A study has found that in surgeries for intertrochanteric fractures in elderly patients, achieving precise alignment of the fracture site can lead to stable treatment outcomes, even without fixation of the detached bone fragments. The research confirmed that the accuracy of bone alignment immediately after surgery is more critical to prognosis than whether the fragments are fixed.
A team of orthopedic surgeons, including Professors Lee Young-kyun and Park Jeong-wi from Seoul National University Bundang Hospital, analyzed 157 patients who underwent surgery for unstable intertrochanteric fractures without fixing the posterior medial fragments. They reported their findings on August 5.
Intertrochanteric fractures occur between the greater and lesser trochanters of the femur and are common among the elderly, particularly those with osteoporosis. The mortality rate is high, with about 20% of patients dying within a year due to complications. Fractures that involve the inner back of the femur, leading to the detachment of the posterior medial fragment, are particularly unstable and have poor prognoses.
The research team followed up with the 157 patients for over six months after they received metal implants without fixation of the posterior medial fragment. They categorized the results based on whether the fractured bones were aligned properly, creating a stable structure, into two groups: those with 'cortical bone support' (79 patients) and those without (78 patients).
The analysis revealed that only five patients (3.2%) required reoperation despite not fixing the posterior medial fragment, while the remaining 96.8% achieved bone union. Although 64 patients (40.8%) experienced some degree of subsidence at the fracture site, most healed well without additional surgeries, such as joint replacement, by managing their weight and engaging in rehabilitation. Only four patients (2.5%) required reoperation.
Notably, the group that achieved cortical bone support had a lower rate of subsidence at the fracture site, with 32.9%, compared to 48.7% in the group that did not.
This study is the first to compare surgical outcomes in patients with unstable intertrochanteric fractures accompanied by large posterior medial fragments who did not undergo fixation. It highlights the importance of precise alignment of the fracture site, especially since elderly patients face increased risks of complications like pneumonia and pressure sores when surgery is delayed or they remain bedridden for extended periods.
Professor Lee stated, "For elderly patients, longer surgery times and increased blood loss can significantly burden recovery. This research could provide a basis for treatment strategies that achieve stable outcomes without expanding the surgical scope." Professor Park added, "This study confirms that the success of surgery depends not on the fixation of bone fragments but on how accurately the fractured bones are aligned."
* This article has been translated by AI.
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