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Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
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Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner

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Poor prognosis after surgery for intertrochanteric fracture in elderly patients with clopidogrel treatment: A cohort

Jianzheng Zhang1, Xiaobin Chen, Juan Wang

  • 1Department of Orthopedic, Beijing Army General Hospital, Beijing, China.

Medicine
|September 28, 2017
PubMed

Insights

Elderly patients on clopidogrel treatment undergoing surgery for intertrochanteric fractures face poorer outcomes. This includes lower survival rates and longer hospital stays compared to those not on the medication.

Area of Science:

  • Geriatric Trauma Surgery
  • Orthopedic Surgery
  • Pharmacology

Background:

  • Intertrochanteric fractures are common in elderly patients, often with comorbidities.
  • Surgical approach decisions for patients on clopidogrel are complex.
  • Clopidogrel is an antiplatelet medication used to prevent blood clots.

Purpose of the Study:

  • To evaluate the prognosis of elderly patients receiving clopidogrel treatment after surgical repair of intertrochanteric fractures.
  • To identify prognostic factors influencing outcomes in this patient population.

Main Methods:

  • A cohort study involving 238 elderly patients undergoing proximal femur intramedullary nailing for intertrochanteric fractures.
  • Patients were divided into two groups: long-term clopidogrel treatment (n=32) and control (n=206).
  • Comparison of demographic, clinical, intraoperative, and postoperative data, including 1-year survival.

Main Results:

  • The clopidogrel group showed significantly higher rates of intraoperative blood transfusion, ICU stay, and hospital stay (all P < .001).
  • Postoperative complications were similar between groups.
  • The 1-year mortality rate was significantly higher in the clopidogrel group (37.5% vs. 20.3%, P = .030).

Conclusions:

  • Elderly patients on clopidogrel treatment have a poorer prognosis after intertrochanteric fracture surgery.
  • Key prognostic factors include American Society of Anesthesiologists (ASA) grade, arterial stenting, and anesthesia mode.
  • Findings suggest careful consideration of surgical management and risk stratification for these patients.

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