Objectives: To investigate hip osteoporosis among elderly patients with intertrochanteric and to evaluate the outcome of fracture treatment with bipolar joint replacement in the elderly. Subjects and methods: A retrospective and prospective study on 60 patients (15 men and 45 women), mean age 82.62 ± 5.75 (from 70 to 102 years old) were treated for hip fracture with hip replacement partially used cement at 103 Military Hospital from 09 - 2012 to 12 - 2015.
Journal of military pharmaco-medicine n09-2018 A RESEARCH ON BONE MINERAL DENSITY IN THE HIP JOINT AND EVALUATION ON INTERTROCHANTERIC FRACTURE TREATMENT WITH BIPOLAR JOINT HIP REPLACEMENT IN THE ELDERLY FROM 2012 TO 2015 AT 103 MILITARY HOSPITAL Le Ngoc Hai1; Tran Dinh Chien2 SUMMARY Objectives: To investigate hip osteoporosis among elderly patients with intertrochanteric and to evaluate the outcome of fracture treatment with bipolar joint replacement in the elderly Subjects and methods: A retrospective and prospective study on 60 patients (15 men and 45 women), mean age 82.62 ± 5.75 (from 70 to 102 years old) were treated for hip fracture with hip replacement partially used cement at 103 Military Hospital from 09 - 2012 to 12 - 2015 Clinical description of age, gender, lesion characteristics, bone mineral density in the hip and immediate and predicted results Results and conclusions: Age group 80 - 89 accouted for 48.33%, women/men ratio 3.0/1 Classified based on AO, group A2 made up 63.33% Bone mineral density measured in accordance with DEXA was 60 patients: BMI index 18.5 - 22.9 accounted for 73.33%, Singh highest grade 55.0%, T-score average femur neck -3.62 ± 0.55, T-score = -3.9 for majority, T-score for femoral neck -3.03 ± 0.44; T-score average intertrochanteric fracture -3.02 ± 0.4; mean T-score of Ward area -3.91 ± 0.58; T-score mean head-to-hip ratio -3.20 ± 0.53 Bone mineral density of the neck - trochanteric - intertrochanteric - total head on the male thigh bone was significantly higher than that of females (p < 0.05); However, Ward's triangle bone between two groups of males and females was not different (p = 0.18487) Immediate evaluation: 100%, distance scale results according to Merle D’Aubigné - Postel: very good: 10.0%, good: 53.33%, quite: 23.33%, medium: 8.33%, bad: 5.0% * Keywords: Intertrochanteric; Bipolar; Elderly; Hip replacemen; DEXA INTRODUCTION Intertrochanteric hip fracture among the elderly is very common Women outnumber men, due to the common cause of falls In the United States, it is expected that 200,000 patients suffer from hip fractures usually with mortality up to 15 - 30%, commonly found in patients older than 70 years, whose treatment is up to $10 bil per year [5] Intertrochanteric fracture is painful, even more traumatic specifically in the elderly treatment due to the elderly‘s fracture complexity, poor bone quality and chronic systemic combination Many methods of treatment of intertrochanteric fractures have been studied and applied such as bone grafts with DHS splint, braces, nails Gamma have brought good results However, in cases of unstable fractures, Thanhhoa Department of Health 103 Military Hospital Corresponding author: Le Ngoc Hai (phhaingoai@gmail.com) Date received: 11/06/2018 Date accepted: 19/11/2018 134 Journal of military pharmaco-medicine n09-2018 broken bones, or thinning of the bones, fractured bone grading methods are ineffective for classification, Singh grade - - the patients who are unable to bone slow osteoporosis according to Singh, bipolar recovery, ill hip joint, limiting the rapid surgery with cement at 103 Military recovery, making the patients unable to Hospital from 09 - 2012 to 12 - 2015 move early In these cases, many authors provided with accompanied documents: advocate partial hip replacement for the Full purpose of helping patients quickly to operative, postoperative and scheduled restore their movement or even to sit up screening Bone mineral density in the hip early based DEXA surgery were measured and This approach helps avoiding systemic complications due to long-term restlessness including ulceration, pneumonia, or other systemic diseases In Vietnam in recent years, many hip type medical A1, A2, records, A3 by with AO pre- recorded - All 60 patients with the first time of hip replacement, with the mortar in good condition, not degraded, not deformed replacement surgery clinics have applied partial hip replacement on the elderly patients Methods with intertrochanteric fractures However, no - Retrospective and prospective study, agreement on this issue has been reached and no study has evaluated osteoporosis in the elderly patients with intertrochanteric fractures Therefore, we have conducted a study on the topic with the goal: - To review osteoporosis in the hip of associated with intertrochanteric fracture - To evaluate bipolar partial hip replacement in the elderly patients with intertrochanteric fracture clinical description Reseach categories include: Age, sex, traumatic features, bone density survey, indicative draw and studies of treatment results: Evaluation of the close results: Closeness of wound rehabilitation of hip joint and the complications of premature and complete onset Outcome evaluation: According to Merle D'Aubigné - Postel: 17 - 18 points: excellents; 15 - 16 points: SUBJECTS AND METHODS Subjects - 60 patients aged 70 years old and above, regardless of sex, intertrochanteric good; 13 - 14 points: quite; 10 - 12 points: medium; ≤ points: bad * Data processing: Processed on Epi.info software 135 Journal of military pharmaco-medicine n09-2018 RESULTS Classification of intertrochanteric fracture based on age, gender in elderly patients Table 1: Age, gender (n = 60) Gender Men Women Total Percentage % 70 - 79 years old 14 21 35.0 80 - 89 years old 23 29 48.33 > 90 years old 10 16.67 15 45 60 25.0 75.0 Age Total Percentage % 100 The age group of 80 - 89 accounted for the highest proportion (48.33%); women/men ratio: 3.0/1 Causes of fracture: cases of traffic accident accounted for 3.33%, falls: 58 cases (96.67%); intertrochanteric fracture alone was 58 patients, with two patients with forearm fractures and software lesions Table 2: Classification of intertrochanteric fractures by AO (n = 60) AO A1 A2 Total Percentage % 70 - 79 years old 12 21 35.0% 80 - 89 years old 11 18 29 48.33% ≥ 90 years old 10 16.67% 22 38 60 100.0% 36.67% 63.33% Age Total Percentage % Intertrochanteric fracture was rated by category AO with the highest percentage of 63.33% in A2 fracture, the age group of 80 - 89 had 29 patients (48.33%) in which A2 was present in 18 patients Table 3: Measurement of bone mineral density of intertrochanteric fracture to Singh (n = 60) Osteoporosis Grade I Grade II Grade III Total Percentage % 70 - 79 years old 13 21 35.0% 80 - 89 years old 19 29 48.33% ≥ 90 years old 10 16.67% 14 33 13 60 100.0% 23.33 55.0 21.67 Age Total Percentage % 136 Journal of military pharmaco-medicine n09-2018 Among grades of osteoporosis, grade II accounted for the highest percentage (55.0%) Out of the three groups of age, the group aged 80 - 89 made up the highest percentage (48.33%) Compared to male, females aged more vulnerable to osteoporosis - Systemic combined disease: There was no systemic disease: 20 patients (33.33%), cardiovascular disease, blood pressure: 31 patients (51.67%), diabetes: patients (5.0%), others: patients (10.0%) Table 4: Osteoporosis level in patients with intertrochanteric fractures with age (n = 60) Gender Male (n = 15) Female (n = 45) Note Neck 0.54 ± 0.05 0.48 ± 0.07 p = 0.00346 Troch 0.50 ± 0.05 0.45 ± 0.07 p = 0.00950 Inter 0.74 ± 0.21 0.61 ± 0.16 p = 0.01498 Ward’s 0.29 ± 0.09 0.28 ± 0.08 p = 0.83085 Total 0.64 ± 0.16 0.54 ± 0.14 p = 0.01505 Neck -3.42± 0.50 -3.68±0.56 p = 0.11739 Troch -2.88 ± 0.30 -3.08±0.47 p = 0.12216 Inter -2.8 ± 0.25 -3.1 ±0.42 p = 0.01069 Ward’s -3.75 ± 0.47 -3.98±0.61 p = 0.18487 Total -2.95±0.30 -3.27 ±0.56 p = 0.04130 Variable BMD (g/cm ) T-score A research on bone density in the hip area revealed a decrease in bone density among 60 patients of hip bone fracture with DEXA technique, compared to the mean bone density in the femoral head However, the comparison between the genders showed that women's osteoporosis level was higher than that of men with difference from p = 0.01069 < 0.05 Comparison of mean hip osteoporosis on the femur with the corresponding Singh score: Grade 1/grade 2/grade 3: mean T-score -3.26 ± 0.47/-3.02 ± 0.38/ -2.78 ± 0.19, respectively, correlated well with Singh-singularity, the difference between the level of significance and p = 0.00710 was statistically significant Treatment results * Review immediate results: First dry scalp 60 patients (100%), early X-ray results after surgery 100.0% of the following artificial joint replacement in the right place, with no dislocated or semi-located joint Average postoperative objective exercises were 2.95 ± 0.47 days after surgery, postoperative subjective exercises from 5.32 ± 0.65 days, mean hospital stay after surgery was 8.02 ± 2.55 days * Outcome evaluation: During the follow-up from months to 40 months on 60 patients, which mainly falls on the follow-up duration of 36 months, X-ray after surgery shows 100% joint still 137 Journal of military pharmaco-medicine n09-2018 in position The patients had tendency to be able to move at the highest frequency of fold/stretch/format/fit/ rotate in/offset were: 100 degrees/5 degrees/ 45 degrees/25 degrees/40 degrees/ 40 degrees * Evaluation based on the Merle D'Postel scale: Very good: patients (10.0%); good: 32 patients (53.33%); quite: 14 patients (23.33%); medium: patients (8.33%); bad: patients (5.0%) DISCUSSION Characteristics of intertrochanteric fractures of the elderly Table 5: Comparison of patient characteristics with other authors Author Proportion of women/men The average age Tran Manh Hung et al (2014) [1] 2.3/1 81.8 (70 - 94) Hoang The Hung (2013) [2] 2.8/1 82.19 ± 4.8 (72 - 95) Nguyen Manh Khanh (2012) [3] 3.3/1 78.9 (70 - 97) Joong-Myung Lee (2011) [6] 2.6/1 78.3 (64 - 95) Zhang Q et al (2005) [7] 1.25/1 72 - 91 Laffosse JM et al (2007) [8] 3.8/1 81.1 (70 - 91) We (2015) 3.0/1 82.62 ± 5.75 (70 - 102) In 60 patients, the lowest was 70 years old, the highest was 102 years old The mean age was 82.62 ± 5.74 The age group of 80 - 89 accounted for the highest percentage (48.33%) Men accounted for 25.0%, women accounted for 75.0% Women/men ratio 3.0/1 We found that there was no considerable difference between our results and other domestic and foreign authors’ findings in terms of the age of patients who had the joint replacement and the proportion of women/men The proportion of intertrochanteric fracture in women is higher compared to men, as the level of osteoporosis increased, the bone quality decreased over time and the rate of high long life 138 expectancy in females was higher than that of meles [9] Our study found that Singh's grade II osteoporosis had the highest proportion (33/60 patients = 55.0%), which is more common in the age group of 80 - 89 years old and in females than males Bone mineral density measured by DEXA method were in 60/60: BMI 18.5 - 22.9 accounted for 73.33%, T-score average femur neckline -3.62 ± 0.55, T-score = -3.9 for the majority, T-score for femoral neck -3.03 ± 0.44; T-score average Intertrochanteric fractured -3.02 ± 0.4; Mean T-score of Ward area -3.91 ± 0.58; T-score mean head-to-hip ratio -3.2 ± 0.53 BMD of the neck-capillary-transitional-total head on the male thigh bone was significantly higher than that of females Surgery comment Journal of military pharmaco-medicine n09-2018 disease: 20 patients, cardiovascular disease, blood pressure: 31 patients (51.67%), diabetes: patients (5.0%), other diseases: patients (10.0%) All cases have been treated before surgery Evaluation of treatment results * The short-term results: Dry scalp, right in the first treatment were found 60/60 patients (100%) Immediate X-ray results after surgery showed that 100% of artificial joints were in the right position, cases of dislocated or half-dislocated joint No complications in surgery occured Only one case of cerebral stroke after days of surgery was detected promptly and treatment is stable before the patient’s discharge Patients were instructed to exercise passively from day after surgery (2.95 ± 0.47 days), active training from day 4, medium from 5.32 ± 0.65 days, slight incision Other authors’ findings [2, 6, 10] suggested that rapid rehabilitation after treatment due to joint activity and exercise, reduces overall complications intertrochanteric fracture caused * Follow-up results: The follow-up of 60 patients after surgery ranged from months to 40 months, average 22.82 ± 10.15 months, the number of 36 month follow-up patients accounted for the highest rate, prostoperative X-ray surgery shows 100% in the right position without any cases of dislocation Merle D'Postel: very good: 10.0%, good: 53.33%, quite: 23.33%, medium: 8.33%, bad: 5.0% Our follow-up period was longer than that of Hoang The Hung [2], where 140 average follow-up time was 16.17 ± 10.86 months with excellent results 37.1%, good 42.9%, fair 17.1%, bad 2.9% According to Joong-Myung Lee et al, 32 out of 41 patients (78%) recovered walking ability CONCLUSION According to a study of 60 high-risk fractured hip fracture patients with bipolar with cement at 103 Military Hospital from September 2012 to December 2015, we conclude that: - Bone mineral density survey: 60/60 bone mineral density survey DEXA technique showed that all patients had osteoporosis in femoral neck, osteoporosis levels in women were higher than in men with a difference of p = 0.04130 < 0.05 Comparison of mean hip osteoporosis on DEXA females with Singh score: Grade 1/grade 2/grade 3: average T-score -3.39 ± 0.50/-3.24 ± 0.53/-2.83 ± 0.36, respectively, correlated well with Singh-singularity, the difference between the level of significance and p = 0.01425 was statistically significant - Evaluation of partial hip replacement in patients with intertrochanteric fracture: + Personal and traumatic features: Age from 70 to 102 years (mean 82.62 ± 5.75) Age from 80 to 89 was the highest (48.33%) Women/men ratio 3.0/1 Class A2 was the high rate (63.33%), A2 fracture in the age of 80 - 89 was 18 patients Osteoporosis II, III was 76.67% Journal of military pharmaco-medicine n09-2018 + Specification review: Bipolar has cement for fixation of firmer joints with intertrochanteric fractures of the elderly, osteoporosis This helped the patients to move early, in which the average postoperative active exercise was 5.32 ± 0.65 days after surgery The treatment provided better pain relief, reducing hospital stay to 8.02 ± 2.55 days, which enabled the patients rapidly rehabilitate, thus improving the quality of life - Surgical results: + 100% incision in the first period Patients are instructed to exercise after surgery soon + Excellent: 10.0%, good: 53.33%, fair: 23.33%, medium: 8.33%, bad: 5.0% REFERENCES Tran Manh Hung, Tran Trung Dung Evaluation of partial hip replacement surgery for hip fracture in elderly patients Journal of Military Medicine 2014, 295 (1 - 2) Hoang The Hung Evaluation of treatment intertrochanteric fracture in the elderly by joint hip replacement bipolar at 103 Military Hospital 2013 Nguyen Manh Khanh Partial replacement in patients with broken fractures is unstable Journal of Orthopedics 2012, pp.35-38 Ho Pham Thuc Lan et al Diagnosing osteoporosis: The impact of reference value Medical Journal 2011, Vol 01 & 02, No 57, pp.3-11 David G, LaVelle Fractures and dislocations of the hip in Cammpbell's Operative Orthopaedics 2007, 11th ed, Eleventh, Ed., USA, MOSBY ELSEVIER, pp.3237-3296 Joong-Myung Lee, Hee-Tae Nam, Sang-Hun Lee Bipolar hemiarthroplasty with cementless femoral stem for unstable intertrochanteric fractures Original Article J Korean Orthop Assoc 2012, Vol 47, No 2, pp.79-85 Zhang Q, Pang Q, Huang T, Ge Z, Tang T, Chen L The clinical effect of bipolar longstem prosthetic replacement on the treatment of comminuted intertrochanteric fracture of hip in the elderly osteoporotic patients Chinese Journal of Reparative and Reconstrutive Surgery 2005, Vol 19, No 3, pp.198-200 Laffosse J.M, Molinier F, Tricoire J.L, Bonnevialle N, Chiron P, Puget J Cementless modular hip arthroplasty as a salvage operation for failed internal fixation of trochanteric fractures in elderly patients Acta Orthop Belg 2007, 73 (6), pp.729-36 Kiran Kumar G.N et al Bipolar hemiarthroplasty in unstable intertrochanteric fractures in elderly: A prospective study Journal of Clinical and Diagnostic Research 2013, Vol 7, No 8, pp.1669-1671 10 Sancheti K.H, Sancheti P.K, Shyam A.K, Patil S, Dhariwal Q, Joshi R Primary hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in the elderly: A retrospective case series Indian J Orthop 2010, Vol 44, No 4, pp.428-434 141 ... - To evaluate bipolar partial hip replacement in the elderly patients with intertrochanteric fracture clinical description Reseach categories include: Age, sex, traumatic features, bone density. .. Dung Evaluation of partial hip replacement surgery for hip fracture in elderly patients Journal of Military Medicine 2014, 295 (1 - 2) Hoang The Hung Evaluation of treatment intertrochanteric fracture. .. survey, indicative draw and studies of treatment results: Evaluation of the close results: Closeness of wound rehabilitation of hip joint and the complications of premature and complete onset Outcome