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

Authors

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.

References

1) Koval K, Zuckerman J. Fracturas intertrocantéreas. En: Bucholz R, Heckman J, eds. Rockwood & Green’s fracturas en el adulto. Madrid: Marbán, 2007:1635-64.
2) Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 2007; 22(3):465-75. doi: 10.1359/ jbmr.061113.
3) Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury 2006; 37(8):691-7. doi: 10.1016/j.injury.2006.04.130.
4) Gallagher JC, Melton LJ, Riggs BL, Bergstrath E. Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clin Orthop Relat Res 1980; (150):163-71.
5) Ehlinger M, Adam P, Bonnomet F. Fractura del extremo superior del fémur del adulto. EMC-Aparato Locomotor 2014; 47(3):1-19. doi: 10.1016/S1286-935X(14)68514-2.
6) Aresti N, Kassam J, Nicholas N, Achan P. Hip osteoarthritis. BMJ 2016; 354:i3405. doi: 10.1136/bmj.i3405.
7) Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med 2010; 26(3):355-69. doi: 10.1016/j.cger.2010. 03.001.
8) Felson DT. An update on the pathogenesis and epidemiology of osteoarthritis. Radiol Clin North Am 2004; 42(1):1-9. doi: 10.1016/S0033-8389(03)00161-1.
9) Dequeker J, Goris P, Uytterhoeven R. Osteoporosis and osteoarthritis (osteoarthrosis). Anthropometric distinctions. JAMA 1983; 249(11):1448-51.
10) Cumming RG, Klineberg RJ. Epidemiological study of the relation between arthritis of the hip and hip fractures. Ann Rheum Dis 1993; 52(10):707-10. doi: 10.1136/ard. 52.10.707.
11) Franklin J, Englund M, Ingvarsson T, Lohmander S. The association between hip fracture and hip osteoarthritis: a case-control study. BMC Musculoskelet Disord 2010; 11:274. doi: 10.1186/1471-2474-11-274.
12) Weintroub S, Papo J, Ashkenazi M, Tardiman R, Weissman SL, Salama R. Osteoarthritis of the hip and fracture of the proximal end of the femur. Acta Orthop Scand 1982; 53(2):261-4. doi: 10.3109/17453678208992213.
13) Middleton R, Ferris B. The influence of osteoarthritis on the pattern of proximal femoral fractures. Clin Orthop Relat Res 1996; (324):214-6. doi: 10.1097/00003086-19960300000025.
14) Colhoun EN, Johnson SR, Fairclough JA. Bone scanning for hip fracture in patients with osteoarthritis: brief report. J Bone Joint Surg Br 1987; 69(5):848. doi: 10.1302/0301620X.69B5.3680362.
15) Foss MV, Byers PD. Bone density, osteoarthrosis of the hip, and fracture of the upper end of the femur. Ann Rheum Dis 1972; 31(4):259-64. doi: 10.1136/ard.31.4.259.
16) Bonnaire F, Lein T, Bula P. [Trochanteric femoral fractures: anatomy, biomechanics and choice of implants]. Unfallchirurg 2011; 114(6):491-500. doi: 10.1007/s00113-0111973-2.
17) Hoffmann M, Hartel M, Rueger JM, Lehmann W. Primary prosthetic replacement in perand intertrochanteric fractures. Eur J Trauma Emerg Surg 2014; 40(3):273-7. doi: 10.1007/s00068-014-0412-9.
18) Giannotti S, Bottai V, Dell’Osso G, De Paola G, Bugelli G, Guido G. The hip prosthesis in lateral femur fracture: current concepts and surgical technique. Clin Cases Miner Bone Metab 2014; 11(3):196-200.
19) Kim SY, Kim YG, Hwang JK. Cementless calcar-replacement hemiarthroplasty compared with intramedullary fixation of unstable intertrochanteric fractures. A prospective, randomized study. J Bone Joint Surg Am 2005; 87(10): 2186-92. doi: 10.2106/JBJS.D.02768.
20) Aguado-Maestro I, Panteli M, García-Alonso M, García-Cepeda I, Giannoudis PV. Hip osteoarthritis as a predictor of the fracture pattern in proximal femur fractures. Injury 2017; 48(Suppl 7):S41-46. doi: 10.1016/j.injury.2017. 08.037.
21) Calderazzi F, Groppi G, Ricotta A, Ceccarelli F. Does hip osteoarthritis have a protective effect against proximal femoral fractures? A retrospective study. Hip Int 2014; 24(3):231-6. doi: 10.530/hipint.5000116.
22) Geiger F, Zimmermann-Stenzel M, Heisel C, Lehner B, Daecke W. Trochanteric fractures in the elderly: the influence of primary hip arthroplasty on 1-year mortality. Arch Orthop Trauma Surg 2007; 127(10):959-66. doi: 10.1007/s00402-007-0423-7.
23) Bonnevialle P, Saragaglia D, Ehlinger M, Tonetti J, Maisse N, Adam P, Le Gall C; French Hip and Knee Society (SFHG); Trauma Surgery Academy (GETRAUM). Trochanteric locking nail versus arthroplasty in unstable intertrochanteric fracture in patients aged over 75 years. Orthop Traumatol Surg Res 2011; 97(Suppl 6):S95-100. doi: 10.1016/j.otsr.2011.06.009.
24) Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma 2018; 32 (Suppl 1):S1-10. doi: 10.1097/BOT.0000000000001063.
25) Pal C, Dinkar K, Mittal V, Goyal A, Singh M, Hussain A. Role of bipolar hemiarthroplasty and total hip arthroplasty in unstable intertrochanteric fracture femur. J Orthop Allied Sci 2016; 4(2):69-74. doi: 10.4103 / 2319-2585.193844.
26) Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg Br 1949; 31B(2):190-203.
27) Boese CK, Buecking B, Schwarting T, Debus F, Ruchholtz S, Bliemel C, et al. The influence of pre-existing radiographic osteoarthritis on functional outcome after trochanteric fracture. Int Orthop 2015; 39(7):1405-10. doi: 10.1007/s00264-014-2663-9.
28) Biyani A, Simison AJ, Klenerman L. Intertrochanteric fractures of the femur and osteoarthritis of the ipsilateral hip. Acta Orthop Belg 1995; 61(2):83-91.
29) Oztürkmen Y, Uzümcügil O, Sükür E, Karamehmetoðlu M, Caniklioðlu M. The use of a cementless modular stem in the treatment of subtrochanteric femoral fractures in conjunction with ipsilateral coxarthrosis. Orthopedics 2011; 34(1):13. doi: 10.3928/01477447-20101123-12.
30) Kellgren JH. Osteoarthrosis in patients and populations. Br Med J 1961; 2(5243):1-6. doi: 10.1136/bmj.2.5243.1.
31) Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969; 51(4):737-55.
32) Andress HJ, Kahl S, Kranz C, Gierer P, Schürmann M, Lob G. Clinical and finite element analysis of a modular femoral prosthesis consisting of a head and stem component in the treatment of pertrochanteric fractures. J Orthop Trauma 2000; 14(8):546-53. doi: 10.1097/00005131-20001100000005.
33) Egol KA. Subtrochanteric femur fracture below an arthritic hip: Opinion: Open reduction and internal fixation in conjunction with total hip arthroplasty. J Orthop Trauma 2005; 19(1):60-1. doi: 10.1097/00005131-200501000-00012.
34) Binns M, Shardlow D, Soames R. Proximal femoral fracture. Range of hip motion as a predictor of fracture type. Clin Orthop Relat Res 2000; (376):222-8.