The Results of Proximal Femoral Nail for Intertrochanteric Fracture in Hemodialysis Patient.
OBJECTIVE
Hip fractures in hemodialysis patients are accompanied by high rates of complications and morbidities. Previous studies have mainly reported on nonunion and avascular necrosis of femoral neck fractures in this patient group. In this study the complication and clinical results of hemodialysis patients with intertrochanteric fractures treated with proximal femoral intramedullary nailing have been investigated through comparison with patients with normal kidney function.


METHODS
Forty-seven patients were included; the hemodialysis group (n=17) and the control group with normal kidney function (n=30). The medical history and clinical findings including preoperative and postoperative blood examinations, radiological examinations and ambulatory status (measured using the Koval score). The rate of complications and morbidities were also investigated and compared.


RESULTS
Preoperative hemoglobin/hematocrit was lower but a significant increase in partial thromboplastin time was observed in the hemodialysis group. The amount of bleeding/transfusions were higher and operative time was longer in the hemodialysis group. Upon radiologic examination, there was no significant difference in rate of unstable fracture and nonunion between the two groups. However the postoperative Koval score was significantly worse and the odds ratio of inability to walk after surgery was 13.5 times higher in the hemodialysis group.


CONCLUSIONS
There was no significant difference in radiological results, but the risk of inability to walk after surgery was 13.5 times higher in the hemodialysis group. Hemodialysis patients have more morbidities and are hemodynamically unstable therefore require special attention. Accurate reduction and firm fixation is required and attentive postoperative rehabilitation is needed.
Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea.
Kyung Sub
KS
Song
Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea.
Sang Phil
SP
Yoon
Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea.
Su Keon
SK
Lee
Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea.
Seung Hwan
SH
Lee
Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea.
Bong Seok
BS
Yang
Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea.
Byeong Mun
BM
Park
Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
Ick Hwan
IH
Yang
Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea.
Beom Seok
BS
Lee
Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea.
Ji Ung
JU
Yeom
Femur; Internal fixation; Intertrochanteric fracture; Proximal femoral nail; Renal dialysis