{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T14:27:33Z","timestamp":1790605653384,"version":"4.1.0"},"reference-count":59,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T00:00:00Z","timestamp":1698192000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Intertrochanteric fracture is a very common but serious type of hip fracture in nonagenarians. The surgical treatment remains a significant challenge for orthopedists. The objective of this study was to investigate postoperative complications and survival outcomes compared between bipolar hemiarthroplasty (HA) and proximal femoral nail anti\u2010rotation (PFNA) in nonagenarians with intertrochanteric fractures, and to evaluate the efficacy and safety of the two surgical procedures in this patient population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 113 consecutive nonagenarians who underwent bipolar HA or PFNA for the treatment of intertrochanteric fractures from January 2006 to August 2021 were retrospectively studied in the current paper. There were 34 males and 79 females, with a mean age of 92.2\u2009years (range 90\u2013101\u2009years) at the time of operation. The average duration of follow\u2010up was 29.7\u2009months (range 1\u2013120\u2009months). The full cohort was divided into bipolar HA (77 cases) and PFNA (36 cases) groups. Damage control orthopedics was used to determine the optimal surgery time and assist in perioperative management. A restrictive blood transfusion strategy was employed, along with appropriate adjustments under multidisciplinary assessment, throughout the perioperative period. Perioperative clinical information and prognostic data were analyzed. Kaplan\u2013Meier survival curves were used for survival analysis, and landmark analysis divided the entire follow\u2010up period into 1\u201312\u2009months (short\u2010term), 13\u201342\u2009months (medium\u2010term) and 43\u2013120\u2009months (long\u2010term) according to the configurations of Kaplan\u2013Meier survival curves.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Both groups had similar general variables except for the proportion of high adjusted Charlson comorbidity index (aCCI) (\u22656 points) (6.5% in bipolar HA group and 22.2% in PFNA group, <jats:italic>p<\/jats:italic>\u2009=\u20090.024). Intraoperative blood loss and transfusion requirements were greater, and the intraoperative transfusion rates were higher in the bipolar HA group compared to the PFNA group (all <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). The complications rates, 1\u2010 to 60\u2010month cumulative all\u2010cause mortality, postoperative optimal Harris hip score (HHS), and Barthel index (BI) presented no significant difference between the two groups (all <jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05). Both groups had similar overall survival curves (<jats:italic>p<\/jats:italic>\u2009=\u20090.37). However, landmark analysis revealed that bipolar HA group exhibited higher survival rates in medium\u2010term (<jats:italic>p<\/jats:italic>\u2009=\u20090.01), while similar survival rates were observed in the short\u2010 and long\u2010term post\u2010operation periods (both <jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05). Cox regression with survival\u2010time\u2010dependent covariate calculated the hazard ratio (HR) of bipolar HA was 0.41 in medium\u2010term (<jats:italic>p<\/jats:italic>\u2009=\u20090.039).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Bipolar HA is equally effective and reliable as PFNA for treating intertrochanteric fractures in nonagenarians. Despite resulting in more intraoperative blood loss and transfusions, bipolar HA therapy is associated with a higher medium\u2010term survival rate compared to PFNA treatment. The application of damage control orthopedics and precise perioperative patient blood management could contribute to the positive clinical outcomes observed in this patient population.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.13913","type":"journal-article","created":{"date-parts":[[2023,10,26]],"date-time":"2023-10-26T03:11:53Z","timestamp":1698289913000},"page":"3231-3242","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Complication Rates and Survival of Nonagenarians after Hip Hemiarthroplasty versus Proximal Femoral Nail Antirotation for Intertrochanteric Fractures: A 15\u2010Year Retrospective Cohort Study of 113 Cases"],"prefix":"10.1111","volume":"15","author":[{"given":"Xingchen","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Daping Hospital Army Medical University (Third Military Medical University)  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7432-3011","authenticated-orcid":false,"given":"Wenlong","family":"Gou","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Daping Hospital Army Medical University (Third Military Medical University)  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siyu","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Daping Hospital Army Medical University (Third Military Medical University)  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Daping Hospital Army Medical University (Third Military Medical University)  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziming","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Daping Hospital Army Medical University (Third Military Medical University)  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6653-5356","authenticated-orcid":false,"given":"Yan","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Daping Hospital Army Medical University (Third Military Medical University)  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1611090"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003180"},{"key":"e_1_2_8_4_1","first-page":"122","volume-title":"Tabulation on the 2010 population CENSUS of the People's Republic of China (BOOK I)","author":"Population Census Ofice under the State Council, Department of Population and Employment StatisticsNational Bureau of Statistics","year":"2012"},{"key":"e_1_2_8_5_1","first-page":"113","volume-title":"China population CENSUS yearbook 2020 (BOOK1)","author":"Office of the Leading Group of the State Councilfor the Seventh National Population Census","year":"2021"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ocl.2019.11.011"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40001-019-0398-1"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2022.926745"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11657-011-0060-1"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199609000-00020"},{"issue":"1","key":"e_1_2_8_11_1","first-page":"64","article-title":"Hip fracture mortality: differences between intertrochanteric and femoral neck fractures","volume":"27","author":"Frisch NB","year":"2018","journal-title":"J Surg Orthop Adv"},{"key":"e_1_2_8_12_1","unstructured":"American Academy of Orthopaedic Surgeons.Management of Hip Fractures in Older Adults:Evidence\u2010Based Clinical Practice Guideline 2021. 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