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Rehabilitation protocols in unstable trochanteric fractures treated with cephalomedullary nails in elderly: current practices and outcome

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Abstract

Background

Optimal rehabilitation treatment after surgery for fixation of unstable trochanteric fractures is challenging in elderly patients.

Purpose

The objective of this study is to analyse the existing literature on available rehabilitation protocols with regards to permitting or restricting early weight bearing following fixation of unstable trochanteric fractures treated by the use of cephalomedullary nails in patients at least 65 years of age.

Methods

A systematic review was performed based on the checklist of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies published between 1948 and 2018 on elderly patients with unstable trochanteric fractures treated with cephalomedullary nails that offered information on the postoperative rehabilitation protocol have been selected. Subsequently, the results and complications have been analysed according to the protocols.

Results

Fifteen of the 7056 initial articles have been selected for analysis. Authors who did not restrict weight bearing to their patients reported a shorter hospitalization time and a lower orthopaedic complication rate but a greater systemic complication rate, worse functional scores, and a higher reoperation and mortality rates. Those results should be taken with caution because of the heterogeneity of provided clinical information and the fact that none of the included studies considered the different rehabilitation protocols as study variables to analyse its influence on the results.

Conclusion

With evidence available to date, there is no clear agreement on the postoperative rehabilitation protocol following fixation of an unstable trochanteric fracture by cephalomedullary nail in the elderly.

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Acknowledgements

We thank Mr Vasanthakumar Eswaramoorthy FRCS (Tr & Orth), Arthroplasty Fellow, St. George’s University Hospital NHS trust, London for linguistic support in the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Fundació Hospital de L’Esperit Sant, Universitat de Barcelona (UB), Santa Coloma de Gramenet, Barcelona, Spain

    Xavier Lizano-Díez

  2. Department of Orthopaedic and Trauma Surgery, University of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland

    Marius Johann Baptist Keel, Klaus Arno Siebenrock & Johannes Dominik Bastian

  3. Trauma Center Hirslanden, Clinic Hirslanden, Zurich, Switzerland

    Marius Johann Baptist Keel

  4. Department of Orthopaedic Surgery and Traumatology, Parc de Salut Mar, Hospital del Mar and Hospital de L’Esperança, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain

    Marc Tey

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  1. Xavier Lizano-Díez
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Correspondence to Johannes Dominik Bastian.

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Lizano-Díez, X., Keel, M.J.B., Siebenrock, K.A. et al. Rehabilitation protocols in unstable trochanteric fractures treated with cephalomedullary nails in elderly: current practices and outcome. Eur J Trauma Emerg Surg 46, 1267–1280 (2020). https://doi.org/10.1007/s00068-019-01294-z

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