Bipolar Hemiarthoplasty versus Proximal Femoral Nail in Management of Unstable Intertrochanteric Femur Fracture

Abstract

Background Intertrochanteric fractures (ITFs), commonly occurred in the elderly, are still a big challenge for orthopedic surgeons due to the multitude of co-morbidities and high 1-year mortality rate associated with them. Aim of the Work The aim of this study is to review systematically studies about the use of bipolar hemiarthoplasty versus proximal femoral nail in management of unstable intertrochanteric femur fracture. Patients and Methods We included randomized control trails (RCTs), controlled clinical trials, retrospective comparative cohort studies and prospective comparative cohort studies and we excluded case reports, case series studies, cross sectional studies and non English studies. Search results was conducted to systematic review management software and manually screened for eligibility to be included. Surgical treatment of unstable intertrochanteric femur fractures by bipolar hemiarthoplasty versus proximal femoral nail. Results Regarding the patients included in the review there is no significant difference in the age or sex between the two groups of comparison. This review provides us with enough evidence regarding the superiority of PFN, which being a significantly faster surgery and has relatively lower incidence of intraoperative blood loss this in turn provides general wellbeing to the patient and gives better function. Although there is no significant difference between two group of comparison regarding percentage of failure and percentage of reoperation, PFN shows the superiority of duration of hospital stay which could be beneficial for the mental health of the patients, which adds to their overall quality of life, also PFN show the superiority regarding percentage of infection, decreasing patient suffering and risk of reoperation, also PFN show the superiority regarding percentage of mortality increasing life expectancy of patients, percentage of DVT decreasing pulmonary complications and also PFN show the superiority regarding Harris hip score so show better outcomes. Conclusion PFN proves itself as a better modality than hemiarthroplasty in unstable intertrochanteric femur fractures in the elderly, with decreased post-operative mortality and better functional results. Hemiarthroplasty is best reserved for individuals with short life expectancies who require immediate weight bearing and mobilization.