Result of hemiarthroplasty and internal fixation in trochanteric fractures in elderly

Abstract

Background: There is no specific protocol as to whether internal fixation or hemiarthroplasty is more appropriate for the treatment of intertrochanteric femur fractures in elderly patients. Hemiarthroplasty offers early mobilization, internal fixation preserves the hip joint and avoids long-term complications associated with the prosthesis. A large number of patients with trochanteric fractures are admitted in our hospital including those cases referred from peripheral hospitals. Considering the superior infrastructural set up in our hospital in terms of pre-operative planning and rehabilitations, comparative study was conducted between cemented hemiarthroplasty and internal fixations in unstable trochanteric fractures in elderly to dictate a treatment protocol.Objective: To compare the post operative clinical and functional outcome between hemiarthroplasty and internal fixation.Method: 75 patients, all of who were more than 60 years of age, with trochanteric fractures and comminution were treated between 2015 to 2017 (45 women, 30 men; 50 hemiarthoplasty, 25 internal fixation). 22 of 25 patients in the internal fixation group (G1) and 41 of 50 patients in the hemiarthoplasty group (G2) were alive at the final follow-up. The mean follow up was at 10+/-3 months. In both the groups the post operative ambulation capacity were assessed according to Clawson classification and complications related to implant were evaluated with radiographic examination.Results: At the end of the follow up clinical comparision in both the groups were done through the ambulatory capacity which were found more to be in class 4 with G2 according to Clawson classification.Conclusion: Primary cemented hemiarthroplasty as a treatment for unstable trochanteric fractures is a viable option for the elderly population. It results in early mobilization which avoids the hazards of prolonged inactivity and prevents implant failure due to osteoporosis.