Study of effectiveness of coxofemoral bypass in comparison to proximal femoral nail in the treatment of unstable intertrochanteric fractures in the elderly

Abstract

Background: Osteosynthesis of unstable intertrochanteric (IT) fractures in geriatric population needs prolonged bed rest to prevent implant failure, which in turn results in complications such as pressure sore and pulmonary infection. In literature, a newer approach, such as prosthetic replacement for unstable intertrochanteric fractures, has been described to allow earlier restoration of postoperative weight bearing. Our study aimed to evaluate the effectiveness of coxofemoral bypass in comparison to proximal femoral nail in the treatment of unstable intertrochanteric fractures in the elderly. Materials and Methods: Forty-two elderly patients with unstable IT femur fractures were included in this study, of which 21 patients underwent coxofemoral bypass with remaining 21 patients treated with proximal femoral nail. Both the groups were comparable with regard to demographic data and injury variables. The clinicoradiological evaluation was done at regular follow-up visits at 6 weeks, 3 months, and 6 months postoperatively. The functional outcome between the two techniques was evaluated using Harris hip score. Results: The complications such as pressure sore and pulmonary infection were higher in proximal femoral nail group compared to coxofemoral bypass group. There was statistically significant difference in functional outcome between two groups at the end of 6 weeks (P = 0.048) but not significant at the end of 6 months (P = 0.357, better in coxofemoral bypass group). Conclusion: Coxofemoral bypass is a better option than proximal femoral nail in the treatment of unstable IT fractures in the elderly as it provides stable, pain-free, mobile joint with earlier restoration of walking ability, less complications, and good functional outcome.