To investigate the curative effect of biological long-stem joint replacement and proximal femoral anti-rotation intramedullary nail in the treatment of unstable intertrochanteric fractures of femur in the elderly patients.

Eighty elderly unstable femoral intertrochanteric fractures of femur patients were retrospectively admitted to the Tai-he County People’s Hospital from January 2016 to January 2020 were selected as the research objects. Inclusion criteria: unstable intertrochanteric fracture of the femur; the affected side was the first operation. Exclusion criteria: dysfunction of the affected limb before injury; severe osteoporosis leading to abnormal thinning of the femoral cortical bone; severe bone tumors. The patients were divided into the internal fixation group (40 cases) and the joint replacement group (40 cases) according to different treatment methods. The internal fixation group were treated with a proximal femoral anti-rotation intramedullary nail, and the joint replacement group were treated with a biological long-stem joint replacement. Both groups were followed up for one year after surgery. The operation indicators, the hip joint function, quality of life before and three weeks after operation, and the incidence of complications followed up one year of the two groups were compared and used independent sample t test, paired t test and chi-square test.

The intraoperative blood loss of the joint replacement group was higher than that of the internal fixation group (t=5.514, P<0.001). The operation time was longer than that of the internal fixation group(t=6.520, P<0.001). The postoperative drainage volume was lower than that of the internal fixation group (t=3.900, P<0.001), and the time of postoperative landing was shorter than that of the internal fixation group (t=5.419, P<0.001). Compared with the preoperative data, the scores of deformity, mobility, pain, functional, the total score of Harris hip score (HHS), and the scores of physical pain, vitality, social function, and overall health of the two groups increased three weeks after operation (the joint replacement group: t=19.578, 41.350, 35.154, 20.180, 29.849, 96.274, 109.39, 45.90 and 61.437, all P<0.001; the internal fixation group: t=5.966, 24.298, 35.154, 20.18, 29.849, 15.805, 22.269, 13.55 and 15.884, all P<0.001), and the joint replacement group was higher than the internal fixation group(t=13.969, 23.917, 7.911, 5.980, 9.251, 15.805, 22.269, 13.550 and 15.884, all P<0.001). At one year of follow-up, the rate of complication in the joint replacement group was 5.0%, which was lower than that (27.5%) in the internal fixation group (t=7.440, P<0.05).

Biological long-stem joint replacement and proximal femoral anti-rotation intramedullary nail have their own advantages and disadvantages in the treatment of unstable intertrochanteric fractures of femur in the elderly patients. The proximal femoral anti-rotation intramedullary nail shows the advantages of less intraoperative blood loss and short operation time, while the biological long-stem joint replacement shows the advantages of fast postoperative recovery, good hip function recovery, high quality of life and fewer postoperative complications.