Fracturas subtrocantéreas e intertrocantéreas del ancianocomparación de la técnica quirúrgica de enclavado con cerclaje y enclavado aislado

Abstract

Subtrochanteric fractures in the elderly are specially difficult to treat, with a negative impact on the patients quality of life. Better outcomes are achieved when fracture reduction is good. The aim of this study is to compare the close reduction nailing technique with the open reduction nailing technique using cerclages, and assesing their effect over fracture reduction, health-related quality of life, musculoskeletal and social function. Methods: two cohorts observational study with prospective follow up from a sample of patient with a subtrochanteric fracture. One of the groups was treated wih nailing and close reducuction manoeuvers (60) and the other with nailing, focus fracture opening and reduction with cerclage wiring (30). The main outcomes were orthopaedic complications, mortality, health-related quality of life assesed with the EQ-5D index score, and mobility and social function assesed with the Parker & Palmer score and the Jensen Index. Results: comparing both groups there were not differences in mortality and orthopaedic complications. There were significant differences in length of stay in hospital, quality of reduction and bone union, better for the cerclage group. Patients treated with cerclage wiring had significantly better EQ-5D at 12 months and Jensen index at 12 and 18 months. Comparing the patients sample according the quality of reduction we found significant differences in the number of orthopaedic complications, that were fewer when quality of reduction was better. Conclusions: the nailing technique with cerclage has better quality of reduction and time to union than the close nailing technique. These fractures have a negative effect on elderly patients quality of life but better outcomes were observed when using the cerclage technique.