Comparison of intramedullary fixation and hemiarthroplasty for treatment of femoral intertrochanteric fracture in the elderly patients following stroke

Abstract

Objective To compare the operative outcomes of intramedullary fixation and hemiarthroplasty in the treatment of femoral intertrochanteric fracture in the elderly patients following stroke.Methods A retrospective study was conducted to analyze the clinical data of the elderly patients who had received surgery in our department from June 2005 to June 2011 for femoral intertrochanteric fracture following stroke.They were 24 males and 8 females,with a mean age of 80.3 years (from 65 to 91 years).By AO classification,8 cases were of type A1,14 of type A2 and 10 of type A3.Twelve patients received hemiarthoplasty and 20 patients intramedullary fixation.The 2 groups were compared in terms of incision length,intraoperative blood loss,operation time,ambulation time,complications and Harris score one year postoperation.Results In the hemiarthoplasty and intramedullary fixation groups,the incision length was respectively 10.0 ± 2.1 cm and 5.1 ± 2.3 cm,the intraoperative blood loss respectively 301.8 ± 98.2 mL and 156.3 ±45.1 mL,the ambulation time respectively 6.4 ±2.9 days and 30.5 ±8.7 days,the intraoperative complication rate respectively 33.3％ (4/12) and 65.0％ (13/20) and the Harris score one year postoperation respectively 61.3 ± 5.4 points and 57.4 ± 4.6 points.There were significant differences between the 2 groups in all the above items (P ＜ 0.05).There was no significant difference between the 2 groups regarding the postoperative complication rates [25.0％ (3/12) versus 26.3％ (5/19)] (P ＞ 0.05).Conclusion In treatment of femoral intertrochanteric fracture in the elderly patients following stroke,hemiarthoplasty may be better than intramedullary fixation because the former may reduce intraoperative complications,shorten time for ambulation and improve hip functional recovery. Key words: Cerebrovascular accident; Hip fractures; Arthroplasty, replacement, hip; Fracture fixation, intramedullary; Aged