<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_rjaic-2020-0016_s_006_w2aab3b7c12b1b6b1aab1c14b1Aa"><h3>Introduction</h3><p>Trochanteric fractures are a major trauma in the elderly population and represent a significant part of public health spending. Various fixation devices are used as treatment for these fractures. This study aimed to evaluate three surgical methods in the treatment of pertrochanteric femoral fractures.</p></sec><sec id="j_rjaic-2020-0016_s_007_w2aab3b7c12b1b6b1aab1c14b2Aa"><h3>Materials and methods</h3><p>From January 1, 2013, to December 31, 2014, 86 patients were divided into 3 groups. Fifteen patients were treated with osteosynthesis by reamed intramedullary nailing (RIMN), 15 patients were treated with unreamed intramedullary nailing (UIMN), and 13 patients were treated with dynamic hip screw (DHS) plate osteosynthesis. All patients were >75 years of age. They were evaluated with a clinical radiological follow-up and laboratory examination (LDH, CPK, IL-1-B, IL-8, TNF-α, alpha-1-acid glycoprotein, D-dimer, fibrinogen, ESR, CRP, and procalcitonin).</p></sec><sec id="j_rjaic-2020-0016_s_008_w2aab3b7c12b1b6b1aab1c14b3Aa"><h3>Results</h3><p>IL-8, TNF-α, fibrinogen, D-dimer and alpha-1-acid glycoprotein levels were higher in the DHS group compared with the other two groups at 1 month after surgery (P&lt;0.05). LDH, IL-1β, and IL-6 levels were higher in the DHS group compared with the other two groups at 3 months after surgery (P&lt;0.05). From 3 to 6 months after surgery, the TNF-α level was high in the DHS and RIMN groups (P&lt;0.05). Infection markers did not demonstrate a difference among the 3 groups. Twelve patients died during the 12-month follow-up. Regardless of the method used, morbidity and mortality are linked to enticement and comorbidities rather than surgery within 48 hours after the trauma.</p></sec><sec id="j_rjaic-2020-0016_s_009_w2aab3b7c12b1b6b1aab1c14b4Aa"><h3>Conclusions</h3><p>From our study, we can affirm that the values of cytokines and interleukins observed remain high during the 12-month follow up, regardless of whatever fixation devices or surgery type was performed within 48 hours of injury. Inflammatory markers are higher in patients in the DHS group. This can probably be explained by the fact that DHS technique is performed by open surgery, and this can create a higher inflammation of soft tissue. Mortality is reduced in the first 30 days after surgery if patients are mobilized early. Therefore, mortality in our study population of patients aged >75 years is linked more to the chronic inflammatory state and comorbidities, rather than fixation device or surgical type used.</p><p>However, future studies are needed to answer further questions that go beyond the scope of our study.</p></sec></abstract>

IntroductionTrochanteric fractures are a major trauma in the elderly population and represent a significant part of public health spending. Various fixation devices are used as treatment for these fractures. This study aimed to evaluate three surgical methods in the treatment of pertrochanteric femoral fractures.Materials and methodsFrom January 1, 2013, to December 31, 2014, 86 patients were divided into 3 groups. Fifteen patients were treated with osteosynthesis by reamed intramedullary nailing (RIMN), 15 patients were treated with unreamed intramedullary nailing (UIMN), and 13 patients were treated with dynamic hip screw (DHS) plate osteosynthesis. All patients were >75 years of age. They were evaluated with a clinical radiological follow-up and laboratory examination (LDH, CPK, IL-1-B, IL-8, TNF-α, alpha-1-acid glycoprotein, D-dimer, fibrinogen, ESR, CRP, and procalcitonin).ResultsIL-8, TNF-α, fibrinogen, D-dimer and alpha-1-acid glycoprotein levels were higher in the DHS group compared with the other two groups at 1 month after surgery (P<0.05). LDH, IL-1β, and IL-6 levels were higher in the DHS group compared with the other two groups at 3 months after surgery (P<0.05). From 3 to 6 months after surgery, the TNF-α level was high in the DHS and RIMN groups (P<0.05). Infection markers did not demonstrate a difference among the 3 groups. Twelve patients died during the 12-month follow-up. Regardless of the method used, morbidity and mortality are linked to enticement and comorbidities rather than surgery within 48 hours after the trauma.ConclusionsFrom our study, we can affirm that the values of cytokines and interleukins observed remain high during the 12-month follow up, regardless of whatever fixation devices or surgery type was performed within 48 hours of injury. Inflammatory markers are higher in patients in the DHS group. This can probably be explained by the fact that DHS technique is performed by open surgery, and this can create a higher inflammation of soft tissue. Mortality is reduced in the first 30 days after surgery if patients are mobilized early. Therefore, mortality in our study population of patients aged >75 years is linked more to the chronic inflammatory state and comorbidities, rather than fixation device or surgical type used.However, future studies are needed to answer further questions that go beyond the scope of our study.

Metabolic shock in elderly pertrochanteric or intertrochanteric surgery. Comparison of three surgical methods. Is there a much safer?

Romanian Journal of Anaesthesia and Intensive Care

This work is licensed under the Creative Commons Attribution 4.0 International License.

IntroductionTrochanteric fractures are a major trauma in the elderly population and represent a significant part of public health spending. Various fixation devices are used as treatment for these fractures. This study aimed to evaluate three surgical methods in the treatment of pertrochanteric femoral fractures.Materials and methodsFrom January 1, 2013, to December 31, 2014, 86 patients were divided into 3 groups. Fifteen patients were treated with osteosynthesis by reamed intramedullary nailing (RIMN), 15 patients were treated with unreamed intramedullary nailing (UIMN), and 13 patients were treated with dynamic hip screw (DHS) plate osteosynthesis. All patients were >75 years of age. They were evaluated with a clinical radiological follow-up and laboratory examination (LDH, CPK, IL-1-B, IL-8, TNF-α, alpha-1-acid glycoprotein, D-dimer, fibrinogen, ESR, CRP, and procalcitonin).ResultsIL-8, TNF-α, fibrinogen, D-dimer and alpha-1-acid glycoprotein levels were higher in the DHS group compared with the other two groups at 1 month after surgery (P75 years is linked more to the chronic inflammatory state and comorbidities, rather than fixation device or surgical type used.However, future studies are needed to answer further questions that go beyond the scope of our study.

IntroductionTrochanteric fractures are a major trauma in the elderly population and represent a significant part of public health spending. Various fixation...

Metabolic shock in elderly pertrochanteric or intertrochanteric surgery. Comparison of three surgical methods. Is there a much safer?

Article Category: Original Paper

Published Online: Dec 31, 2020

Page range: 17 - 26

DOI: https://doi.org/10.2478/rjaic-2020-0016

Keywords
Surgical Trauma, Metabolic Shock, Intramedullary Nailing, Gliding Hip Screw, Minimally Invasive Technique, Interleukins

© 2020 David Gómez-Garrido et al. published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Metabolic shock in elderly pertrochanteric or intertrochanteric surgery. Comparison of three surgical methods. Is there a much safer?

Article Category: Original Paper

Published Online: Dec 31, 2020

Page range: 17 - 26

DOI: https://doi.org/10.2478/rjaic-2020-0016

KeywordsSurgical Trauma, Metabolic Shock, Intramedullary Nailing, Gliding Hip Screw, Minimally Invasive Technique, Interleukins

© 2020 David Gómez-Garrido et al. published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Keywords
Surgical Trauma, Metabolic Shock, Intramedullary Nailing, Gliding Hip Screw, Minimally Invasive Technique, Interleukins