Abstract
Introduction: The treatment for unstable intertrochanteric fractures in the elderly patient has always been controversial. The aim of this study was to compare the outcome of porous coated cementless mono-block long stem hemiarthroplasty (CPH) and proximal femoral nail (PFN) on unstable intertrochanteric femoral fracture in the elderly patients. Methods: From March 2017 and March 2020, 132 elderly patients with unstable femoral intertrochanteric fractures were treated by CPH or PFN. 73 patients were treated using proximal femoral nail (PFN) and 59 were treated using hemiarthroplasty (CPH). Bleeding amount, weight training time, hospitalization time, Harris scores, one-year mortality, pre-existing disease and postoperative complications were analyzed. Results: The average follow-up time was 23.2 months in the CPH group and 22.9 months in the PFN group. No significant differences was found between the two groups in terms of demographic data. There was no significant differences between the two groups regarding the ASA score, pre-existing disease, postoperative complications, and revision surgery. The mean operation time and the average amount of blood loss were significantly higher in the CPH group (p<0.05). Conclusion: Both PFN and CPH are two satisfactory methods for treating the elderly with unstable IT fractures but in the CPH group, early postoperative mobilization and decreased dependency are the primary advantages.
Highlights
The treatment for unstable intertrochanteric fractures in the elderly patient has always been controversial
No difference was observed in demographic data and American physical condition classification (ASA) scores between the cementless bipolar hemiarthroplasty (CPH) and proximal femoral nail (PFN) groups (p > 0.05) (Table 1)
It has been stated in the literature that the distribution of comorbidities in the patients is similar for both the PFN and CPH groups [22,23]
Summary
The treatment for unstable intertrochanteric fractures in the elderly patient has always been controversial. Patients are frequently affected by additional diseases such as diabetes, osteoporosis, chronic lung disease and hypertension; hip fractures in these patients often result in low surgical tolerance and a poor general condition. They are prone to complications from bed rest after operation. The failure rate with internal fixation in the treatment of unstable IF has been reported to be approximately 50% [3] Many treatment options, such as bipolar hemiarthroplasty, PFN and dynamic hip screw (DHS) were used in the treatment of unstable IF femoral fractures [5,6].
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