Hip Pelvis.  2017 Mar;29(1):54-61. 10.5371/hp.2017.29.1.54.

The Results of Proximal Femoral Nail for Intertrochanteric Fracture in Hemodialysis Patient

• Song KS
• Yoon SP
• Lee SK
• Lee SH
• Yang BS
• Park BM
• Yang IH
• Lee BS
• Yeom JU

• KMID: 2371768
• DOI: http://doi.org/10.5371/hp.2017.29.1.54

Abstract

PURPOSE
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.
MATERIALS AND 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.
CONCLUSION
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.

Keyword

Renal dialysis; Femur; Intertrochanteric fracture; Proximal femoral nail; Internal fixation

MeSH Terms

Femoral Neck Fractures
Femur
Fracture Fixation, Intramedullary
Hip Fractures
Humans
Kidney
Necrosis
Odds Ratio
Operative Time
Partial Thromboplastin Time
Rehabilitation
Renal Dialysis*

Figure

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  Fig. 1 Radiograph images. (A) At preoperation, anteroposterior and lateral radiographs show severe communited displaced fracture. (B) Postoperative radiographs reveal a good reduction achieved. (C) After three months' follow up, a complete union was achieved.

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