• Eur J Trauma Emerg Surg · Dec 2020

    Review

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

    • Xavier Lizano-Díez, Keel Marius Johann Baptist MJB Department of Orthopaedic and Trauma Surgery, University of Bern, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland. , Klaus Arno Siebenrock, Marc Tey, and Johannes Dominik Bastian.
    • Department of Orthopaedic Surgery and Traumatology, Fundació Hospital de L'Esperit Sant, Universitat de Barcelona (UB), Santa Coloma de Gramenet, Barcelona, Spain.
    • Eur J Trauma Emerg Surg. 2020 Dec 1; 46 (6): 1267-1280.

    BackgroundOptimal rehabilitation treatment after surgery for fixation of unstable trochanteric fractures is challenging in elderly patients.PurposeThe 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.MethodsA 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.ResultsFifteen 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.ConclusionWith 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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