Role of hemiarthroplasty in comminuted intertrochanteric fractures in elderly

Abstract

Introduction: Intertrochanteric fractures in osteoporotic bones which are grossly comminuted are highly unstable and difficult to treat. Conservative treatment with traction and prolonged immobilization lands up with many complications and often fatality. Rate of failure with internal fixation, with dynamic hip screws has been found to be high, especially in osteoporotic bones. Revision osteosynthesis is technically demanding and it leads to complications. The aim of this study was to assess the efficacy of cemented hemiarthroplasty in the management of proximal femoral fractures in elderly patients with severe osteoporosis.Material and Methods: seventeen patients (10 males and 7 females- all were 60 years old or above) who underwent bipolar arthroplasty for unstable intertrochanteric fractures were prospectively evaluated. Moore’s approach was used in all patients. Greater Trochanter encirclage was done in 11 (64%) patients. Harris hip score was used for the clinical evaluation. The mean follow up period was 12 months.Results: In our study which was done on 17 cases which had a mean age 72.5 years, 12 cases were of type 2 fractures, 3 were of type 3, 1 was of type 1 fractures and 1 was of type 4. The average Harris hip score was 75. Excellent to fair results were obtained at follow-up in 15 (90%) cases and in 2 (10%) cases, the results were poor. Average hospital stay was 13.3 days. There was one case of a superficial operative site infection and one case of a deep infection. There was no case with loosening of the prosthesis, break in the cement or sinking of the prosthesis.Conclusion: The treatment of unstable intertrochanteric fractures in elderly patients with severe osteoporosis differs from the treatment of patients with other proximal femoral fractures. These fractures are better treated with cemented hemi-arthroplasty than with internal fixation. Besides an early ambulation and less hospital stay, cemented hemi-arthroplasty provides stable and mobile hips. Weight bearing can be started earlier than in other methods of treatment, which prevents any recumbency related complications.