Abstract
Unstable intertrochanteric fractures in osteoporotic bones of elderly patients was a real challenge that face orthopedic surgeon because of difficult anatomical reduction, poor bone quality and complication of prolonged bed redden or limited ambulation. The aim of study was to assess the clinical outcome of cemented bipolar as primary management of comminuted intertrochanteric fracture femur in elderly Sudanese patients. Material and methods: (30) Elderly Sudanese patients with unstable intertrochanteric fractures (kyle type III or IV) treated by primary hemiarthroplasty using a cemented bipolar prosthesis. Suture or wire fixations were used for reconstruction of greater trochanter fracture. Harris hip score was used for the clinical evaluation. Result: There was a significant relation between age and kyle classification (p value 0.05). According to Harries hip score 17 out of 30 had a good to excellent result (56.7 %) If the patients with a fair result were also included, the percentage goes up to (93.4%). Conclusion: The primary cemented bipolar hemiarthroplasty in unstable intertrochanteric fracture in elderly patients' dose provide staple, pain free with early mobilization, better range of motion and less complication rate in short term follow up.
Highlights
Intertrochanteric fractures were a major cause of disability and death in the elderly
The management of unstable intertrochanteric fractures (Evans type III or IV and AO/OTA type 31-A2.2 and 2.3) [3, 8] in elderly patients is a challenge because of the difficulty in obtaining anatomical reduction, it was associated with high rates of morbidity and mortality, the results have improved with the use of internal fixation
Unstable intertrochantric fractures with osteoporosis or comminution could be effectively managed by cemented bipolar hemiarthroplasty, allowing mobilization with a stable, pain free and mobile joint with acceptable complication rate
Summary
Intertrochanteric fractures were a major cause of disability and death in the elderly. The management of unstable intertrochanteric fractures (Evans type III or IV and AO/OTA type 31-A2.2 and 2.3) [3, 8] in elderly patients is a challenge because of the difficulty in obtaining anatomical reduction, it was associated with high rates of morbidity and mortality, the results have improved with the use of internal fixation. In these patients comminution, osteoporosis, and instability often preclude the early resumption of full weight bearing. Treatment with primary bipolar arthroplasty rather than internal fixation could perhaps return these patients to their pre-injury level of activity more quickly, obviating the postoperative complications caused by immobilization or failure of the implant
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