vs. 0.71 ± 0.08), misdiagnosis rate (0.13 vs. 0.29 ± 0.08), and time consumption (5 min vs. 18.20 ± 1.92 min). As for the sensitivity and missed diagnosis rate, there was no statistical difference between the AI and orthopedic attending physicians (0.89 vs. 0.87 ± 0.03 and 0.11 vs. 0.13 ± 0.03).Conclusion: The AI diagnostic algorithm is an available and effective method for the clinical diagnosis of FIF. It could serve as a satisfying clinical assistant for orthopedic physicians.

Jiqi Wang,1 Youming Zhao,1 Bingjie Jiang,1 Xiaojing Huang2 1Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, People’s Republic of China; 2Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, People’s Republic of ChinaCorrespondence: Xiaojing HuangDepartment of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Shangcai Village Ouhai District, Wenzhou 325000, Zhejiang, People’s Republic of ChinaEmail wzhuangxiaojing@hotmail.comPurpose: The aim of our study was to explore the risk factors related to blood transfusion after intramedullary nail fixation of elderly femoral intertrochanteric fracture (FTF) and establish a nomogram prediction model.Patients and Methods: We conducted a retrospective study including elderly FTF patients treated by intramedullary nail between January 2017 and December 2019. Perioperative information was obtained retrospectively, uni- and multivariate regression analyses were performed to determine risk factors for blood transfusion. A nomogram model was established to predict the risk of blood transfusion, and consistency coefficient (C-index) and correction curve were used to evaluate the prediction performance and consistency of the model.Results: Of 148 patients, 119 were finally enrolled in the study and and 46 patients (38.7%) received a blood transfusion after the operation. Logistic regression analysis the female, lower preoperative Hb, ASA score > 2, general anesthesia, and higher intraoperative blood loss were independently associated with the blood transfusion. The accuracy of the contour map for predicting transfusion risk was 0.910.Conclusion: These risk factors are shown on the nomogram and verified. Through the assessment of the risk of blood transfusion and the intervention of modifiable risk factors, we may be able to reduce the blood transfusion rate to a certain extent, so as to further guarantee the safety of the elderly patients during the perioperative period.Keywords: blood transfusion, femoral intertrochanteric fracture (FTF), elderly, nomograms, risk factors, intramedullary nail fixation

Objective: The aim of this study was to investigate the effect of skeletal sarcopenia on the prognosis of intertrochanteric fracture in the elderly. Methods: We collected information on 144 patients with femoral intertrochanteric fracture (FIF). The influence of sarcopenia on the chance of death was determined using binary Probit regression analysis. For additional analysis, the Chow test was utilized to select the best distinguishing node in the instrumental activities of daily living (IADL) score. We looked for characteristics that were linked to a higher probability of death and a poor IADL outcome within 1 year. The data collected above were analyzed using logistic regression analysis. The internal calibration degree and model validity were assessed by GiViTI calibration. Results: Sarcopenia, EuroQol-5D 1 month score, age, gender, and hypertension were identified as risk factors for death in older patients with FIF within a year by logistic regression analysis. Sarcopenia, psychotropics, BMI, and length of hospital stay were all found to be risk factors for poor IADL outcomes (P < 0.1). The calibration curves indicated that the anticipated and actual probabilities of these two models were very close. The study's reliability coefficient was 0.671, showing a satisfactory level of reliability. Conclusion: In elderly patients with FIF, sarcopenia, EuroQol-5D score, age, gender, and hypertension were risk factors for death; sarcopenia, hospital stay length, BMI were risk factors for poor quality of life. [ABSTRACT FROM AUTHOR]

Objective To assess long‐term follow‐up evaluations for the treatment of femoral intertrochanteric fractures with the “three‐finger method” assisted by proximal femoral nail antirotation (PFNA). Methods From January 2010 to January 2017, 123 patients were selected and followed for the treatment of femoral intertrochanteric fractures with PFNA assisted by the “three‐finger method” (application of the index finger, middle finger, and ring finger in the process of surgery to assist PFNA). There were 56 male patients and 67 female patients aged 52–93 years with an average age of 75.6 years, and 88 cases were due to a fall and 35 due to a traffic accident injury. The femoral necks were fixed with PFNA assisted by the “three‐finger method” applying the following procedure: traction reduction, determining the incision, inserting the needle, and placing screw. The Harris hip score, postoperative complications, hip pain and function status were statistically analyzed to evaluate the surgical efficacy and to discuss the surgical technique of the “three‐finger method” assisted by PFNA. Results According to the Harris scoring criteria, patients were followed for 1, 2, 4, 6, and 8 years, and the good outcomes of patients were recorded. The excellent and good rate of 87% was the highest in the second year of follow‐up. Then, the rate decreased following the eighth year of follow‐up. The excellent and good rate of 82.7% was the lowest. The patients with incisions healed well, there were no instances of fat liquefaction or infection. There were three cases of effusion, the rate was 2.4%. The secretions were cultured, and no bacterial growth was found. After treatment of the wound, it healed, and the spiral blade used for the femoral head did not wear out. There was one case of femoral head necrosis. There was no significant correlation between hip pain and sex and age (P > 0.05), and the function of the hip joint was significantly correlated with the age of the patients (P

BACKGROUND: Proximal femoral nail anti-rotation is widely used in the treatment of elderly patients with femoral intertrochanteric fracture. Its surgical injury is small and the fixation is reliable, but the perioperative blood loss is still large. The proportion of patients who need blood transfusion after operation is still high, which has been bothering orthopedic surgeons. OBJECTIVE: To explore the related risk factors of blood transfusion after proximal femoral nail anti-rotation fixation of femoral intertrochanteric fracture in the elderly, and to establish and verify a nomogram prediction model to provide guidance for early identification of postoperative high-risk blood transfusion patients. METHODS: The perioperative clinical data of patients with femoral intertrochanteric fracture treated with proximal femoral nail anti-rotation in the Department of Traumatic Orthopedics of Subei People’s Hospital of Jiangsu Province from January 2016 to December 2020 were analyzed retrospectively. According to whether the patients received blood transfusion or not, the patients were divided into transfusion group and non-transfusion group. Univariate and multivariate Logistic regression analyses were performed to explore the independent risk factors for postoperative blood transfusion. According to the results of multiple factors, a nomogram prediction model was established, and the ROC curve and calibration curve were drawn to evaluate the prediction performance and consistency. RESULTS AND CONCLUSION: (1) Totally 366 patients were included in the study, with 142 patients in the transfusion group, and the probability of postoperative blood transfusion was 38.8%. (2) Univariate analysis showed that age, type of fracture, preoperative hemoglobin, preoperative albumin, time from injury to operation, type of anesthesia and intraoperative blood loss were related to postoperative blood transfusion (P < 0.05). (3) Multivariate Logistic regression analysis showed that fracture type, preoperative albumin, preoperative hemoglobin and intraoperative blood loss were independent risk factors for blood transfusion (all P < 0.05). (4) The ROC curve showed that the area under the curve for predicting the risk of postoperative blood transfusion by the model was 0.95, and the slope of the calibration curve was close to 1, indicating that the model had good differentiation and accuracy. (5) The prediction model of postoperative blood transfusion in elderly patients with femoral intertrochanteric fracture based on the results of multivariate Logistic analysis can provide scientific guidance for clinical orthopedic surgeons and further ensure the perioperative safety of such patients. [ABSTRACT FROM AUTHOR]

Copyright of Izmir Katip Celebi University Faculty of Health Sciences Journal / İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi is the property of Izmir Katip Celebi University, Faculty of Health Sciene Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The 1-year mortality rate after femoral intertrochanteric fracture is higher than that of femoral neck fracture, which also belongs to hip fracture (Cui et al. in Arch Osteoporos 14(1):55, 2019). With the application of the concept of co-management model of orthopedics and geriatrics, the short-term and long-term mortality of all types of hip fractures has decreased (Van Heghe et al. in Calcif Tissue Int, 2021, https://doi.org/10.1007/s00223-021-00913-5). However, the mortality of Chinese femoral intertrochanteric fracture patients under this model has not been reported in the literatures. Aim: This paper aims to study the risk factors of postoperative all-cause mortality in aged patients with femoral intertrochanteric fracture under the co-management model of orthopedics and geriatrics. Materials and methods: This is a single-center prospective cohort study based on the real world, under the co-management of orthopedics and geriatrics, 363 patients aged ≥ 65 years with femoral intertrochanteric fracture were enrolled and followed up for 2–3 years; 52 patients were lost to follow up. Age, gender, body mass index (BMI), history of comorbidities, hip Bone Mineral Density (BMD), fracture history, 25(OH)D level, hemoglobin level, anti-osteoporosis treatment were risk factors to be tested. Kaplan–Meier survival curves and multivariate Cox proportional hazards models were constructed to analyze the impact of factors on all-cause mortality. Results: (1) Most of the dead patients were older (the mean age was 83.4 years, compared with 79.8 years for surviving patients), with more complications and without anti-osteoporosis medication; gender, pre-fracture history, BMI, total hip BMD, hemoglobin, 25(OH)D had no difference between the dead and the living patients. (2) Elderly patients with Intertrochanteric fracture can benefit from the early treatment of Zoledronic Acid (within 3 days after the operation). Conclusion: Under the co-management of orthopedics and geriatrics, to Chinese patients with Femoral Intertrochanteric fracture, Doctors should pay more attention to their age and chronic disease, and give anti-osteoporosis treatment if allowed. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effects of enhanced recovery after surgery (ERAS) in the perioperative period of intramedullary fixation on elderly patients with femoral intertrochanteric fracture. Methods Totally 144 elderly patients with femoral intertrochanteric fracture, treated with intramedullary fixation, were divided into the ERAS group (86 cases) and control group (58 cases)，respectively. During perioperative period, patients in the ERAS group were treated with ERAS interventions, and patients in the control group were treated with conventional management of trauma orthopedics. Visual analog scale (VAS) was used to evaluate the pain degree of the two groups before operation, on the 3rd day, 7th day, 1 month, 3 months, 6 months and 1 year after operation. The Harris scoring method was used to evaluate the hip joint function of patients before operation, on the 7th day, 1 and 6 months, and 1 year after operation. The bone mineral density (T value) was measured one year after operation. The other related parameters, including the time from injury to operation, operation time, intraoperative blood loss, first postoperative weight-bearing time, average hospitalization time, postoperative complications and treatment satisfaction, were compared between the two groups. Results Compared with the control group, the VAS score of the ERAS group was lower on the 1st and 3rd day after operation, and Harris score was higher on the 7th day and 1 month after operation (all P<0. 05). The time from injury to operation in the ERAS group and control group was (3.43 ±2.58) and (7.34 ±3.69) days, the first postoperative weight-bearing time was（4.9 ±1.4） and（33.2 ±6.5) days, and the average hospitalization time was（11. 8 ±3. 7) and (13.7 ±4.3）days，respectively（all P<0.01). The T values of bone mineral density in the ERAS group and control group were -1. 66±0.57 and -2.25±0.52， the patient satisfaction was 96. 7%±5. 8% and 91. 4%±6. 6%，and the incidences of complications were 5. 8%（5/86）and 19. 0%(11/58)，respectively (all P<0.01). Conclusion The application of ERAS intervention during the perioperative period of intramedullary fixation for elderly patients with femoral intertrochanteric fracture can promote the recovery of hip function, improve the postoperative quality of life, reduce the occurrence of postoperative complications, and shorten the length of hospital stay without affecting the treatment effect. [ABSTRACT FROM AUTHOR]

Abstract Background The treatment for unstable intertrochanteric fractures in the elderly has always been a controversial issue. The aim in this study was to compare the curative effects of proximal femoral nail anti-rotation (PFNA) and cementless bipolar hemiarthroplasty (CPH) on femoral intertrochanteric fracture in the elderly. Methods From March 2008 to December 2012, 108 elderly patients with femoral intertrochanteric fractures were treated by PFNA or CPH. There were 63 males and 45 females, aged 75.3–99.1 years [(83.7 ± 5.6) years]. The patients’ bone mineral density was routinely measured, and the fractures were classified according to Evans-Jensen. The patients were divided into CPH group and PFNA group. The differences in operation time, intraoperative bleeding, immobilization duration, hospitalization time, Harris scores and postoperative complications including deep venous thrombosis, lung and urinary infection were analyzed. Results All patients were followed for 12.5–36.2 months [(28.0 ± 6.3) months)]. The operation time was (53.7 ± 15.2) min and (77.5 ± 16.8) min in PFNA group and CPH group, respectively (P 0.05); and the Harris scores after 1 year were (87.7 ± 7.9) points and (88.3 ± 9.2) points, respectively (P > 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05). Conclusion Both PFNA and CPH are safe and effective treatments for femoral intertrochanteric fracture in elderly patients. Nonetheless, CPH allows faster mobilization and recovery. Trial registration Registration Number: ChiCTR1900022846. Reg Date:2019-04-26 00:27:33 Retrospective registration

Abstract With the advent of global aging, the incidence, mortality, and medical costs of hip fracture among aged patients are increasing annually. The number of controlled clinical studies and health economics analyses that conform to evidence-based medicine principles is growing day by day. However, unfortunately, no specific recommendations regarding the procedures for the treatment of hip fracture are available. Meanwhile, the existence of both traditional treatment systems and new treatment theories means that most doctors confront difficult choices in their daily practice. These factors make the therapeutic approach for aged patients, especially among superaged patients with hip fracture, extremely challenging. This study focuses on superaged patients (> 80 years as defined by the World Health Organization) with hip fracture and includes their preoperative pathological condition; therapeutic decision-making in terms of the benefit and risk ratio, damage control theory, and enhanced recovery after surgery were also investigated. These patients were discussed specifically by combining the current treatment strategies from several experts and the results of a meta-analysis published recently. The study presents some new ideas and approaches currently recognized in the field, such as preoperative assessment, surgical planning, safety consideration, complication intervention, and enhanced recovery implementation, and further presents some clear interpretations regarding misunderstandings in clinical practice. Finally, optimized treatment according to damage control principles and enhanced recovery after surgery during the perioperative period among superaged hip fracture patients is defined.

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: There is still no uniform standard for the optimal use of tranexamic acid in proximal femoral nail antirotation for femoral intertrochanteric fracture.OBJECTIVE: To investigate the effect and safety of repeated intravenous tranexamic acid in the perioperative period of proximal femoral nail antirotation in patients with femoral intertrochanteric fracture. METHODS: Totally 100 patients with intertrochanteric fracture treated by proximal femoral nail antirotation in the Affiliated Hospital of Xuzhou Medical University from September 2017 to June 2020 were randomly divided into three groups. In the single-dose group, 33 patients were given tranexamic acid 1.0 g intravenously half an hour before operation. In the repeated-dose group, 35 patients were given the same medicine as the single-dose group before operation, and repeated intravenous drip of tranexamic acid 1.0 g at 3 and 6 hours after operation. In the control group, 32 patients were given an equal volume of physiological saline half an hour before operation. The baseline data, operation time, intraoperative blood loss, postoperative drainage volume, perioperative hemoglobin, hematocrit, C-reactive protein and interleukin-6 were collected from the three groups. Color Doppler ultrasound examination of lower extremity deep vein was conducted; and the total blood loss, hidden blood loss and thrombosis rate were calculated before and 7 days after operation. RESULTS AND CONCLUSION: (1) Total blood loss was significantly lower in the repeated-dose group (499.20±189.80) mL than that in the single-dose group (722.33±241.76) mL and control group (859.41±165.03) mL (P < 0.05). The hidden blood loss was significantly lower in the repeated-dose group (359.03± 208.57) mL than that in the single-dose group (544.73±290.69) mL and control group (719.22±204.08) mL (P < 0.05). (2) Compared with C-reactive protein and interleukin-6 in three groups after operation, the inflammatory indexes in repeated-dose group were the lowest and those in the control group were the highest (P < 0.05). (3) There was no pulmonary embolism in the three groups, and the lower extremity thrombosis was asymptomatic intermuscular venous thrombosis. There were two cases (2/32) in the control group, four cases (4/33) in single-dose group, and three cases (3/35) in repeated-dose group. The difference was not statistically significant (P < 0.05). (4) It is indicated that repeated use of tranexamic acid in the perioperative period of proximal femoral nail antirotation can further reduce the hidden blood loss, and reduce the inflammatory reaction without increasing the risk of thrombosis. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Clinical & Experimental Medicine is the property of Archives of Clinical & Experimental Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To study the clinical efficacy of Jiawei Bazhen Decoction combined with proximal femoral nail antirotation (PFNA) in the treatment of elderly patients with femoral intertrochanteric fracture and its effect on the postoperative hidden blood loss and hemorheology. Methods: From March 2014 to March 2017, 68 cases of intertrochanteric fractures treated by PFNA in our hospital were randomly divided into the observation groups (34 cases, oral Jiawei Bazhen Tang granules for 7 days after operation) and the control group (34 cases). The total blood loss, recessive blood loss, proportion of recessive blood loss, blood rheology indexes (plasma viscosity and whole blood viscosity low, medium and high cut) and incidence of adverse reactions were compared between the two groups. Results: (1) Two cases were excluded from each group, and 94.12% (64/68) of the subjects completed the study.（2）No significant difference was found in the total blood loss between two groups (P>0.05); the amount of implicit blood loss and the incidence of implicit blood loss in the observation group were significantly lower than those of the control group (P<0.05). (3) Before treatment, there was no statistically significant difference in the plasma viscosity and low, medium and high cut whole blood viscosity between the two groups (P> 0.05); after treatment, the plasma viscosity and low, medium and high cut whole blood viscosity of both groups were significantly lower then those before treatment (P<0.05), and the above indicators in the observation group were significantly lower than those in the control group (P<0.05). ⑷ One case of intramuscular venous thrombosis was found in the observation group without drug allergy and toxic and side effects; one case of deep vein thrombosis and 4 cases of intermuscular venous thrombosis were found in the control group. The adverse reaction rate in the observation group was 3.125%, which was significantly lower than that in the control group (15.625%, P<0.05). Conclusion: Jiawei Bazhen Decoction can not only significantly reduce the postoperative PFNA hidden blood loss in elderly patients with intertrochanteric fractures, but also improve the hemodynamics and safety. [ABSTRACT FROM AUTHOR]

Objective: To assess long‐term follow‐up evaluations for the treatment of femoral intertrochanteric fractures with the "three‐finger method" assisted by proximal femoral nail antirotation (PFNA). Methods: From January 2010 to January 2017, 123 patients were selected and followed for the treatment of femoral intertrochanteric fractures with PFNA assisted by the "three‐finger method" (application of the index finger, middle finger, and ring finger in the process of surgery to assist PFNA). There were 56 male patients and 67 female patients aged 52–93 years with an average age of 75.6 years, and 88 cases were due to a fall and 35 due to a traffic accident injury. The femoral necks were fixed with PFNA assisted by the "three‐finger method" applying the following procedure: traction reduction, determining the incision, inserting the needle, and placing screw. The Harris hip score, postoperative complications, hip pain and function status were statistically analyzed to evaluate the surgical efficacy and to discuss the surgical technique of the "three‐finger method" assisted by PFNA. Results: According to the Harris scoring criteria, patients were followed for 1, 2, 4, 6, and 8 years, and the good outcomes of patients were recorded. The excellent and good rate of 87% was the highest in the second year of follow‐up. Then, the rate decreased following the eighth year of follow‐up. The excellent and good rate of 82.7% was the lowest. The patients with incisions healed well, there were no instances of fat liquefaction or infection. There were three cases of effusion, the rate was 2.4%. The secretions were cultured, and no bacterial growth was found. After treatment of the wound, it healed, and the spiral blade used for the femoral head did not wear out. There was one case of femoral head necrosis. There was no significant correlation between hip pain and sex and age (P > 0.05), and the function of the hip joint was significantly correlated with the age of the patients (P < 0.05). Conclusion: The "three‐finger method" in the process of surgery to assist PFNA for the treatment of patients with intertrochanteric fractures of the femur simplified the operation steps, reduced the operation difficulty, shortened the operation time, improved the operation efficiency, and reduced the incidence of postoperative complications. [ABSTRACT FROM AUTHOR]

Objective To investigate biomechanics of proximal femoral nail anti-rotation (PFNA) with different entry points in the treatment of lateral wall fracture of femoral intertrochanteric fracture by finite element method. Methods Based on CT data of the hip of volunteers, three-dimensional model of right femur was extracted and optimized by Mimics and Geomagic software. Then, three A models (crushed lateral femoral wall and completed medial femoral wall) and three B models (crushed lateral femoral wall and medial femoral wall) were obtained by assembling different entry points with PFNA model in SolidWorks software and simulating different fracture lines of lateral wall. All the six models were imported into Abaqus software to set material properties and boundary conditions for transportation. The Von Mises cloud pictures of the model were calculated and viewed. Results In model A, the upper entry of the lateral wall formed stress concentration, the middle showed largest displacement and the bottom showed uniform stress distribution and smaller displacement. In model B, the upper entry of the lateral wall showed larger displacement, the middle showed largest stress concentration and the bottom showed smaller stress dispersion and displacement. Conclusion PFNA, which is selected the bottom entry of lateral femoral wall, has the best biomechanical effect in the treatment of lateral wall fracture of femoral intertrochanteric fracture. [ABSTRACT FROM AUTHOR]

BACKGROUND: For the treatment of intertrochanteric fracture in elderly patients, if there is no operative contraindication, surgical treatment is recommended. Operative methods include internal fixation and joint replacement. Surgical techniques are mature, but the choice of surgical methods is controversial. OBJECTIVE: To compare the efficacy of artificial femoral head arthroplasty and proximal femoral nail antirotation in elderly patients with injured lateral wall femoral intertrochanteric fracture so as to provide the basis of clinical method selection and to provide the original data for the systematic analysis of large sample. METHODS: According to the case criterion, 48 cases of AO classification of type A2.2, A2.3 intertrochanteric fractures were selected in Department of Orthopedics, the 71 Group Army Hospital of Chinese PLA from January 2012 to December 2017. They were divided into femoral head arthroplasty group (n=29) and proximal femoral nail antirotation group (n=19). All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The patients were followed up for 1-3 years. Operation time, bleeding volume, hospitalization expenses, the incidence of complications, and Harris hip score at 1 month and 1 year after the surgery were compared between the two groups. RESULTS AND CONCLUSION: (1) After statistical analysis, operation time was significantly shorter in the femoral head arthroplasty group than in the proximal femoral nail antirotation group (P < 0.05). There was no statistically significant in bleeding volume between the two groups (P > 0.05). The cost of hospitalization was significantly more in the femoral head arthroplasty group than in the proximal femoral nail antirotation group (P < 0.05}. (2) Harris hip score was significantly better in the femoral head arthroplasty group than in the proximal femoral nail antirotation group at 1 month after operation (P < 0.05}. There was no significant difference in Harris hip score between the two groups at 1 year after operation (P > 0.05). (3) There was no significant difference in the incidence of complications between the two groups (P > 0.05}. (4) For the patients over 70 years old with intertrochanteric fracture of injured lateral wall, artificial femoral head replacement has the advantages of early getting out of bed, high quality of life and quick recovery of joint function. It is suggested to choose artificial femoral head replacement first. [ABSTRACT FROM AUTHOR]

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Curative effect of artificial femoral head replacement on hip joint function and complications of elderly patients with femoral intertrochanteric fracture were investigated. Eighty patients who were operated for femoral intertrochanteric fractures operation were randomly divided into observation group (n=40) and control group (n=40). The observation group was treated with artificial femoral head replacement, while the control group received internal proximal femur locking plate fixation. In the observation group, the operation time was shorter than that in the control group (P<0.05). The intraoperative bleeding was less than that in the control group (P<0.05). The postoperative indwelling drainage time was shorter than that in the control group (P<0.05). Besides, at 3, 6 and 12 months after operation, 10 m walking speed in the observation group was significantly higher than that in the control group (P<0.05). The 5-time sit-stand time was shorter than that in the control group (P<0.05). At 1 week, 1 month, 3, 6 and 12 months after operation, Harris hip joint scores and visual analogue scale scores in the observation group were both superior to those in the control group (P<0.05). Moreover, the total hospitalization time in the observation group was shorter than that in the control group. Time of walking on crutches and walking without crutches was earlier than that in the control group (P<0.05). The overall proportion of postoperative chronic pain, thrombosis and failed surgery in the observation group was significantly lower than that in the control group (P<0.05). Finally, physical and psychological scores in the observation group after intervention were obviously higher than those in the observation group before intervention and the control group after intervention (P<0.05). Artificial femoral head replacement is characterized by the short operation time, less intraoperative bleeding, fast postoperative recovery of joint function, low degree of pain and fewer complications in the treatment of senile femoral intertrochanteric fracture, which can improve the postoperative life quality of patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study sought to compare the effects of proximal femoral nail anti-rotation (PFNA) and dynamic hip screw (DHS) helical blade treatments in patients with osteoporotic femoral intertrochanteric fractures. PATIENTS AND METHODS: Eighty elderly osteoporosis patients with femoral intertrochanteric fracture complications admitted to the hospital between January 2013 and December 2014 were selected and divided into control (n=40) and observation (n=40) groups. The control group received DHS internal fixation while the observation group received PFNA treatment. Patients were followed up for 18 months, during which pre- and post-operative duration, Harris hip joint function scale, pain, bone mineral density and calcitonin level, 10 meter walking speed, five-fold-sit-to-stand test time, fracture healing and weight bearing time, and related complications were compared between groups. RESULTS: Operational duration, hemorrhaging and drainage volume were all decreased in the observational group relative to the control group (p<0.05). Pre-operative Harris hip joint function scale scores were not significantly different between the two groups, but were superior in the observation group post-operation (p<0.05). A similar trend was observed for pain degree, bone mineral density and calcitonin levels, 10-meter walking speed, five-fold-sit-to-stand test time, and fracture and weight healing time (p<0.05). Complication incidence, such as coxa vara, loose nail, bone nonunion, delayed union of fracture, femoral head necrosis and deep venous thrombosis, etc., in the observation group was significantly lower than in the control group (p<0.05). CONCLUSIONS: PFNA is characterized by minimal invasiveness, shorter time of operation, and accelerated post-operative recovery during the treatment of osteoporotic intertrochanteric fractures, and effectively improved patient bone density post-operatively, thus further promoting joint function recovery and reducing complication incidence. [ABSTRACT FROM AUTHOR]

Objective: Femoral intertrochanteric fractures are usually fixed with short, straight cephalomedullary nails. However, mismatches between the nail and the femur frequently occur, such as tip impingement and tail protrusion. The authors designed a new type of short femoral intertrochanteric nail (fitn) with an anterior curvature (length=19.5cm, r=120cm) and herein report the geometric match study for the first of 50 cases.Methods: A prospective case series of 50 geriatric patients suffering from unstable intertrochanteric fractures (AO/OTA 31 A2/3) were treated. There were 15 males and 35 females, with an average age of 82.3 years. Post-operatively, the nail entry point position in the sagittal greater trochanter (in three categories, anterior, central and posterior), the nail-tip position in the medullary canal (in 5-grade scale) and the nail-tail level to the greater trochanter (in 3-grade scale) were measured using X-ray films.Results: For the nail entry point measurement, 5 cases were anterior (10%), 38 cases were central (76%), and 7 cases were posterior (14%). For the distal nail-tip position, 32 cases (64%) were located along the central canal axis, 13 cases (26%) were located anteriorly but did not contact the anterior inner cortex, 2 cases (4%) showed less than one-third anterior cortex thickness contact, and 3 cases (6%) were located posteriorly with no contact. For the proximal nail-tail level, there were no protrusions over the greater trochanter in 15 cases (30%), protrusion of less than 5mm in 29 cases (58%), and protrusion of more than 5mm in 6 cases (12%). The fitness was very high, as 96% cases showed no tip-cortex contact, and 88% cases showed less than 5mm proximal tail protrusion.Conclusion: The newly designed femoral intertrochanteric nail has a good geometric match with the femur medullary canal and the proximal length in the Chinese population. [ABSTRACT FROM AUTHOR]

Objective： To further explore the clinical effect of artificial joint replacement on Harris score and prognosis of aged femoral intertrochanteric fractures, and to provide reference for clinical practice. Methods： 226 patients with intertrochanteric fractures in the department of orthopedics of our hospital from December 2014 to November 2016 were enrolled. According to surgical methods, they were divided into the study group and the control group, and 113 cases in each group. The patients were taken with internal fixation and artificial joint replacement surgery. The incidence of postoperative pain, Harris score 6 months and 12 months after the surgery and postoperative complications were observed and compared between the two groups. Results： (1) There was no significant differences in pain score between the two groups before operation and there were no statistical significance. Regarding the pain scores 3 weeks and 3 months after operation, the study group was lower than the control group, and the differences were statistically significant. (2) The level of Harris score 6 months and 12 months after operation was significantly higher than that of control group, and the differences were statistically significant. (3) The incidence of complications in study group was significantly lower than the control group, and the differences were statistically significant. Conclusion： Artificial joint replacement can improve the clinical prognosis of elderly patients with intertrochanteric fractures, which is one of the ideal surgical methods for the treatment of intertrochanteric fractures in the elderly patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the treatment effect of low molecular weight heparin calcium combined with Ginkgo Leaf Extract and Dipyridamole Injection on the lower extremity deep femoral intertrochanteric fracture postoperative venous thrombosis treatment. Methods: Selected SO patients with femoral intertrochanteric fractures at department of orthopedics in our hospital from June 2015 to December 2016, which were randomly divided into study group (n=40) and control group (n=40) according to the random number table method. Patients of two groups were treated with surgical treatment. The control group was treated with low molecular weight heparin calcium 6000IU after surgery, subcutaneous injection. 2 times/d: The study group were treated with Ginkgo Leaf Extract and Dipyridamole Injection 20 mL on the basis of the control group, intravenous drip. 1time/d. and the course of treatment in two groups was l0d. Observed incidence of lower extremity deep venous thrombosis, the 15 cm diameter and the swelling rate of the upper pole of the patella and the inferior pole of the patella of patients in two groups after surgery, the prothrombin time (PT), activated partial thromboplastin time (APPT). D-dimer (D-D) levels and blood rheology examination index before and after treatment. Results: The incidence of lower extremity deep venous thrombosis in the study group was 2.50%, which was lower than that 15.00% in the control group (P<0.05). After treatment, 15 cm diameter of the superior pole of the patella and the 15cm diameter of the inferior pole of the patella of patients in two groups were increased slightly, and there was no statistical difference compared with before treatment (P>0.05). There was no significant difference between the two groups in the swelling rate of 15 cm on the upper pole of the patella and 15 cm in the inferior pole of the patella (PX1.05). PT and APPT of patients in the study group were significantly higher than the control group at 2 d after treatment, and D-D was significantly lower than the control group (P<0.05). At l0d after treatment, APPT and PT were significantly higher than the control group, D-D was significantly lower than the control group (P<0.05). At 2d, l0d after treatment, the whole blood high and low shear blood plasma viscosity, hematocrit, erythrocyte aggregation index and fibrinogen in study group were significantly lower than the control group (P<0.05). Conclusion: Low molecular weight heparin calcium combined with Ginkgo Leaf Extract and Dipyridamole Injection can reduce blood coagulation, improve blood rheology, which has a good effect on prevention of deep vein thrombosis of lower extremity in patients with femoral intertrochanteric fractures. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate the application of 3D printing (3DP) rapid prototyping (RP) technique-assisted percutaneous fixation in the treatment of femoral intertrochanteric fracture (ITF) using proximal femoral nail anti-rotation (PFNA). A total of 39 patients with unstable ITF were included in the current study. Patients were divided into two groups: 19 patients were examined using computed tomography scanning and underwent PFNA with SDP-RP whereas the other 20 patients underwent conventional PFNA treatment. Anatomical data were converted from the Digital Imaging and Communications in Medicine format to the stereolithography format using M3D software. The 3DP-RP model was established using the fused deposition modeling technique and the length and diameter of the main screw blade was measured during the simulation. The postoperative femoral neck-shaft angle (NSA), surgery duration, intraoperative and postoperative blood loss, and the duration of hospital stay were recorded and compared with the corresponding values in conventional surgery. No significant differences were observed in mean PFNA size between the implants used and the preoperative planning estimates. It was demonstrated that the 3DP-RP assisted procedure resulted in more effective reduction of the NSA. Furthermore, patients undergoing 3DP-RP experienced a significant reduction in duration of surgery (P<0.01), as well as reductions in intraoperative (P=0.02) and postoperative (P=0.03) blood loss, compared with conventional surgery. At 6 months post-surgery, no cases of hip varus/vague deformities or implant failure were observed in patients that underwent either the 3DP-RP-assisted or conventional procedure. The results of the present study suggest that the 3DP-RP technique is able to create an accurate model of the ITF, which facilitates surgical planning and fracture reduction, thus improving the efficiency of PFNA surgery for ITFs. [ABSTRACT FROM AUTHOR]

Objective To investigate the methodology and efficacy of the treatment on unstable osteoporotic intertrochanteric fractures in the elderly． Methods A total of 194 elder patients，who accepted operation of proximal femoral nail anti-rotation ( PFNA) ，or dynamic hip screw ( DHS) ，or hip replacement，or proximal femur locking compress plate ( PF-LCP) for unstable intertrochanteric fractures in our hospital from January 2005 to May 2015，were retrospectively analyzed． The operation time， amount of bleeding，time of hospital stay，ambulation time，score of Harris，and complication，etc． ，were evaluated． Ｒesults The surgery and hospitalization time was the shortest in PFNA group，and followed by GTF prosthetic group，PF-LCP group，and DHS group ( P ＜ 0. 01) ． The amount of bleeding was the lowest in PFNA group，and it was no statistical difference among joint replacement group，PF-LCP group，and DHS group． The ambulation time was the shortest in GTF prosthetic group，and followed by PFNA group，PF-LCP group，and DHS group，with no statistical difference． Harris score was the highest in GTF prosthetic group，and followed by PFNA group，PF-LCP group，and DHS group after 1 month of operation ( P ＜ 0. 01) ，and it was not significantly different among the 4 groups after 6 months of operation ( P ＞ 0. 01) ． Conclusion The key of treatment for elderly patients with femoral intertrochanteric unstable fracture is how to reduce operation risk，to shorten the ambulating time，and to avoid complications． PFNA should be preferred for the patients with better physical condition，low degree of osteoporosis，and lighter degree of fracture comminution． On the contrary，hip arthroplasty has more advantage for patients with severe osteoporosis and heavy fracture comminution degree，and DHS needs to be chosen carefully [ABSTRACT FROM AUTHOR]

The dynamic hip screw (DHS) is commonly used in the treatment of femoral intertrochanteric fracture with high satisfactory results. However, post-operative failure does occur and result in poor prognosis. The most common failure is femoral head varus collapse, followed by lag screw cut-out through the femoral head. In this study, a novel-designed DHS with two supplemental horizontal blades was used to improve the fixation stability. In this study, nine convention DHS and 9 Orthopaedic Device Research Center (ODRC) DHSs were tested in this study. Each implant was fixed into cellular polyurethane rigid foam as a surrogate of osteoporotic femoral head. Under biaxial rocking motion, all constructs were loaded to failure point (12 mm axial displacement) or up to 20,000 cycles of 1.45 kN peak magnitude were achieved, whichever occurred first. The migration kinematics was continuously monitored and recorded. The final tip-to-apex distance, rotational angle and varus deformation were also recorded. The results showed that the ODRC DHS sustained significantly more loading cycles and exhibited less axial migration in comparison to the conventional DHS. The ODRC DHS showed a significantly smaller bending strain and larger torsional strain compared to the conventional DHS. The changes in tip-to-apex distance (TAD), post-study varus angle, post-study rotational angle of the ODRC DHS were all significantly less than that of the conventional DHS ( p  < 0.05). We concluded that the ODRC DHS augmented with two horizontal wings would increase the bone–implant interface contact surface, dissipate the load to the screw itself, which improves the migration resistance and increases the anti-rotational implant effect. In conclusion, the proposed ODRC DHS demonstrated significantly better migration resistance and anti-rotational effect in comparison to the conventional DHS construct. [ABSTRACT FROM AUTHOR]