Tratamiento de las fracturas trocántero-subtrocantéricas asociadas a coxartrosis ipsilateral en pacientes mayores de 65 años

Pedro Catalurda; Juan Del Castillo; Luis Francescoli

doi:10.29193/RMU.37.4.10

Pedro Catalurda Universidad de la República, Facultad de Medicina, Clínica de Ortopedia y Traumatología, Residente
Juan Del Castillo Universidad de la República, Facultad de Medicina, Clínica de Ortopedia y Traumatología, Asistente
Luis Francescoli Universidad de la República, Facultad de Medicina, Clínica de Ortopedia y Traumatología, Profesor

DOI: https://doi.org/10.29193/RMU.37.4.10

Keywords: SUBTROCHANTERIC FRACTURES, FEMORAL FRACTURES, COXARTHROSIS

Abstract

Introduction: hip fractures and hip joint arthrosis are highly prevalent conditions among older adults. However, according to clinical examination, they are seldom seen together and today there is no general consensus on the best therapy for these associated conditions. The study aims to update existing knowledge on the treatment of trochanteric and subtrochanteric fractures that are associated to ipsilateral coxarthrosis in patients older than 65 years old.
Method: we conducted a systematized search on Pubmed and Ovid including 2,499 articles and selected 12 studies to perform our bibliographic review based on inclusion and exclusion criteria.
Result: most studies analysed are series of retrospective cases. Cases were classified them into three subgroups to analyse results.
Discussion: the association between proximal femur fractures and ipsilateral coxarthrosis is rather unusual. When seen, trochanteric fractures are the most frequent ones. There are two therapeutic options to treat this condition: treating the fracture and the articulation in the same surgery, by means of an arthroplasty, or treating the fracture first with osteosynthesis and operating afterwards to treat the articulation condition. Arthroplasty reduces the time of postoperative ambulation and thus avoids medical complications in connection with the fracture disease, what results in better functional outcome in the short term. Osteosynthesis requires a shorter surgery and implies smaller blood loss, what makes it less technically demanding as a procedure.
The mortality rate does not depend on the therapy chosen, but on the presence of three or more comorbilities, or the patient being older than 80 years old.
It is important to define what the most appropriate treatment is for these associated conditions, what would contribute to reducing the effects of the fracture on this group of vulnerable patients.
Conclusion: there is no sufficient scientific evidence to state whether one therapy is better than the other one in these patients.

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Treatment of trochanteric and subtrochanteric fractures associated to ipsilateral coxarthrosis in patients older than 65 years old

Abstract

References

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