Hip fractures are one of the most frequent fractures in older adults. There is still controversy which surgical strategy is the best option for treatment of hip fractures especially trochanteric region fractures. Surgical intervention that follows hip fracture induces biochemical, physiological and fibrinolytic changes that are so-called "second hit phenomenon" which trigger systemic inflammatory response syndrome. The investigators are aiming to study this phenomenon after two different surgical procedures and help surgeons in everyday practice to choose the most suitable surgical treatment for patients with trochanteric region fracture and give the scientific community more evidence which methods is better since there is still controversy.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
60
Dynamic Hip Screw fixation: Fracture will be reduced under image intensifier. The incision will be made 7-10 cm with a lateral approach. The fascia lata will be incised and the vastus lateralis muscle will be splited along the axis of the femur, without stripping the periosteum. A135° angle guide will be inserted in the lower half of the femoral neck. The barrel of the plate will be guided to the hip screw by direct palpation to minimize the soft-tissue injury. After the insertion of the cortical screw, soft tissue will be protected with 4.5mm drill sleeve during drilling and tapping.
Proximal Femoral Nail fixation: Fracture will be reduced under image intensifier. The incision 2-3 cm with a lateral approach that extended from the cranial part to the tip of the greater trochanter. After palpating the greater trochanter tip, the nail will be then introduced manually into the femoral shaft. The guide wire of the anti-rotational hip blade then introduced. The hip blade should be introduced in the direction of the lower half of the femoral neck. Drilling will be performed under soft-tissue protection with a retractor. The blade will be inserted, and a distal static locking screw and end cap will be inserted under soft tissue protection with a drill sleeve.
Qendra Klinike Universitare e Kosoves
Pristina, Kosovo
The difference of the level of IL-6 in operated patients.
The blood will be collected and after that centrifuged and then stored in -20 grade celsius. The analysis of each sample will be performed no later than 3 months.
Time frame: 1 hour before and 24 hours after operation
The difference of the level of CRP in operated patients.
The analysis will be performed immediately after the blood sample is collected.
Time frame: 1 hour before and 24 hours after operation. Length of operation, length of incision, blood loss perioperatively. Complication and mortality rate within 1 month after OP
The difference of the level of D-dimer
The analysis will be performed immediately after the blood sample is collected.
Time frame: 1 hour before and 24 hours after operation
The difference of the level of ESR
The analysis will be performed immediately after the blood sample is collected.
Time frame: 1 hour before and 24 hours after operation
The difference of the length of operation
The stopwatch will be turned on from the incision until the end of the skin suture
Time frame: Intra-operatively
The difference of the level of length of incision
The measure will be made with centimeters (cm)
Time frame: After the wound closure
Blood loss
HB-balance method will be used
Time frame: Levels of HB before and after surgery. Also the total volume of blood transfusion.
Complications after surgery
All complications that might occur after surgery will be registered
Time frame: Within 1 month after surgery
Mortality rate
The mortality of patients that might happen after surgery
Time frame: Within 1 month after surgery
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