title: Unstable intertrochanteric femur fractures in geriatric patients treated with the DLT trochanteric nail.
abstract: OBJECTIVE
  To evaluate clinical-functional and radiological results of geriatric patients with unstable intertrochanteric femur fracture treated with intramedullary nail.
  
  
  METHODS
  Thirty-two patients treated with intramedullary nail (DLT trochanteric nail) due to unstable intertrochanteric femur fractures were reviewed retrospectively. Fractures 31-A2 and 31-A3 (AO classification) were evaluated. Operation time, blood loss, and blood transfusion requirements, hospitalization period, time to fracture union were evaluated and perioperative and postoperative complications were recorded. According to the modified Baumgaertner criteria fracture reduction was analyzed radiologically, and nail tip-apex distance was measured. Femoral neck-shaft angle was also evaluated. Harris Hip Score for clinical evaluation and Kyo criteria for walking capacity were used.
  
  
  RESULTS
  The mean age was 72 years (65-81), mean follow up time was 18.3 months (12-26). Nineteen patients had type 31-A2 and 13 had type 31-A3 fractures. Mean operation time was 36.3min (25-45), blood loss 185.9ml (100-250). Blood transfusion was required in 7 patients. The average hospitalization duration was 6 days (4-14) while the time to surgery from admission was 2.9 days (2-6). Radiologically, in 21 of the cases fracture reduction was well (65.6%), acceptable in 9 (28.1%), and poor in 2 (6.3%). In early postoperative period, the mean collo-diaphyseal angle was 129.1° (120-140°), mean tip-apex distance was 15.5mm (10-27). The mean Harris Hip Score was 63.4 (38-90). Two patients (6.3%) had excellent, 21 patients (65.6%) had good, 7 patients (21.8%) had moderate, and 2 patients (6.3%) had poor results. Walking capacity in the last follow-up in 20 of the cases (62.5%) was pre-fracture level. While complications were observed in seventeen patients (53.1%) (5 superficial wound infections, 5 fractures of the greater trochanter, 3 cases of secondary varus angulation and 4 cases of heterotopic ossification) none of them required additional surgery, no implant failures or cut-outs were observed.
  
  
  CONCLUSIONS
  Functional and radiological results are satisfactory in using intramedullary nailing in the treatment of geriatric patients with unstable intertrochanteric fractures. Optimum surgical technique can minimize the risk of implant-related complications.
authors.affiliation: Orthopaedics and Traumatology Clinic, Edremit State Hospital, Balıkesir, Turkey. Electronic address: aytuntemiz@hotmail.com.
authors.forename: Aytun
authors.initials: A
authors.lastname: Temiz
authors.affiliation: Emergency Medicine, Hakkari State Hospital, Hakkari, Turkey. Electronic address: aslidurakis@hotmail.com.
authors.forename: Aslihan
authors.initials: A
authors.lastname: Durak
authors.affiliation: Department of Orthopaedics and Traumatology, Uludag University, Medical Faculty, Bursa, Turkey. Electronic address: teoman@uludag.edu.tr.
authors.forename: Teoman
authors.initials: T
authors.lastname: Atici
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D001858:Bone Nails; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Geriatric; Intertrochanteric fracture; Intramedullary nail